Q. Last week I completed my disability and compensation examination at a Veterans Affairs hospital. The doctor said I did indeed have post-traumatic stress disorder based on some criteria in a book. What book would she be referring to?
A. If you see a mental health provider, whether it’s related to seeking counseling or completing a disability evaluation, chances are you will be given a formal diagnosis … maybe more than one.
The Diagnostic and Statistical Manual of Mental Disorders, or DSM for short, is published by the American Psychiatric Association and often referred to as the “psychiatric Bible.” It’s now in its fifth edition, published in 2013.
The DSM houses 18 broad diagnostic categories with multiple specific diagnoses within each category. PTSD falls into the “Trauma-and Stressor-Related Disorders” category. This is a change from the last edition, when PTSD was considered an anxiety disorder and listed in the anxiety disorders grouping. Although PTSD has a strong anxiety component, the switch was an attempt to destigmatize by recognizing that the disorder was connected to an external event.
Mental health providers rely on psychiatric labels for several reasons. First, and probably foremost: It allows providers to get paid; insurance companies generally do not reimburse private providers for mental health services unless a formal diagnosis is submitted.
Second, diagnostic labels allow mental health professionals to communicate with each other. For example, if a person is seen by one doctor and transfers to another, a diagnosis theoretically provides the new doctor general information about the person’s mental health status.
Third, it helps scientists conduct research on a particular group of people, symptoms, or both.
And last, in the case of disability evaluations, it helps the VA or military clinician confirm a diagnosis. That, coupled with an estimation of severity, allows the disability evaluation system to determine the level of compensation.
The use of the DSM is not without criticism. Critics say that it labels people as sick when they have normal reactions to stress, and lumps people into narrow and demeaning categories. Plus, some consider it an arrogant approach to understanding human nature, from the perspective that the human psyche is complex and cannot be accurately categorized by a stranger after an hourlong conversation.
The DSM is just a tool to help evaluators make a decision about your mental status. The most important thing to keep in mind is that your situation may look similar to someone else’s, but it’s not the same — so you shouldn’t be viewed the same or treated the same. You are the expert on you. And you know what works best for you. Don’t let anyone try and convince you otherwise.
Bret A. Moore, Psy.D., is a board-certified clinical psychologist who served two tours in Iraq. Email him at kevlarforthemind@ militarytimes.com. This column is for informational purposes only and is not intended to convey specific psychological or medical guidance.
