Crappy diagnostics (and masters-level therapists?)

[WisNeuro]

Oh, it definitely does. It's a big problem in aviation.

I can imagine. I've only been involved with FAA stuff on the cognitive side, though, which I would fall on the side of overwhelming caution (e.g., dementia, sequelae of a TBI) and such. I got tangled up in this in my clinical work due to an anoxic injury that led to some pretty stark EF and attention issues. Definitely not someone I'd be comfortable flying a plane.

But, I know they're pretty tough on other MH stuff. I have a colleague who does a good deal of evals for MH prescription med waivers. Expensive.

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[Therapist4Chnge]

It's definitely an issue for the FAA & basically all of the 3-letter agencies. Also local, county, and state LEOs. A lesser considered area is driving. In some states, the provider is REQUIRED to report if a patient should not be driving, but there is wide variance by state. Epilepsy and other seizure disorders almost all require a report, though in some states it's not up to the doc to report. They can "recommend" and in others they don't care. I'm not saying it's the best way...but it was eye opening when I did a deep dive after having to figure this out a few years back.

 

[BuckeyeLove]

Varies by state for psychology (and somewhat for other fields). Here's a study that was published on it a couple years back, specifically for psychology licensing boards: APA PsycNet

Thank you so much for sharing this!

 

[R. Matey]

Yeah. Such a rule would--on its face--heavily discourage providers with treatable MH conditions from seeking help.

...and graduate students studying to become providers. Very concerning given what we know about graduate student mental health. I've seen a lot of graduate students at the UCCs I've worked at.

 

[futureapppsy2]

...and graduate students studying to become psychologists. Very concerning given what we know about graduate student mental health.

We've done some work on disability (including mental health disabilities) in grad students. On the issue of disclosure, participants with invisible/non-apparent disabilities generally advised that people not disclose whenever possible, while those with visible/apparent disabilities were more likely to advise disclosure as way to control the conversation and allay potential interviewer concerns. Of course, this often leads to trainees with invisible disabilities not getting accommodations and under-performing needlessly due to stigma and discrimination.

 

[R. Matey]

We've done some work on disability (including mental health disabilities) in grad students. On the issue of disclosure, participants with invisible/non-apparent disabilities generally advised that people not disclose whenever possible, while those with visible/apparent disabilities were more likely to advise disclosure as way to control the conversation and allay potential interviewer concerns. Of course, they often leads to trainees with invisible disabilities not getting accommodations and under-performing needlessly due to stigma and discrimination.

That fits my clinical experience. Accommodations are harder to justify when they're invisible and students are either scared at the prospect of being "found out" and have it hurt their chances in some future endeavor or demoralized at what it takes to get an accommodation. This specific issue hasn't come up, but you're right in saying it affects more fields than psychology. I can't give any details obviously, but I cannot emphasize enough how situations like these have had detrimental effects on a person's mental health.

 

[futureapppsy2]

That fits my clinical experience. Accommodations are harder to justify when they're invisible and students are either scared at the prospect of being "found out" and have it hurt their chances in some future endeavor or demoralized at what it takes to get an accommodation. This specific issue hasn't come up, but you're right in saying it affects more fields than psychology. I can't give any details obviously, but I cannot emphasize enough how situations like these have had detrimental effects on a person's mental health.

Couple of recent articles on this:

APA PsycNet

psycnet.apa.org

APA PsycNet

psycnet.apa.org

APA PsycNet

psycnet.apa.org

 

[Fan_of_Meehl]

...and graduate students studying to become providers. Very concerning given what we know about graduate student mental health. I've seen a lot of graduate students at the UCCs I've worked at.

I also wish that licensing boards would pay more attention to provider BEHAVIOR (in the professional context, i.e., competent vs. incompetent or harmful practices) rather than SYMPTOMS/DIAGNOSES.

It may be anecdotal, but I've known a few exceptionally ethical, skilled, competent and beloved providers who have had mental health SYMPTOMS/DIAGNOSES that rose to clinical significance and for which they sought treatment, all the while, never--to my knowledge--engaging in incompetent practice or inappropriate behavior in a clinical setting.

On the other hand, I've also known of providers who--despite not having a (known/diagnosed) mental health condition, per se (besides maybe psychopathy, narcissism, and/or sociopathy)--have demonstrated consistently sub-par clinical work over their entire careers (with impunity) but because there was no substance abuse/diagnosis on record, they had nothing to worry about.

 

[chicandtoughness]

The problematic one I see a lot is BPD - probably in higher frequencies than I even see bipolar. A lot of folks like to self diagnose BPD too for some reason. It’s like a twisted badge of honor for some patients and I think has fallen into the same trap that ASD has. The autistic community has taken a leaf out of the d/Deaf community’s book in terms of embracing their condition as an identity that shouldn’t be actively treated. I’m finding folks are leaning into that sentiment with BPD too, and/or using BPD to explain away what is just standard emotion dysregulation.

 

[futureapppsy2]

The autistic community has taken a leaf out of the d/Deaf community’s book in terms of embracing their condition as an identity that shouldn’t be actively treated.

Side note, but it bugs me that the Deaf community so heavily preaches that "Deafness is not a disability" while simultaneously arguing for protection for Deaf people under the ADA. A) your internalized ableism is really showing and b) pick one--either Deafness is a disability that's protected under disability civil rights law or it's not and it isn't.

 

[erg923]

I see both strange over fixation on diagnosis (when it really wouldn't alter treatment choices that much and is more of academic musing than anything else), as well as an all too common sloppiness/laziness when it really does matter.

 

[cara susanna]

The FAA thing is extremely problematic. The university where I attended grad school had a very prominent aviation program, so I saw it firsthand. I also saw firsthand how big of an issue alcohol use is with pilots.

 

[PsyDr]

@Therapist4Chnge

Adjustment Disorders do not last beyond 6 months following the end of the stressor or its consequence.....

 

[DrKeto]

My clinical work largely focused on diagnostic assessment so maybe I’m hypersensitive to this, but it’s so frustrating to see so much just unbelievably bad diagnosis, and it seems even more common (although not exclusive) among masters-level providers, IME (and, to a somewhat lesser extent, among PCP physicians). I'm not talking about cases that are really complicated or are iffy on meeting criteria, but incredibly textbook cases being missed (or obviously wrong diagnoses being given) and patients not getting appropriate treatment as a result. The baffling thing is that patients seem okay with it (“You can’t really expect a therapist to diagnose well”) or
express that it was their fault for not doing the entire diagnostic assessment themselves, when that’s not their job. It’s so frustrating to me and makes me think more and more that psychologists should maybe directly supervise masters-level clinicians.

I couldn’t agree more. I’m a neuropsychologist, and I am forever receiving referrals for children who were mis diagnosed with ADHD by PCP (and medicated with stimulants). Also come across a lot of mis diagnoses of high-functioning autism, when it’s actually OCD and/or social anxiety disorder. Very frustrating indeed.

 

[Mama Bear]

This is what I was wondering about. I just got curious. Nowhere in my state bylaws, code, or on renewal does it ask about if you have a mental health condition that could preclude practice, like a declarable.

My state has a question of this sort on the licensure application.

 

[chicandtoughness]

Also come across a lot of mis diagnoses of high-functioning autism, when it’s actually OCD and/or social anxiety disorder. Very frustrating indeed.

I come across a lot of ASD diagnoses from masters level clinicians that are simply a lack of social skills! It baffles me that clinicians are so trigger happy with the ASD dx without proper assessment. Sometimes an individual just doesn’t know how to act around others - that doesn’t make it pathological

Amusingly, I was thinking of this thread just yesterday. I got a transfer from another clinician at my clinic, and when I opened his file he was dx’ed with PTSD, OCD, ADD, and PDD. Not a single assessment done for any of these, not even a dinky self report scale. Her formulation on the intake was nonexistent (“Client meets criteria for PTSD, OCD, ADD, and PDD”, full stop, no aeb or other explanation). They’ve been doing CBT skills training for the past 5 sessions. Whyyyyy are people like this.

 

[medicabruja]

Assessment just isn't 'fun' or 'cool' in modern practice, despite it leading directly to appropriate treatments and good clinical care decisions....

Which is sad. I love assessment, it does get tedious after a while but its always interesting.

 

[LavenderGoat]

Speaking from the other end as someone who saw a psychiatrist multiple times I was misdiagnosed with BPD likely due to the visible SH scars and gender. Looking back I was a 16 year old who was just having a difficult time in high school. The criterions on the DSM are so broad that even though I didn't have any interpersonal relationship issues I still checked off on the other boxes. Even then I couldn't believe I got diagnosed with a personality disorder at such a young age, especially given the heavy load of stigma that's associated with BPD. I figured since my psychiatrist is the expert and he confirmed it twice I may as well believe him (even when my therapist told me that couldn't be true) and I took on a lot of BPD attributes through association. It ended up causing a lot of strain and unlearning. Honestly, it was because of that experience, spite, and interest that fueled me to pursue a career in psychology. I just hope psychiatrists in the future don't immediately stereotype a patient into a 'textbook case' diagnosis without actually getting to know them.

 

[futureapppsy2]

Speaking from the other end as someone who saw a psychiatrist multiple times I was misdiagnosed with BPD likely due to the visible SH scars and gender. Looking back I was a 16 year old who was just having a difficult time in high school. The criterions on the DSM are so broad that even though I didn't have any interpersonal relationship issues I still checked off on the other boxes. Even then I couldn't believe I got diagnosed with a personality disorder at such a young age, especially given the heavy load of stigma that's associated with BPD. I figured since my psychiatrist is the expert and he confirmed it twice I may as well believe him (even when my therapist told me that couldn't be true) and I took on a lot of BPD attributes through association. It ended up causing a lot of strain and unlearning. Honestly, it was because of that experience, spite, and interest that fueled me to pursue a career in psychology. I just hope psychiatrists in the future don't immediately stereotype a patient into a 'textbook case' diagnosis without actually getting to know them.

The “self injury always equals BPD” assumption is such a pervasive and frustrating myth in mental health, imo.