The Trouble of Polydiagnosis | Psychology Currently

Several patients with whom I meet for the first time tell me that they have been diagnosed with a laundry record of psychiatric ailments. It is not unheard of, for instance, for a patient to inform me that they have “MDD, GAD, ADHD, and PTSD.” When I from time to time review patients’ earlier data, I discover that even formal psychological evaluations conducted by scientific psychologists typically record four, five, 6 (or far more!) psychiatric diagnoses.

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This observe of diagnosing the client with various psychiatric disorders—what I have elsewhere called polydiagnosis—is a reasonably novel pattern in psychiatry. As my Tufts colleague Nassir Ghaemi (2018) has pointed out, this exercise stems from the absence of a diagnostic hierarchy in psychiatry and from the field’s wholesale adoption of the DSM diagnostic method, which basically promotes listing as many diagnoses as achievable (with a several confined exceptions, these types of as listing both equally schizophrenia and bipolar condition).

Prior to the publication of DSM-III in 1980, two or much more diagnoses were seldom used to the very same client. The question clinicians asked was, “What kind of disease does this patient have?” as opposed to, “Which diseases does this individual meet up with conditions for?” Fairly than making an attempt to conceptualize the scientific image as a whole, many modern day clinicians just search for to see how quite a few DSM criteria sets the patient’s indications fulfill. This is typically accomplished without having taking into consideration how a far more important disease can clarify the patient’s other signs or symptoms.

For instance, individuals with borderline persona disorder, a severe mental sickness, can present with pretty much any psychiatric symptom noticed in Axis I conditions: depressed mood, anxiety, agitation, impulsivity, problems with consideration and concentration, psychosis, etcetera. If diagnosis is used piecemeal, and the patient’s overall photo is not taken into thing to consider, four or five different psychiatric diagnoses could be listed relatively than a solitary “borderline temperament disorder” prognosis. This transpires usually.

So, far too, with mood disorders. Sufferers with temper temperaments or manic depressive disease (which is now break up into the classes of MDD and bipolar dysfunction) characteristically wrestle with difficulties of awareness, focus, and panic. As Ghaemi and I have noted, this does not warrant further diagnoses of notice-deficit/hyperactivity condition or generalized anxiousness condition, because these symptoms can be absolutely discussed by the mood sickness (Ruffalo & Ghaemi, 2023).

The idea of a diagnostic hierarchy, which is a fundamental basic principle across all of medication, has been largely forgotten by psychiatry for about the earlier 40 a long time. In sum, diagnostic hierarchy refers to the concept that not all diagnoses are designed equal—that some are a lot more important or much more major than other people. Since the DSM program supplies couple exclusionary regulations, and considering the fact that medical requirements for several issues overlap, several diagnoses are usually assigned simultaneously—creating the trouble of polydiagnosis or comorbidity.

The challenge of polydiagnosis is not only a theoretical a single. In observe, it can lead to insufficient procedure or overtreatment. Much has been created in new many years about the trouble of polypharmacy—the use of various psychiatric medication across drug lessons and at times in just drug classes—but small notice has been paid out to one particular of its most important motorists: polydiagnosis. If multiple, unique psychiatric conditions are identified, it follows that several remedies may well be utilized: a drug for this condition, and this one, and this one particular. In the circumstance of individuality condition misdiagnosed as several Axis I problems, this can lead to “symptom chasing” with medication rather than ideal remedy with psychotherapy.

This is surely not to say that all psychiatric sufferers have only a one disorder. While I argue that it is ideal to err on the side of warning, it is conceivable that some patients have numerous forms of psychopathology developing at the same time. But 150 many years of psychiatric and psychotherapeutic wisdom teaches us that this is mainly the exception, not the rule.

As disenchantment with the DSM program grows, even in psychiatry, it is time additional awareness is paid out to the theoretical and clinical complications posed by psychiatric polydiagnosis.