Should I seek a diagnosis?

This question features frequently in the therapy room as one that clients may ask in relation to themselves or their young children. This is why I thought it could be helpful to discuss some of the factors that might be worth considering when coming to a decision.

As a therapist, I am not qualified to diagnose. However, over the years, I have worked with a number of clients with existing diagnoses, and I have supported others in exploring whether or not to seek a diagnosis.

These discussions have shown me that a diagnosis is a double-edged sword. On the one hand, it can open doors to understanding and support. On the other hand, there are risks of overidentification, limitation and discrimination.

Why would I seek a diagnosis?

I am aware that neurodiversity, and particularly ADHD and autism, are much more widely discussed in society these days. In principle, I welcome this increased openness towards the diversity of our minds. However, I also note that it creates worries among my clients whether different conditions could apply to them. Moreover, I am concerned by the increased trend to self-diagnose based on limited, and sometimes inaccurate, information on social media.

Over the years, other conditions that clients have wondered if they could apply to them have included OCD, narcissism or borderline personality disorder. Here again, I am aware that certain words are widely used and sometimes overused in societal discourse and that we risk losing sight of the specificity and seriousness of certain disorders.

Generally speaking, my sense is that if the worry about a particular condition begins to overshadow your whole life and/or you feel restricted by the manifestations of your condition, it may well be beneficial to seek a diagnosis. However, I still believe it is useful to consider this step in more detail.

Sometimes, the wish to be diagnosed comes from a fear to end up like one’s parent who may have had a mental health diagnosis or whose behaviour may have indicated mental illness. Here the worry may be that there is a genetic predisposition, and clients may scrutinise themselves for any signs that they may follow into their parent’s footsteps. In a situation like this, a diagnostic assessment can help to alleviate fears and/or identify concrete parameters and types of treatment to focus on.

Sometimes, the wish for a diagnosis comes from a desire to understand and be able to talk about one’s struggles in a better way. A diagnosis may be a form of verifying particular disadvantages that someone is experiencing because of how their mind works. Having this recognised by a professional and subsequently in other areas of life can feel validating and boost self-esteem: There is finally a name for it, and I am not alone with it.

For example, several clients have shared with me how being diagnosed as dyslexic has helped them a great deal in making sense of their difficulties and has enabled them to receive both practical support and a deeper level of understanding at university or in their jobs.

Sometimes, especially when it is a parent seeking a diagnosis for a child, the focus may be on identifying the best support or treatment available. This may include medication, different kinds of therapy, contact with others with a similar diagnosis or more practical support at nursery or school.

There is so much pressure on parents these days, and different observations at nursery or school can easily ring alarm bells. Very often the question we circle around in therapy is what constitutes normal behaviour.

Parents may feel the need to arrange for a diagnosis to know that they are supporting their child as best as they possibly can. And some of them tell me that they wonder whether a diagnosis could also strengthen their patience when dealing with difficult behaviours.

While parents might seek a diagnosis for their child to access or tailor support, adults may be more driven by questions of performance and companionship. Some of my clients have wondered if, once diagnosed, tailored medication could make them access their full potential at work and lead to better results and higher job satisfaction.

Others may have been recommended by their friends or romantic partners to seek a diagnosis in order to provide a better explanation for recurring relationship issues.

What could speak against a diagnosis?

Two practical criteria that often hold people back from seeking a diagnosis are costs and time.

If you are seeking a diagnosis via the NHS for yourself or your child, this can involve long waiting lists of several months. During this time, life can feel like being in limbo with this big question hanging over your head.

This is why more and more people decide to go private, which can be very costly. In addition, when seeking a diagnosis privately, in my view it is important to identify a trustworthy organisation and/or individual who is specialised in this particular condition and recognised by the NHS.

While your GP can be a useful first port of call to discuss your concerns and ask for a referral, many GPs have received a very generalist medical training and are therefore not necessarily specialised in mental health.

In my opinion, the best person to diagnose a mental health condition is a psychiatrist or a clinical psychologist, and ideally someone with a particular focus on the condition you are seeking a diagnosis for.

Different to physical health assessments where doctors can conduct a range of tests, mental health assessments rely on patients’ self-reports and the doctor’s knowledge and application of various diagnostic criteria. As such, there is unfortunately some room for misdiagnosis, which clients occasionally tell me about. To minimise this risk, some people consult different medical specialists to verify a diagnosis, which can however increase costs or waiting times and/or lead to even more confusion when these specialists don’t agree.

Another useful question to ask yourself is what the diagnosis will help you achieve. Some clients have told me that while it would be nice to know, it doesn’t really change much for them since they wouldn’t want to take medication anyway. They might argue that what is most important to them is to improve their mental health and to find better ways of working with their difficulties, irrespective of whether these could be summarised under a particular diagnostic label.

Others have said to me that they wouldn’t want to have a diagnosis because they don’t want to see themselves as primarily bipolar, autistic or whatever the diagnosis might reveal. They don’t want to start identifying with their diagnosis at the expense of other aspects of their personality. And they also don’t want others to see them predominantly in that way.

Also in parenting, there is the risk that children become their diagnosis rather than the diagnosis explaining aspects of the child. Moreover, when there are several children in a family, having a diagnosis can lead to one child receiving most of the care with others feeling sidelined or neglected.

In addition to parental care being spread unevenly amongst children, a mental health diagnosis for one child often also leads to very different expectations and development opportunities. Finding the right mix of support and encouragement can hence become a particularly delicate balancing act.

There is also the question how a diagnosis, once established, will be communicated. Whether this concerns a parent disclosing a child’s diagnosis at school and in social circles or an adult considering if, who and when to tell at work or among family or friends. Even if schools or workplaces present themselves as particularly inclusive, clients tell me about their fears or experiences of discrimination that are sometimes very subtle and difficult to prove.

Where to go next?

Seeking a diagnosis is a very personal pursuit that I am happy to discuss with my clients. In my professional opinion, going into a mental health assessment with open eyes and a good understanding of the pros and cons can only help in achieving a beneficial outcome. Given the profound implications that a diagnosis can have for ourselves and others, exploring this decision with someone impartial may be invaluable.