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To Diagnose or Not


I was explaining to a neighbor that someone we were talking about had Attention Deficit Disorder (ADD), and she got miffed and said it was unnecessary to label people. This happened during the same week that a client mentioned to her sister that I suggested she (the sister) might carry the diagnosis of Borderline Personality Disorder and that caused trouble in already dysfunctional family dynamics.

In my first post-grad school job, I was required to submit a DSM (Diagnostic Statistical Manual) diagnosis. Ditto when I was an insurance provider. I didn’t think much about mental health diagnosing until a friend explained to me how it had negatively impacted her brother with schizophrenia and I started looking at it from the client’s point of view, that is, feeling that they were being reduced to a psychiatric label. I understood how harmful this could be.

Years later, I had two clients in my Boston private practice with Borderline Personality Disorder with whom I shared what I believed was their diagnosis. One was extremely relieved to know there was a name to her suffering and greatly benefitted from having a name for her symptoms. The other never returned to therapy. Instead, she wrote me an angry letter (long before emails) denying the diagnosis and said she never wanted to see me again. 

Now, many of my clients come into therapy having been previously diagnosed and some start off by asking me if I would diagnose them so that they’d better understand what was going on within them. One was comforted to find out she had an underlying anxiety disorder driving her dysregulated eating because then she could address that as the problem. 

To complicate the subject, when I was binge-eating, vomiting up my food for fear of gaining weight, and didn’t think I was thin enough when I was, I had no problem accepting that I had Binge-eating Disorder, Bulimia and a touch of Body Dysmorphia. I actually didn’t feel one way or the other about it. I knew that this mental health diagnosis wasn’t who I was but what I had. Call it whatever you wanted, I just wanted to fix it.

Then there’s mental versus physical health diagnoses. Most people don’t seem to object to the latter. Part of the problem is due to the stigma of having mental health issues, never mind a bona fide diagnosis. If you buy into that kind of thinking, then any label will feel wrong. If you don’t, then maybe a diagnosis won’t be such a big deal to you and may help you move forward and progress out of it.