Diagnosis

Diagnosis in mental health is a difficult subject. We cannot see the problem. We cannot see inside people's minds. If a leg is broken, we see it, we fix it and then it's gone. With mental health not only can we not see the problem but it cannot be totally fixed, but instead managed. Managed with medication, therapy and support.

To diagnose a mental health condition in the UK, a person needs to be involved with mental health services which includes a psychiatrist, care coordinator, CPN (Community Psychiatric Nurse), support workers, social workers and a psychologist. Only a psychiatrist can make a diagnosis as well as manage medication. In order to make a diagnosis, the psychiatrist will need to get to know all of the symptoms a person is experiencing. Certain cases show classic symptoms of certain disorders, such as depression or anxiety. However, there are also complex cases which can include comorbidity (more than one disorder). Certain symptoms can also present a complex case, including psychosis, which can be a symptom of many disorders, therefore making it harder to make a correct diagnosis. 

Psychosis includes:

- Hallucinations (things that are not there)- visual, auditory (hearing voices), smell, touch and taste.

- Delusions- For example, believing that you are an alien imposter or that people are poisoning your food.

- Delusions of grandeur- believing that you are important or have special powers e.g. believing you are an angel or you can fly.

- Paranoia- believing that you are being followed, monitored or watched.

There are many disorders of which psychosis is a symptom, including:

- Schizophrenia

- Bipolar Affective Disorder

- Schizoaffective Disorder

- Personality Disorders

- Dissociative Disorders

I will be doing separate posts on specific disorders so will not delve into them right now.

Not only are psychotic symptoms uneasy to diagnose, but mood problems are too. There are many disorders where are person can have unstable emotions, or highs and lows in mood, again, making it difficult to make a correct diagnosis.

Disorders which have mood fluctuations include:

- Bipolar Affective Disorder (mania and depression)

- Bipolar II (hypomania and depression)

- Schizoaffective Disorder (mania or hypomania and depression as well as symptoms of schizophrenia)

- Personality Disorders- particularly Emotionally Unstable Personality Disorder (Borderline Personality Disorder).

- Clinical Depression or Major Depressive Disorder (Recurrent Depressive Disorder)

As you can notice by now, diagnosing mental health conditions can be extremely complex, especially when a person has many different symptoms. Someone could have psychotic symptoms, dissociative symptoms as well as mood fluctuations. This could fit into either one disorder or many. It depends on the severity and frequency of the symptoms.

MISDIAGNOSIS

Because of the extreme difficulty with diagnosis, a lot of people are misdiagnosed a few times before receiving a correct diagnosis over time. This can be incredibly frustrating for the patient. At the same time, some patients trust the psychiatrist and don't question their diagnosis, which can result in misdiagnosis lasting longer than necessary. It can take literally years to get a diagnosis that is right and that a patient can truly identify with. At the same time, different psychiatrists have different approaches and therefore different opinions. This can make it confusing and conflicting for the patient and I believe should be avoided at all costs. One psychiatrist that the patient trusts is enough.

PERSONAL STORY

I have experienced a misdiagnosis. In January 2017 I experienced a quick and rushed diagnosis of Emotionally Unstable Personality Disorder. The psychiatrist knew nothing about me, and didn't have time to get to know my experiences or symptoms. This hugely frustrated me. I couldn't identify with this diagnosis. I did my research (extensively). I even read the ICD-10 and the DSM- IV to see the criteria for diagnosing EUPD. I didn't meet the criteria. I knew this from the beginning, but there was the proof in front of me. For eight whole months, I fought and fought to get this diagnosis off my back. It seemed like an eternity. I asked for a second opinion several times. In August 2017, I finally managed to see another psychiatrist for a second opinion. He was a lovely man, very understanding and compassionate. We spent a long time going over my symptoms and experiences. Prior to the session, he had researched my background in my mental health records. He asked important questions. He understood everything I was saying. He said he believed I didn't have EUPD. Finally, someone who listened to me! This was a weight off my shoulders, but because it was only one session, my EUPD diagnosis couldn't be officially written off. It wasn't until I ended up in hospital in September 2017 that it was. Apparently there was a robust study on EUPD and Lamotrigine (mood stabiliser drug which I am taking) and it concluded that Lamotrigine makes no difference in patients with EUPD. However, it makes a huge difference for me. Another sign showing I don't have EUPD. So now I'm rid of that shit that I knew wasn't true. I finally feel listened to after being so frustrated for eight months. Now my diagnosis is up in the air. There's been mentions of a few different things, but I don't think I'll get diagnosed until I move teams and see another psychiatrist next year (which will be the psychiatrist who gave me my second opinion).

If you have a diagnosis that you don't agree with, then please, fight for a second opinion. You have the right to do this and you are deserving of a correct diagnosis that you can identify with.

I think I may have a mental health condition. What do I do?
If you are struggling in any way mentally, then the best thing to do is to tell your doctor. You may have a fear of this but I can assure you that your doctor will not judge and has heard this many times before. He may offer you medication (it is up to you whether or not you want to accept this) and refer you to counselling, Talking Changes or even the Community Mental Health Team where you will undergo an assessment. As well as talking to your GP, it is also a good idea to open up to family and friends, or people you really trust. This is to create a support system for you for when you're having a particularly hard time.
This all seems a lot to take in and very daunting but at the end of the day if your mental health is compromised then these people are there to help YOU and to teach you skills to manage the problems you are having. There are many different types of therapy and so there will be one that will suit you. Don't hesitate to talk. It's ok not to be ok.