It is all about the labels

Last update: February 21, 2024
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Reading time: 4 minutes
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By Brain Matters

In the current society, we have the tendency to try to label everyone, so we can justify someone’s behavior. In psychology we do the same; someone can be labeled as having ADHD, depression, or a burn-out as soon as you check the right amount of boxes in accordance with the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V:the holy grail for psychologists and psychiatrists to diagnose people with various psychological and psychiatric disorders). However, doubts are rising within the field about whether the usage of this handbook is fully justified and if there are no potentially better ways of diagnosing these disorders. Currently, the DSM-V treats each psychological or psychiatric disorder as a dichotomous disease, which means you either get the label or you don’t. But in reality, it is not as black and white as one might think. Importantly, we will not be pleading that one solution would be the best, instead, we would like to give you a concise overview of possible alternative ideas that are currently floating around in the literature.

Take for example depression, a common and serious mood disorder. The DSM-V outlines the following criteria in order to give a person the diagnosis of depression. Those who are diagnosed with depression experience five or more symptoms (e.g. depressed mood most of the day; diminished interest or pleasure in (almost) all activities most of the day etc.) present for at least two weeks and at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure both on (almost) a daily basis). Imagine that two different people both experience a depressed mood; however only one of them fits the criteria for getting the diagnosis ‘depression’ in accordance with the DSM-V. The other experiences almost the exact same symptoms (maybe even to a more severe degree), however they qualify only for four out of the required five symptoms. This cut-off of five symptoms results in only one of them receiving the diagnosis, even though the second person might suffer more from them. This is a problem with the DSM-V. We are ticking boxes to give a diagnosis, while the severity of symptoms are mostly neglected.

What we forget with this type of approach, is that a diagnosis according to the DSM-V is very broad and can mean a lot of different things. If we take depression as an example, the list of which 5 symptoms should be present, contains 9 symptoms in total. A study found 1030 unique profile symptoms for depression; which means that one person with depression could have a completely different set of symptoms compared to another person who has the same diagnosis. Moreover, the most common symptom profile was only exhibited in 1.8% of the cases. As a result, people diagnosed with depression according to the DSM-V are a very mixed group of patients. 

For the last 10 years, research interest has been sparked by applying techniques such as (f)MRI or genetic techniques to try to dive into the biological basis of mental disorders in order to improve its treatment. The idea was that if we could get insight into how the healthy brain works and how it can become distorted in the case of these disorders, we could look at the disorder from a continuous perspective. This means that with depression for example, biological factors (such as having certain risk genes or having an abnormal brain activity in a specific brain area could heighten the chance of you developing depression). Because these biological factors are not dichotomous, but continuous (e.g. the amount of risk genes you have), it would result in a more precise continuous risk profile, where all these risk factors added up result in some people passing the threshold for getting the diagnosis and some people not.

However, it is important to point out that this research into a biological risk profile has been done on a group level. This means that for example 20 depressed patients and 20 healthy participants are compared in brain activity or genetic profile. However, at the moment, these techniques are not refined enough to be able to diagnose one individual with depression.

Therefore, another solution proposed in current literature is not to focus on diagnoses but to look at the individual symptoms on a continuum. This is called the network theory of mental health. This could give a way more accurate and precise picture of the problems than just a broad diagnosis such as depression that could mean a lot of different things. In this way, the patient could recognise themselves more in such a profile, in comparison to getting only the label depression. 

In conclusion, up to now, the DSM-V is still the holy grail when it comes to diagnosing different psychological and psychiatric disorders, however possible improvements and alternative ideas are proposed by experts!

Author: Joyce Burger

Image: Joyce Burger

References:

  • D Adam. (n.d.). On the spectrum. Nature, Vol. 496.
  • Eli Vakil. (n.d.). Neuropsychological assessment: Principles, rationale, and challenges. Journal of Clinical and Experimental Neuropsychology, Vol. 34. https://doi.org/10.1080/13803395.2011.623121
  • Fried, E. I., & Nesse, R. M. (2015). Depression is not a consistent syndrome: an investigation of unique symptom patterns in the STAR* D study. Journal of affective disorders, 172, 96-102.
  • Hans-Jürgen Möller. (n.d.). The consequences of DSM-5 for psychiatric diagnosis and psychopharmacotherapy. International Journal of Psychiatry in Clinical Practice, Vol. 18. https://doi.org/10.3109/13651501.2014.890228
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