What's in a Name: Do Psychiatric Diagnoses Mean Anything?

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Unlike other branches of medicine, psychiatric diagnoses are more usually extrapolated from less objective data. Psychiatry has no blood tests, no MRI options, no biopsy results, no bacterial cultures that help define illness and suggest treatment. Subjective descriptions of the patient’s internal symptoms, marinated in the clinician’s personal biases, determine the psychiatric classification. A label of Major Depressive Disorder suggests a collection of symptoms that define a variety of clinical presentations.

A new study¹ analyzed the current Diagnostic and Statistical Manual (DSM-5) to evaluate the criteria for classifying several disorders. The research indicated that diagnoses were determined by different decision-making rules, that there was a huge overlap of symptoms among different diagnoses, that diagnoses ignored the role of preceding traumatic events, and that little was understood about the individual patient. Researchers opined that diagnostic labels create an “illusion of an explanation,” can create stigma, and ultimately are “scientifically meaningless.”

Another report² examined the World Health Organization’s proposed alternative classification system, the International Classification of Diseases and Related Health Problems (ICD-11). Investigators asked patients with psychiatric disorders how accurately the definitions of their illnesses reflected their experiences. Participants noted that the ICD draft omitted individualized emotional experiences. They suggested more specific symptoms to define an illness. They felt that certain designations, such as “disorganized” and “maladaptive,” were unclear and stigmatizing.

These studies suggest that we have a long way to go to definitively establish psychiatric labels that will generate individualized treatment plans. Our current classification systems may be far from perfect, but they are attempts to better understand psychopathology and develop new ways to treat psychological pain.