SurvivingInfidelity.com^®

Who is (legally? officially? formally? medically?) allowed to diagnose someone with a mental illness or personality disorder? I'm assuming psychiatrists and psychologists, but what about licensed clinical social workers? Or medical doctors?

Also, how does someone get formally diagnosed with a disorder? Does it go in writing somewhere on their medical record? If a LCSW mentions that a patients "sounds like they have X-disorder" during a session, is that an official diagnosis? Curious how this works.

For context, I have long suspected that FWS has bipolar disorder (and/or at times wondered if possibly borderline personality disorder or ADHD or some combination of these). He recently started seeing a LCSW, and mentioned in passing that they said something to the effect of, "what you're describing sounds like someone with bipolar disorder."

I am not surprised at all, and part of me feels slightly vindicated because any time I (delicately) brought up my suspicions over the years he would get highly offended and shut down the conversation immediately. But I don't know what this means now, and I haven't been pushing him for details because what he discusses in therapy is between him and his therapist. But, does this mean that he has a diagnosis now written down in a medical chart somewhere? If he disagrees with their assessment does that end the conversation? I understand that seeking treatment is a whole different bridge to cross, but I just... don't understand quite what this means.

I may not be up on the latest, but when I was taking coursework from professors who trained clinicians, we were told that there are multiple diagnoses with overlapping traits, such that it isn't a sure bet to make a categorical diagnosis. So, I think most therapists who are working with the general population probably hesitate to label a client with a diagnosis they have no empiric evidence to support, such as from results of psychological testing, a specialized service offered by Clinical Psychologists or Psychiatrists.

On the other hand, we had a visiting professor who taught that in the psychiatric hospital he worked in, treating the severe or criminally insane as they used to say, when he tested patients with the psychological assessment they used, the MMPI, patients were found to suffer from an average of 3 co-morbid psychiatric disorders! (He explained that we students were learning about these disorders from the standard criteria for determining a specific disorder. But in practice, mentally ill people often have a mix of this or that or the other disorder!)

That explained a lot of my confusion about certain people who had impacted my life. They can have traits of more than one disorder, yikes....Wish there was a better answer!

The documentation of the diagnosis is the responsibility of the provider who is legally responsible for the medical and/or mental health record.

Who can make the diagnosis? That may vary by state, as state scope of practice laws may differ. Medical doctors, which include psychiatrists, can pretty much diagnose mental health and/or personality disorders. Usually Nurse Practitioners and Physicians Assistants can, too. Usually, mental health counselors are able to diagnose.

The Diagnostic and Statistical Manual (DSM) is a specialty book used by mental health professionals. It groups the diagnosis codes by type, such as depression in one category, schizophrenia in another, personality disorders in another. Then, the book lists the symptoms, which may include a length of time, for the different diagnoses. For example, the person may need to have 3 symptoms from section A, one from section B for at least 6 weeks, and one or more from section C.

Just because they say "it sounds like X", it really isn't official until it's formally diagnosed in the medical record. It could be that after further work, the LCSW may have a different diagnosis. There are many that have overlapping symptoms.

If your WH disagrees with the assessment, he can get a second opinion. Just because he doesn't like it doesn't mean he doesn't have it.

Leafields nailed it