Let me explain something about diagnosis. There is no theory in diagnosis. Diagnosis is entirely symptom driven.
It’s symptom patterns. Certain symptom patterns are associated with certain types of disorder.
How do we know that? Is it because some theory says so? No. It’s because the research on the pathology says so.
The American Psychiatric Association reviews all the mountains of research surrounding each pathology, they assign committees of the top experts in the pathology to look at all the research, and they identify the symptom patterns for each disorder.
Early DSMs from the 1950s and 60s, DSM-I and DSM-II had some theory driven stuff, but not much. By DSM-III, they removed all the theory stuff and it is entirely research based and symptom-driven.
This was further refined, the research base for each diagnosis, with the DSM-IV, and now the DSM-5. Diagnosis is symptom driven and is based on the research.
This whole idea that everyone has over here that their opinions matter is not actually true. We don’t diagnose pathology based on opinion. We collect information about the symptoms and we match patterns to identified diagnoses.
It’s not really a matter of opinion.
There’s sometimes where it might be hard to classify a symptom – is it a psychotic disorder with mood features or a mood disorder with psychotic features. But that’s just small technical niceties.
For example… there’s 8 symptoms identified in the DSM-5 for a depressive episode. if the person has 5 of those 8, they meet diagnostic criteria for a depressive episode.
That’s not really an opinion. Do they have symptom 1, yes or no? Do they have symptom 2, yes or no? Do they have…? If they have 5 symptoms out of 8, then they meet DSM-5 diagnostic criteria for a depressive episode.
Why those 8 symptoms? Because that’s what the research on depression says are the symptoms. Why the criteria of 5 out of 8? Because that’s what the research on depression says, that’s the best cutoff number to identify a depressive episode.
Each diagnosis has that. Each diagnosis in the DSM-5 identifies its primary symptom patterns for that type of pathology. These symptom patterns are based on the research regarding that pathology.
Diagnosis is pattern matching of symptom sets to diagnostic criteria. I used to teach graduate level courses in Diagnosis & Psychopathology for both the DSM-IV and DSM-5.
People over here think their opinions matter. No, they don’t. We don’t make a diagnosis based on someone’s opinion. We do a differential diagnosis. We start with all possible diagnoses on the table for consideration, and then we systematically begin collecting symptom information that supports some patterns and rules out others.
Until we’re left with one fit. That fit of symptom pattern is the diagnosis, whatever it is. It’s not theory driven, its symptom based.
The child presents as being “victimized” by a parent- that’s called the Presenting Problem. Is that belief true or false? That is our differential diagnosis.
If it’s a false belief in supposed “victimization,” how false? does it meet diagnostic criteria for a persecutory delusion? Here is the definition of a persecutory delusion from the American Psychiatric Association,
From the APA: “Persecutory Type: delusions that the person (or someone to whom the person is close) is being malevolently treated in some way.” (American Psychiatric Association, 2000).
Use the BPRS, the Brief Psychiatric Rating Scale to anchor the symptom rating based on symptom features of “full conviction,” and the degree of “preoccupation” and :functional impairment.”
There is no theory in that. Is it true or false, if false, how false? Is it a persecutory delusion? Use the BPRS to anchor the symptom rating.
Your opinion is not really relevant. Diagnosis is entirely symptom driven based on the research. Nobody diagnoses pathology over here, they just have a bunch of opinions.
We need a treatment plan. In order to develop a treatment plan, we need a diagnosis. The treatment for cancer is different than the treatment for diabetes. Diagnosis guides treatment.
Is the belief in “victimization” true or false? If false, how false? Is it a persecutory delusion? Use the BPRS to anchor the symptom rating.
Diagnosis. Diagnosis guides treatment. We need a treatment plan, we therefore need a diagnosis.
Diagnosis is not theory-driven, it’s symptom-based. Pattern matching of symptoms to diagnostic criteria.
The pathology we’re concerned about is a shared persecutory delusion with the allied parent as the “primary case.” Use the BPRS to anchor the symptom rating, “one of the oldest, and most widely used scales to measure psychotic symptoms” (Wikipedia).
Craig Childress, Psy.D.
Licensed Clinical Psychologist