The headline in The Guardian:
New study casts doubt on reliability of mental health diagnosis interviews
All I can say is, well, no surprise there.
Diagnosis in mental health has always been a challenge, even more than in other fields. That’s because of the absence of confirmatory testing.
As one expert explained, if you went to your doctor concerned about having hypertension, perhaps based on some article you read online, their first task would be to check your blood pressure. Begin by confirming the problem, before initiating treatment.
In mental health, this kind of laboratory and radiology testing isn’t available. Instead, practitioners rely on an interview, where they ask questions and interpret the answers. Conclusions are drawn from symptoms as reported by the patient.
It’s vulnerable to bias, both on the part of the patient and the practitioner. There’s too much subjectivity involved in the process.
That results in a degree of variability in diagnosis. The linked study examines this, concluding that overall, some mental health conditions are diagnosed with greater consistency than others.
Which disorders are the most often correctly diagnosed? Ironically, substance use disorders— in particular, opioid use disorder. That’s probably because behavioral markers are involved–– amount and frequency of use, for one. These are easier to measure than someone’s mood and emotions.
Will the day come when the mental health practitioner will have access to objective testing of brain function accurate enough to positively confirm a DSM diagnosis, and affordable enough to be useful in practice?
We can hope.
The authors point to an alternative future where clinicians “move away from strict diagnostic categories, where a condition is either present or absent, and think about symptoms on a spectrum or continuum.” They mention ADHD as an example.
That would presumably allow us to acknowledge the many individual differences between people who share a psychiatric diagnosis, and encourage clinicians to treat a person rather than a disorder.
