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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

The Question of Diagnosis

Allan N. Schwartz, LCSW, Ph.D. Updated: Dec 6th 2007

One of our main missions at Mental Help Net is to inform and educate about issues of mental health. We write many articles about the different diagnostic areas and how to recognize symptoms and either work to prevent mental illness if that is possible or to get the appropriate treatment for a mental illness. It follows, as everyone knows and expects, that our readers ask questions of diagnosis either about themselves or their loved ones. When someone is experiencing symptoms it arouses an enormous amount of concern and anxiety and we are here to help as best we can. Despite the best intentions of Mental Help Net we run up against certain limitations that are inevitable because we are a web site and are not the direct providers who can meet with our readers and make a clear and direct diagnosis. Even then it can be difficult to make a diagnosis and that is why we encourage anyone who has doubts about themselves or their loved ones to seek medical and psychological consultations from the practitioners in their communities. We can point you in a direction but cannot accurately diagnose anyone on the internet.

Following are some of the difficulties that all practitioners face in diagnosing people.

There are many of what are called "co-morbid conditions." What this means is that anyone can have a number of physical and psychological problems at the same time without anyone being certain of what the main diagnosis is until a full examination is done.

For instance:

Co Morbid Conditions:

A. An elderly man is suffering from diabetes and refuses to eat the kinds of foods that will help to control the illness. It turns out that ever since he was diagnosed with diabetes he became very depressed and hopeless about his life. It became apparent that treating the disease without treating the depression resulting from the disease would be a failure.

B. A young 24 year old women presents with symptoms of depression. However, it turns out that she is a major substance abuser and this can cause her depression. Further examination reveals the fact the she suffers from a Bipolar Disorder that runs in her family and that the drug abuse was a form of self medication.

C. An adolescent is acting out in school and it is thought that he has ADHD that had never been diagnosed when he was a child. After having been tested it turns out the he is experiencing an enormous amount of depression along with anxiety and these symptoms have mimicked ADHD.

D. Another adolescent appears very depressed and this is very apparent in school. After being referred to the mental health community for diagnosis and treatment it turns out the student, a female, ADHD but the Inattentive type. Her depression results from her self criticism for not concentrating and doing better in school. She vastly improves with stimulant medication and psychotherapy.

These are just a few of the challenges faced by patients and practitioners when attempting to diagnose and properly treat a disorder. Sometimes ADHD and Bipolar disorder can resemble one another. It is even possible for a person to carry both diagnoses. Besides diabetes, there are other conditions that can lead to depression such as heart disease, kidney failure and many others. Besides substance abuse other complicating organic factors that can complicate a diagnosis are things such as Hypothyroidism and Multiple Sclerosis.

Bottom Line:

It is always important to be certain that a behavioral disorder is just that and not something that is really a disease. People who are depressed often experience physical pain. However, physical pain can and often does result from a disease or physiological problem. Many years ago I knew a wonderful young man, 19 years old when he died of cancer. When he was 16 he complained about chronic feelings of tiredness. It was thought that he was depressed, a diagnosis made by his physician who happened to be his uncle. By the time the correct diagnosis was made, two years later, it was too late to save his life. This was no one's fault but just the result of making normal assumptions about an otherwise healthy and happy teenager. Also, a lot less was known at the time about psychology and psychiatry.

Do not make any assumptions. If you are in doubt, go to your doctor, have full examinations and rule out any physical illnesses before concluding that something is a behavioral or psychological disorder alone. Use these helpful web sites as a guide and not a substitute for a proper diagnosis of yourself or loved one.

Your comments are encouraged.

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

Reader Comments
Discuss this issue below or in our forums.

Insufficiencies in Healthcare System - MomofODDG&TDEPRESSED - May 20th 2008

How can a doctor know, in a 15 minute interview, what to prescribe a child who presents ODD, Depression, Insomnia is Gifted (95% up on tests) and has Asynchronous Development whose parents are divorced?

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