In response to my comment that maybe the DSM-5 doesn’t matter, Rebecca writes
Having a bipolar diagnosis will get you rejected from underwritten health insurance for the self-employed – even if you apply for a policy that specifically excludes mental health coverage (as I did). And you can’t get the faux bipolar diagnosis removed from your medical record because even if it’s a fad diagnosis there is no way to prove that you don’t have it once you’ve been labelled.
This is a great example of why the DSM does matter, even if the particulars of DSM-5 don’t (at least not so much). It’s also a totally underappreciated aspect of using medical insurance to pay for mental health treatment. The diagnosis your therapist puts on your bill, those innocuous-seeming 4 or 5 digits that he or she may or may not even mention to you or may assure you are merely a formality, will become part of your permanent medical dossier. And as electronic medical records become the law of the land, the diagnosis will not be something that someone has to dig around in the paperwork to find.
Rebecca writes of one of the implications: you might be denied health insurance in the future. In the Obamacare era, you won’t be denied, but you may well be put into the assigned risk pool, or whatever it is eventually called, and your premiums increased accordingly. But you may be denied life insurance and, who knows, as all our datalives converge in the Mother Computer, your credit rating, your car insurance premiums, your employment prospects, and so on may also be affected.
And that’s not all. I have a patient who has chronic illnesses that sometimes become acute and life threatening. Her array of symptoms and syndromes is so vast and complicated and confusing, and so confounded by the interactions among her treatments, that she stumps every doctor that comes into contact with her. Once, when hospitalized at a leading university medical center, a psychiatric evaluation was ordered, and she was diagnosed with Somatoform Disorder, largely on the basis of a Minnesota Multiphasic Personality Inventory, an old-line personality test that has among its features a hypochondriasis scale. Conventional wisdom holds that the Hs scale is not valid for people who are actually sick (duh!), but that didn’t stop the clinician, a psychiatrist who spent 45 minutes with the patient and then read the test results, from rendering the diagnosis. Since that time, when she has been hospitalized, and especially when she has been hospitalized in a new (to her) hospital, doctors confronted with her bewildering array of symptoms have seized this one diagnosis to decide that she is a mental patient. She, naturally, objects, and I have often had to enter the fray to try to straighten out the situation–a job at which I am only partly successful.
Moral of the story (and of Rebecca’s comment): Be careful about getting yourself diagnosed. It can haunt you all your life. It might be worth shelling out your own hard-earned cash for therapy to keep yourself safe.
