DSM Diagnosis: How Do You Know If You Have Mental Illness? (VIDEO)

Hey everybody. Cara Santa Maria here. How many times have you said to yourself, "I'm so depressed today." Or "I'm totally OCD about my closet. It weirds me out when anything's out of place."

Does this mean you have a mental illness? How is mental illness diagnosed? And is the line between healthy and mentally ill fuzzy or absolute?

Well, abnormal psychology is a science. And most scientists and medical professionals agree that abnormal behavior is indicative of underlying mental illness.

Which brings us back to my original question... what is a mental illness? How do you know if your mood or thought processes are normal or abnormal? And how do you know whether or not you would benefit from treatment?

Let's say your mood or your thoughts are starting to interfere with your life. You may decide to see a mental health professional. When you sit down in the psychologist or psychiatrist's office, they'll ask you some questions and may have you take a few tests before they decide whether your symptoms warrant a clinical diagnosis. Next, your doctor will generally turn to the "psychiatrist's bible," also known as the Diagnostic and Statistical Manual of Mental Disorders, or the DSM.

If you're diagnosed using the DSM, you'll be assessed across five axes. The first axis includes any and all clinical disorders, such as eating disorders, schizophrenia and other psychotic disorders, mood disorders like depression and mania, and many many more. On the second axis, your doctor will decide whether or not a you have a personality disorder (like histrionic, antisocial, or borderline) and whether or not mental retardation is present. Axis three is for reporting current medical conditions that may be relevant to the treatment of a mental disorder.

For example, if you have cancer, it could be contributing to your major depressive symptoms. In axis IV, your doctor will make note of the factors that may make your recovery more difficult: if you can't get to the clinic, don't have many close friends or relatives, or recently lost your job or home. Lastly, axis V is a place where your psychologist or psychiatrist makes judgments about your overall mental health. It's called the Global Assessment of Functioning scale and it can be rated anywhere from 1-100. 1-10 says that you're danger of severely hurting yourself or others OR that you're unable to maintain minimal hygiene OR that you are hellbent on committing suicide. Ratings between 91 and 100 indicate that you have superior functioning on a wide range of activities; basically, you're completely asymptomatic. But let's be real; extremely high and extremely low scores on the GAF scale are pretty rare.

When it comes to mental health research, diagnostics, and treatment, knowledge is power. Know yourself and know your doctors. If you've been diagnosed with a mental illness, read about it, and find out what you can do to manage it. We'll be engaging in a month-long conversation about the science of mental health, touching on topics like depression and anxiety, schizophrenia and bipolar disorder, and autism and ADHD. We'll be looking at current trends in mental health illness research as well as investigating and questioning current diagnostic and treatment models. I hope you'll join the conversation. Hit me up on Twitter, Facebook, or leave your questions and comments right here on my blog. Come on...talk nerdy to me!

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Comments

[DaylightSun]

10:58 AM on 12/17/2011

"Drug companies are particularly eager to win over faculty psychiatrists at prestigious academic medical centers. Called “key opinion leaders” (KOLs) by the industry, these are the people who through their writing and teaching influence how mental illness will be diagnosed and treated. They also publish much of the clinical research on drugs and, most importantly, largely determine the content of the DSM. In a sense, they are the best sales force the industry could have, and are worth every cent spent on them. Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), almost all of whom would be described as KOLs, ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia."

http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/

[Izzy28]

05:07 PM on 12/16/2011

I have been feeling serious symptoms of depression for about the last five months. I have even resorted to hurting myself, as shameful as that is to admit. It is something I have never in my 28 years done before. This feeling of uncontrollable sadness and depression is hard to cope with and keep under control and I worry about myself. I want to seek help, but I don't know where to turn. I don't have health insurance, so I don't know if there are free mental health centers in NYC. Does that even exist? Any guidance would really help.

[DaylightSun]

11:07 AM on 12/17/2011

It may be best to try and search online for local non-profit mental health or charity-type groups in your area, to see if there are any possibilities to speak to a counsellor or therapist free of charge (possibly over the phone on a help-line?). From personal experience, it really is important to get things off your chest with someone sympathetic, and then figure out longer-term options. Good luck.

[somewhatodd]

10:07 AM on 12/12/2011

" Well, abnormal psychology is a science. And most scientists and medical professionals agree that abnormal behavior is indicative of underlying mental illness. "

do any other freedom loving americans here feel an urge to sound an alarm or ring the town bell?

and where are our local libertarians when at long last we might make good use of them? perhaps they're so inconsolable over the evils of fluoridated water they can spare no attention here to pandora's lid flipping off and away like a flying saucer.

[VirgoLinnea]

05:38 PM on 12/12/2011

I do, but it would take me quite a long reply to talk about how abnormal psych just might not be a science at all, and determining what makes a behavior "abnormal" is strongly based on conforming to a bland society's standards and largely is about controlling people.

[Cara Santa Maria]

09:28 PM on 12/14/2011

Why do you think that abnormal psychology is a science? It is an active field in which researchers endeavor to learn about human behavior from a mental health perspective.

Abnormal psychology and clinical psychology (or psychiatry) are two very different things. I am not claiming that clinical psychology is a science per se. And if you are focusing on the phrase "abnormal behavior," please bear in mind that this is a relative term. As soon as behavior becomes so abnormal as to cause distress or dysfunction in everyday life, researchers and clinicians alike would describe this as being indicative of mental illness.

[DaylightSun]

08:27 AM on 12/15/2011

@Cara, have you ever actually worked with people with serious mental health problems? I'm just wondering what qualifications have afforded you this forum, because your opinions seem no more advanced than those of an unquestioning undergraduate, and far more worrying, because you've somehow got an opportunity to miseducate thousands of people (it's increasingly found that medical-model explanations of mental health problems are more stigmatising, and less accurate, than psychosocial models). And seriously, 'talk nerdy to me'? You think attention-seeking innuendo is an appropriate way to frame discussions about such serious issues?

[somewhatodd]

11:26 AM on 12/15/2011

" As soon as behavior becomes so abnormal as to cause distress or dysfunctio n in everyday life, researcher s and clinicians alike would describe this as being indicative of mental illness.”

interestingly soviet psychology offered the same "compassionate" view, i.e., that their maladaptive comrades weren't necessarily and consciously or willfully or intentionally anti-revolutionary traitors or incorrigible capitalists in need of a firing squad.

on the contrary, quite a few lumpen proletarians and other odd fellows "suffered" from treatable mental ailments and character disorders which were causing their socialist dysfunction. sufficient numbers of troubling individuals were presumed innocently ill enough, in fact, to warrant substantial investment in psychiatric research hospitals where patriotic practitioners of psychology would scientifically study these unfortunate folk and endeavor to treat and to cure them. this approach was considerably more expensive than gulag system, however surely we can assume those hospitals did afford at least somewhat nicer places for university trained professionals to work.

btw, for another interesting take on the subject of abnormality, see also michel foucault's "madness and civilization".

[BannedInBoston]

08:45 PM on 12/11/2011

Much of the _DSM is complete and utter _BS. I know I'm going to catch a lot of _flack for saying this (I always do) but much of what the _psychiatric establishment in this country has been doing over the past several decades is multiplying so called "_mental _disorders" to the point of _absurdity. Give me a copy of the _DSM and I can _nail virtually ANYONE with a convincing-sounding "_diagnosis." Read Thomas Szasz's "The Myth of _Mental _Illness."

[french queen13]

09:58 PM on 12/11/2011

No flack here, I agree with you.

[moonflowerjewelry]

10:16 PM on 12/11/2011

I'll give you a bit of slack on the side of dsm-ifying every little bump in the road... but you've got some chutzpah if you are talking about bipolar disorder, schizoaffective disorder and schizophrenia. There is some real suffering involved with these very serious illnesses. To dismiss it is like telling a person with, for instance, heart disease, diabetes, brain cancer and so forth that there is nothing wrong with them. Be careful.

[brooklyncitizen]

10:59 PM on 12/11/2011

but bipolar is not new it is just re-branded it use to be manic depressive ...and schizophrenia has always been.

[BannedInBoston]

07:40 PM on 12/12/2011

Please note that I said MUCH of the DSM is BS. I wasn't really referring to serious _psychosis, which I agree is real and requires treatment. But at least 80% of the DSM (my impression anyway) is a matter of taking what are really fairly common what I would call behavioral quirks and slapping a psychiatric label on them. And the "diagnoses" of this sort just seem to keep multiplying themselves as each new edition gets thicker and thicker. (And consider whom this benefits financially -- why the very people who are multiplying the "_mental disorders" that the DSM catalogues....

[Vincent Van Der Hyde]

08:45 PM on 12/11/2011

I'll believe in the DSM when I find the
Tea Party
and
Republicanism
listed in it.

[kwinter]

06:47 PM on 12/11/2011

This is a very good, very personal, talk about mental illness. It really starts 5 minutes into the video.

http://www.youtube.com/watch?v=UI-YvrHZVvk

[nypoet22]

06:30 PM on 12/11/2011

some inappropriate behavior exists that does not stem from mental illness. sometimes it's easier for a parent to call their child mentally ill than it is to do their job as parents. the trouble is that things like ADHD and depression stem from medical conditions that actually do exist - just not in the numbers that they're diagnosed. if the problem is medical, there should be a medical way of testing for it rather than assuming a behavior-based diagnosis at face value - much less prescribing drugs.

[ColleenHarper]

01:29 AM on 12/12/2011

But sometimes depression truly does exist, with good medical cause, and therefore prescribing drugs is a reasonable approach.

The problem is in the process of diagnosis. Diagnosing a problem that may or may not need medication almost always leads to medication, and if the original medication does not alleviate the problem, the patient is placed on a wider and wider range of medications, when the most sound course from the start would have been simple counseling to help the patient cope with a temporary life situation that is central to the depression.

[gmikejake]

06:24 AM on 12/12/2011

A fair amount of the problems you identify have to do with how we pay for diagnosis and treatment. A specified, allowable, condition must be identified for many sources of payment. And, following the money, a good amount of our mental health systems, and "non-systems" in too many areas, then depend on a diganosis.

[novabird]

08:17 AM on 12/12/2011

Parents of people with schizophrenia have been blamed for this severe illness for decades but now brain science is telling a different story. While it is true that family dynamic and socio-economic factors affect mental wellness, I wish people would understand that with severe mental illness such as bipolar, schizophrenia and schizoaffective disease, there are clear clinical indicators and treatments that actually help people manage their disease.

[DaylightSun]

02:30 PM on 12/12/2011

@novabird: I'd be much obliged if you'd point me in the direction of the "clear clinical indicators and treatments" you mention. No need for extensive refs, I can get those, just keywords will be fine. Thanks.

[tampamurray]

06:14 PM on 12/11/2011

Sometimes "abnormal behavior" just means you're bad. Or, it could mean that you've never had any consequences for your "abnormal behavior" so you just keep it up. Nowadays though ... there's a drug for that! Back when I was a kid, instead of getting drugs, an ADHD kid (of course that term didn't exist back then) got a spanking from Daddy and straightened up real fast. Today's modern parents ought to give it a try.

[nypoet22]

06:33 PM on 12/11/2011

some perfectly good parents have difficult kids. they're not "bad," they just take longer than average to figure out what they should and should not do. corporal punishment tends to be ineffective, but i agree that we as a society tend to over-medicate instead of just making sure behaviors have consequences.

[golemmom]

06:45 PM on 12/11/2011

Apparently something was seriously wrong with the spanking approach, because many generations tried it and their offspring didn't turn out better, they turned into what you consider a bunch of degenerates who don't know how to parent.

[Enock Zamora]

05:07 PM on 12/11/2011

I am the I am. Am I....Am I....Am I.........

[Jessica Ellermets]

04:05 PM on 12/11/2011

cool stuff CSM, was just talking to a friend about the ins and outs of clinical and social psychology. this is going to help out big time, *sending link*

;) keep it up girl, loving the intellectually stimulating conversations!

[somewhatodd]

03:59 PM on 12/11/2011

maybe next week we'll be introduced to the science of palm reading.

[nypoet22]

06:35 PM on 12/11/2011

i wouldn't quite put psychology on that level. however, there definitely needs to be a little more hard science involved, and a lot less "pseudo-science."

[BannedInBoston]

09:01 PM on 12/11/2011

Psychology is virtually ALL pseudo-science, especially as practiced by American "professionals." If you want to make a career in the field, it helps if you are a master b_llsh_t artist....

[somewhatodd]

09:03 PM on 12/11/2011

western psychology is far more art than science, and more of a business than an art. it's perfectly respectable and not necessarily any less productive or legitimate to practice an art, and it's good to do so as a profitable business, but portraying psychology as science is false advertising.

[Existentialist]

02:55 PM on 12/11/2011

The British psychoanalyst John Rickman once remarked that madness is when you can't find anyone who can stand you.

That seems a much better test than anything on offer in the DSM.

[gmikejake]

06:42 AM on 12/12/2011

Then most of us who have ever been noticed operating in some quite different culture, or sub-culture, are "mad." Often, what is normal in one culture, is not in another. Same with notions of "healthy," and "annoying."

[Existentialist]

10:21 PM on 12/12/2011

The culture or subculture in which you "operate" would be the set of people who can stand you, therefore you would not be "mad" according to Rickman's aphoristic test.

[DaylightSun]

02:47 PM on 12/11/2011

@Cara: You state that: "abnormal psychology is a science."

Is it not a little reductionist to answer the question you offer with the 'conventional wisdom' implicit in the language you use? Or, if 'abnormal psychology is a science', could you suggest a single 'scientific fact' about 'abnormal psychology?'

[ColleenHarper]

01:56 AM on 12/12/2011

Because I do NOT have a portal at my desk to any of several research aggregators, I can not pull down any of the published scientific, peer-reviewed articles on ongoing research into psychology and in particular "abnormal psychology." Such portals exist at most university libraries, and using the library guest account, you would be able to explore to your heart's content. You would find that there is abundant sound scientific research going on in psychology. The problem is that it is usually considered too dry and boring by the mainstream media to receive any coverage.

But to be more straightforward concerning your question, I WILL present one specific instance of research.

Transgender/transsexual people consistently make the claim that they are "men trapped in women's bodies" or "women trapped in men's bodies," depending on the direction of reassignment.

Studies have shown that there is a specific brain structure, identified clearly in rats, where the expression of gendered behaviors is clearly centered. Manipulating this brain structure in rats can cause the rat to respond as the opposite gender.

{continued}

[ColleenHarper]

01:56 AM on 12/12/2011

{continued from above}

Studies in human brains (after death) have shown in a Dutch study, that this brain structure in men is about 1/4" in diameter. In women, it is about 1/8" in diameter. These Dutch scientists had 6 male-to-female transgender brains to examine and found that all 6 cases showed structures compatible with female brains.

The study sample was too small to be conclusive, but the results were highly convincing that the researchers were onto something.

This research was clearly scientific in nature, established several things about the locus of gender in the human brain, and showed that there is likelihood that transgender people actually have a physical component to their identity.

[DaylightSun]

02:59 AM on 12/12/2011

I don't want to seem dismissive, though perhaps it's not a bad thing if I'm brief i my response. You say, summarising the 'scientific fact' you've presented, that you're referring to one [human] study, with 6 post-mortem 'subjects', the results of which were inconclusive (though 'highly convincing'). You're not presenting a scientific fact: you're presenting an opinion reflected in one very questionable 'study'. This is exactly what I'm questioning; why do so many 'professionals', and then lay people, accept such easily-critiqued 'research' as solid science, when it's clearly not?

I work in psychology research, perhaps that's why I'm as critical as I am. I'd still like the author of the piece above to respond to my question (she did invite comments for dialogue).

[DaylightSun]

02:36 PM on 12/11/2011

a

[chicgogo]

02:30 PM on 12/11/2011

My sister is mentally ill, or so we suspect, but she refuses to seek treatment or get a diagnosis though I would consider her borderline or bi-polar based on what I've read and also suspect a chemical imbalance. It started out as depression in college and she has steadily kind of decsended into an increasingly "sick" person to the point she isn't at all the same seemingly happy, well rounded person she once was. Initially (25 years ago) she saw a psychologist at my mother's urging and support and was prescribed meds, but didn't stay on them long enough to determine whether they were effective. Since then, she refuses to seek help and is very suspicious and opposed to psychiatric help. She has lost her friends, no longer works a regular job and has alienated herself for the most part from the rest of the family

We all want her to get help and remember the wonderful person she used to be (and can still be when she is in manic mode). We have long since succumbed to the reality that she has to want it for herself or somehow has to have an awakening. She is very attractive and used to have many, many friends and was the top of her class scholastically. It's like a life unrealized.

[novabird]

04:44 PM on 12/11/2011

My daughter has schizophrenia and after losing her job, her friends, her apartment, she ended up on the streets and in trouble with the law. At that point I was able to have her involuntarily committed where she finally received the proper medical treatment in the form of anti-psychotic medications that I believe saved her life.

The really sad thing is that many, many people who are virulently opposed to anti-psychotic drugs would prefer to see extremely sick people like my daughter suffer on the streets instead of forcing them into treatment. Your sister probably has "lack of insight" which is why many people with severe mental illness refuse the very treatment that could help them. I suggest the books of Dr. Xavier Amador - he also has a website with free videos you will find helpful.

[moonflowerjewelry]

10:18 PM on 12/11/2011

I hear you...

[gmikejake]

06:54 AM on 12/12/2011

Frequently, the very symptoms of the condition make difficult any forms of usual treatment. AND, the common stigmas, myths, stereotypes, that many of us hold about the conditions also often present formidable obstacles. AND, finally, the conditions of our mental health systems, often more often "non-systems" in some locations, present even more problems to those of us struggling with the disorders.
In our case, a very beloved relative, living with the horrors of a psychotic condition, including suicide attempts, various terrifying hallucinations, many hospitalizations, various forms of "treatment," some of which actually added to the difficulties, found an effective treatment only after moving to a different system with a different, quite young, psychiatrist who said, effectively, "let's try this ....., nothing else has worked." It did. The chronic condition continues, with ongoing treatment, but this person now has a good job and a family ... a fairly "normal" life. We just can't give up. There is hope .... too often, somewhere. May your resources allow you to find that realistic hope.