My Thoughts on Diagnosis and Treating the Culturally Diverse

​When I was first introduced to the DSM-IV TR back in 2004, I felt very excited about my career path as a therapist turned clinical psychologist, knowing that there was a manual that existed that described every mental illness imaginable. I thought it was very crafty and genius that a bunch of researchers, doctors, and scientists from various disciplines could come together and exchange ideas that would lead to a general consensus concerning an individual’s mental state of being.  The idea that there was a classification system that had already been tried and tested over many years used by other clinicians in the field was reassuring and motivating because it would soon become the book that I would be trained to use in the months to come.
           
While in my master’s program at the University of North Florida, I was trained on how to assess and diagnose clients using the DSM-IV TR and when I moved to New York City in 2014 to complete my master’s degree, my training continued with the new upgrade, the DSM 5. So I have experience in using the DSM IV-TR with the axes classification as well as applicable experience with the new version of the DSM 5 that has adopted the new ICD 10 codes. In working with the DSM 5 that has the ICD 10 codes, I’ve found that there is not much difference given that the population I was working with (adults with dual diagnoses) at the time did not change. However, I do see where there would be some differential diagnoses across the two different versions when assessing women and children (for Depression and Autism) respectively.
           
In assessing women who present with symptoms of depression and/or anxiety, it is important to rule out Premenstrual Dysphoric Disorder, as many of the symptoms that are present in the Depression and Anxiety Disorders overlap with PDD. When assessing autism in children, improvements in the DSM have made it possible for children who present with milder symptoms to receive a diagnosis that is lower on the spectrum. The same can be said for almost any other diagnosis as the new DSM 5 edition has given clinicians the opportunity to rule out other serious disorders such as Schizophrenia by appropriating labels that are less stigmatizing in nature (i.e. Depression with psychotic features).
           
The benefit of having a classification system such as the DSM is that it helps streamlines the process and makes communication between clinicians and other helping professionals much easier. When a client in Delaware is assigned a diagnosis of 309.81 and is treated for several weeks but then picks up and moves to Nevada, a psychologist, doctor, nurse, or therapist would know exactly what the diagnosis is and be able to form a case conceptualization of the client based on his previous diagnosis and treatment record. Another benefit that a diagnosis serves to aid in the therapeutic process is that it gives the client a sense of control and power, being able to identify what’s causing him/her distress and then put a name on it. When a client knows that what he/she has been experiencing is a common occurrence in society, it lessens the opportunity for them to feel isolated and increases the chances that they will be able to get the help and support that they need.
           
On the contrary, knowing can be just as harmful as not knowing. When a client is assigned a label, it creates the opportunity for him/her to use the label as a crutch. When I was working as a counselor at a residential treatment facility in Florida with a group of sexually reactive young boys, I remember hearing one of them tell a staff member, “I’m bipolar and I can’t control my moods.” It made me question the efficacy of the diagnostic system and take a closer look at its harrowing effects. I witnessed day-by-day, kids getting fed schedule 1 drugs in the name of treatment, which appeared to only have temporary soothing effects for the moment, but with prolonged use have been proven to have some serious adverse psychological and health effects.
           
​So as a clinician who embodies a more holistic approach to mental health, the challenge for me would be incorporating the DSM into a practice that empowers the client and supports an environment of true healing and change as opposed to the traditional protocol that many licensed clinicians find themselves accustomed to in the diagnosis to medication management pipeline. My philosophy is that there is no one-size fits all approach to treating clients of various cultural identities; every individual deserves to be custom treated from the inside out. 

​Copyright 2016. Danielle Leach All Rights Reserved