In this video I provide information on diagnosis of mental illness using the DSM-5, including the use of minimum symptoms, unspecified disorders, and substance or medication induced disorders. I also provide a caveat regarding “medical student’s disease” and the importance of avoiding casual use of diagnostic terminology or disorder names.

Video Transcript

Hi, I’m Michael Corayer and this is Psych Exam Review. In the previous videos in this unit I talked about mental illness in fairly general terms and my hope is that this has given you an overview of the ways to think about mental illness and I also hope you’ve seen the many factors that can be involved in mental illness. So starting in this video and future videos in this unit we’re going to look at mental illness in more detail, we’ll look at particular mental disorders.

Now the first thing to know is that in the DSM-5 you find categories of disorders. So disorders that are similar or they have similar types of symptoms are grouped into categories. So for each video in the rest of this unit I’m going to introduce a category that you’d find in the DSM-5 and then I’ll talk about some particular disorders in that category and for those disorders I’ll talk about the symptoms of the disorder, the estimated 12-month prevalence of the disorder that’s given in the DSM-5, and for some disorders I’ll also talk about some associated factors, other risk factors, or things like comorbidity with other illnesses.

Now the first thing you’ll notice when I talk about these particular disorders is that the DSM-5 gives a minimum number of symptoms that’s necessary for a person to receive that diagnosis. So there might be a disorder that has eight symptoms listed in the DSM-5, eight symptoms that are associated with that disorder and then it might say that a patient needs to show five of those symptoms in order to receive the diagnosis. And so you might wonder who decides or you might wonder why is it that it’s five out of eight symptoms instead of four or six. And the answer of who decides is that the DSM committee has decided that that’s the minimum number of symptoms for that particular disorder and they reach that decision by having discussion and then voting on the number of symptoms that is necessary for the diagnosis. And so what this means is that there is a subjective aspect here and it’s not necessarily the case that there is a clear evidence-based or research-based answer to why it is that it’s five out of eight symptoms instead of six or instead of four.

Now to be fair to the DSM-5 and the DSM-5 committee, they also list in the DSM-5 what are called unspecified disorders and so it’s possible to get a diagnosis of an unspecified version of a disorder. And what this means is that a person might have many symptoms but they don’t reach the full criteria for a particular disorder. So a person might have symptoms of several disorders, they might actually have many symptoms, but none of these symptoms fit together to something that’s actually described in the DSM as a particular disorder. And so rather than saying, well that means this person doesn’t have a mental illness and therefore there’s nothing we can do for them, they could receive a diagnosis that they have an unspecified disorder and there could still be ways of helping them to treat the symptoms of this unspecified disorder, even though it doesn’t reach the full criteria of a particular disorder in the DSM-5.

Okay, another thing that’s worth noting about the DSM-5 before we get to particular disorders is it also includes what are called substance or medication-induced disorders and so the DSM-5 recognizes that there are 10 classes of substances that are known to cause symptoms that might appear to be symptoms of mental illness. And so if those symptoms appear within one month of intoxication or withdrawal from any of those substances then this is taken into consideration for the diagnosis and they might receive a diagnosis of a substance or medication induced disorder. Now it’s also true that some toxins or hallucinogenic drugs have effects that could last longer than one month after intoxication or after withdrawal but that’s generally the cutoff that’s used.

Okay so what this means is that there are diagnoses that are in the DSM-5 that are not really what we would think of as mental illness, even though a person might have many of the symptoms that appear to be symptoms of mental illness. So to give you an example in the DSM-5 you can find things like alcohol intoxication and what this means is if somebody went to a psychiatrist and they had a number of symptoms that might be associated with mental illness if it turns out that the person’s blood-alcohol level is very high and they meet these criteria for alcohol intoxication then it would probably be considered that the person is just drunk and they don’t necessarily have the mental disorder that is associated with some of those other symptoms. Or somebody is going to see a psychiatrist and their heart is racing and they have, you know, shallow breathing and they’re sweating profusely and they’re shaking this might be the result of caffeine intoxication rather than the result of some other mental illness or other symptoms of some mental illness. And so you also see in the DSM-5 things like cannabis intoxication, the symptoms of that or symptoms of something like tobacco withdrawal, and so this would be taken into consideration when a psychiatrist is looking at the symptoms that a patient is expressing. We take into consideration whether or not the person has taken any of these substances that might be influencing these symptoms. And some of these of course are quite common. So in the case of alcohol intoxication the DSM-5 gives a 12-month estimated prevalence for college students that is about 70%, suggesting that many college students are very drunk fairly often.

Okay so another thing to note is that many of these symptoms are common and they’re common not just because of other drugs that might influence behavior, but they’re common and we see them in everyday life, and this doesn’t necessarily mean that somebody has a mental illness. And so we want to avoid what’s called “medical student’s disease“. This is the problem where medical students start studying and learning about all sorts of symptoms of rare diseases and disorders and then they start to recognize those symptoms in their own life and they start thinking “oh my god, my arm has been kind of itchy for the past two days, I must have this rare parasite that I’ve just been reading about”. And so it’s a feeling that you have the symptoms that you’re studying and so we want to keep this in mind when we study mental illness. You’ll probably recognize thoughts or behaviors that are listed as symptoms of disorder, you might recognize those in yourself or in people around you and this, of course, doesn’t necessarily mean that you or those people have some mental illness.

And it’s also important to note, as I’ve noted in previous videos, that these videos are for educational purposes, right? I’m not a clinical psychologist or a psychiatrist and I’m not making these videos to help you to diagnose mental illness. This is just to help you to understand mental illness in general and so if you believe that you or someone that you know has symptoms or is experiencing distress that might be associated with mental illness then they should seek out the help of professionals and these videos are not something that you should turn to for advice in those situations.

Okay, I also want to give the caveat that as you learn about these symptoms and you learn about these disorders it might be tempting to start using these in everyday conversation and what you want to avoid is the casual use of what are diagnostic terms, right? So just because you’ve learned some new terminology and start using it in your daily life, you don’t want to start using these things as adjectives. You don’t want to say something like, as you’re washing your hands for the third time that day, say you know “oh my god I wash my hands so much today I’m so OCD” you know? Or you know as you clean your room and you think “oh you know I’m so OCD I really need my desk to be neat before I can study” or something like that. You want to avoid doing that or you want to say you know you don’t want to say something like “I haven’t had time to eat lunch the past three days I’m practically anorexic” right?

And the reason you want to avoid this is that these are real disorders. People really do suffer from these things and they have these symptoms and they’re distressful and people don’t want to be feeling these symptoms or having these behaviors. And so we don’t want to trivialize that suffering. We don’t want to treat it as something that you make light of, something that you make jokes about, or something that, you know, you treat as something insignificant. And so that’s something to just keep in mind as you learn these terms. It can be tempting to start using them but you want to reserve their use for, you know, more professional or serious conversations about these disorders.

Okay and so lastly I want to mention that in the rest of the videos for this unit I’m going to hope to give you a broad overview of the category, so I’m not going to go through every single category in the DSM-5 and I want to keep in mind that it’s not comprehensive, that it’s not covering all possible categories. And I’m not going to talk about every possible disorder that is listed in the DSM-5 simply I don’t have time for that and it’s really not necessary because if you’re taking, you know, an introductory psychology class you’re probably hoping to get a broad overview. You’re not looking for details of every single disorder.

And it’s also important to remember that when I talk about the symptoms not only are they common and that you might see them in thoughts or behaviors and recognizing them in people around you but keep in mind that with symptoms it’s also important to consider their severity their duration and their distress, which I talked about in a previous video. So it might be the case that you recognize certain symptoms in yourself but if they’re not severe or they are not long-lasting or they’re not distressful then they might not be signs of mental illness. And so that’s also something that psychiatrists would take into consideration when they’re talking with a potential patient. They’re not just going to look at the symptoms in a sort of general way. They’re going to also want to find out about how long has this been, how severe is it, how distressful is it to the person, and that’s all going to play a role in determining whether or not the person receives the particular diagnosis. Okay so I hope you found this helpful, if so, please like the video and subscribe to the channel for more. Thanks for watching!