CLINICAL MENTAL HEALTH COUNSELING

On a previous page, I gave a brief description of mental health issues. [Click here]

 

There are in excess of 150 medical diagnoses in the manual psychiatrists, psychologists, and other mental health professionals use for identification and treatment of disorders. Even with years of clinical experience and supervision, making an accurate diagnosis is both an art and a science. Many symptoms overlap. Clients don't always report the full spectrum of symptoms or are not self aware. In many cases, adults do not know information from their early developmental years because it was never discussed. Then again, many people have clusters of symptoms that lead to more than one diagnosis such as comorbid attention deficit and anxiety disorders. 

 

Why is diagnosis important? Diagnosing a "disorder" or disorders provides clinical guidance on evidence-based treatment interventions and - for doctors - medications. Additionally, as with most medical conditions, it gives the treating professional insight into what the client may be experiencing, may experience in the future (prognosis), how they may be impacting others, and how to best approach working with the client.  

What is a "personality disorder?" While many diagnoses are biologically or brain-based (often exacerbated by environmental stimuli,) personality disorders, as they are called in the profession, are learned and/or trait-based. For example, "Narcissistic Personality Disorder" may have been the result of excessive praise and coddling in the family home, or alternatively, a response to being invalidated during the individual's development.  

Again, what does it matter? Well, putting it bluntly, some diagnoses and personality disorders lead to predictable behaviors - often creating suffering in the client and others. When the traits, patterns, and symptoms are within an individual's awareness and the person actively seeks to manage them, they may be minimized - or in some cases, eliminated!

Likewise, when they are ignored or neglected, the symptoms, patterns, and traits cause pain and frequently worsen. So many people walk around with dysfunction without a clue as to why or worse, how to relieve it. 

Aren't we all dysfunctional in some ways? Sure. One of my core beliefs is that humans are fallible and mess up even when they are trying very hard to be "good people." But not all people have mental health disorders that meet diagnostic criteria. 

So, you may be wondering if you have a diagnosable disorderAsking the question is a hint that there may be something going on that meets criteria. No worries. Having a diagnosis is the beginning of health, healing, and well-being. When we know what's happening, we can work on it! 

Please peruse the resources page and contact Rosie to set up an appointment to explore.

Here are the most common clinical mental health disorders that I treat and the diagnostic criteria for them from the Diagnostic And Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM  V)  along with many variations in the same diagnostic categories (such as "Social Anxiety Disorder," "Bipolar Disorder," and "Impulse Control Disorder." 

 

Major Depressive Disorder

The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

  1. Depressed mood most of the day, nearly every day.

  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

  3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

  4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).

  5. Fatigue or loss of energy nearly every day.

  6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

  7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.

  8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.

Generalized Anxiety Disorder 

​A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months): Note: Only one item required in children.

1. Restlessness, feeling keyed up or on edge.

2. Being easily fatigued.

3. Difficulty concentrating or mind going blank. 4. Irritability.

5. Muscle tension.

6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

F. The disturbance is not better explained by another medical disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development:

  1. Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

    • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

    • Often has trouble holding attention on tasks or play activities.

    • Often does not seem to listen when spoken to directly.

    • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).

    • Often has trouble organizing tasks and activities.

    • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).

    • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

    • Is often easily distracted

    • Is often forgetful in daily activities.

  2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

    • Often fidgets with or taps hands or feet, or squirms in seat.

    • Often leaves seat in situations when remaining seated is expected.

    • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).

    • Often unable to play or take part in leisure activities quietly.

    • Is often “on the go” acting as if “driven by a motor”.

    • Often talks excessively.

    • Often blurts out an answer before a question has been completed.

    • Often has trouble waiting their turn.

    • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:
  • Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.

  • Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).

  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.

  • The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

Image by Mikel Parera
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