Do you have a psychological disorder?

This question is a common one, but it may surprise you to learn that the answer is rarely as simple as a yes or no. I think it’s worth trying to understand the concept of mental illness a little better, as how it can be a help (or hindrance) to us often comes down to how we approach it.

Psychological disorders, mental health issues, mental disorders. These are all different names for the same thing, and there are all sorts of problems that fall under this umbrella. In Australia and many other countries, health professionals assess which issue we’re dealing with according to our “bible”: the Diagnostic and Statistical Manual of Mental Disorders - currently, the Fifth Edition (DSM-5, for short). This book lists all the diagnostic criteria for problems ranging from Depression, to Schizophrenia, to Autism spectrum disorders, to sleep issues - and dozens more.

F.RdeC / CC-BY-SA-3.0

The thing to understand here is that diagnosis relating to mental health is not the same as when you have a physical illness - there is (as yet) no blood test, no biopsy that we can extract that will confirm that yes, you have Obsessive Compulsive Disorder. All we can do is hear from you what you’ve been experiencing, how long it’s been happening, what you think has triggered it, and whether or not it’s having a negative impact on your everyday life. We can then compare this to the collections of symptoms listed in the DSM-5, and figure out whether it looks like your situation aligns with one or more particular disorders.

What causes mental health issues?

This is a complex question that I can’t possibly hope to answer here. Genetics are often involved, as well as aspects of brain chemistry and physical health. However, also relevant are any number of life experiences. For example, Post Traumatic Stress Disorder (PTSD) and other trauma-related issues arise only following traumatic experiences. Social anxiety and a often grows following the stress of a big speech (especially if it goes poorly). The highly self-critical depressed person has grown up being taught they need to do everything perfectly. Hoarding can be learned from a parent who themselves hates to let go of things.

My point is: mental health issues are not something that one catches, and very, very rarely is it something that emerges out of thin air. It often reflects coping mechanisms developed in response to specific life scenarios, and as such, it’s in understanding what’s contributed to the issue - more so than identifying the “right” label - that we can really start to improve things.

So - how useful really is a psychological diagnosis?

As a psychologist, I’ll always consider whether there’s a diagnosis that fits because there is research that can point to what is most effective in helping people recover. This might be a particular approach to therapy, but may also include medication - not my domain, but something a GP or psychiatrist (a medical doctor who specialises in psychological illness) can help with.

However, how useful a diagnosis is to an individual really varies. For some, being able to say “I have an anxiety disorder” is greatly reassuring, because it lets them know they’re one of many people (perhaps around 20% of us) to experience the same thing at some point in their lives. For others, the label itself can feel overwhelming and may even keep them feeling stuck. If you don’t understand it, it’s easy to feel doomed rather than able to make use of a diagnosis as a tool on the way to change.

In the end, a diagnosis gives us only a small portion of the information we need to work with in therapy. Much more important are things like what contributes to your feelings or being distressed or stuck? What do you want to be doing differently?

Remember, you don’t need to fit any specific criteria to seek therapy! Just do it. I, and my fellow psychotherapists, will develop a shared formulation with you - a kind of case study in you - in order to understand what’s going on for you, and how we might work together to help you. If you are wondering about what it means to be mentally ill or mentally healthy, don’t hesitate to ask!