Diagnosis

One of the areas of complaint to the Health Care Complaints Commission and to the Psychology Council of NSW relates to diagnosis. Formulation and diagnosis are a core part of competency development for psychologists, irrespective of their training pathway. 

However, the DSM-5 and ICD-11 both run to hundreds of diagnoses. Therefore, it is not expected that psychologists will have a working knowledge of all diagnoses. Practitioners should use only the DSM 5 or ICD-11 when referring to a diagnosis of a person under our care and/or assessment. 

It is also expected that when a psychologist uses a diagnostic term it is consistent with either the DSM-5 or the ICD-11 and not used in a lay or pop-psychology manner. When providing such a diagnosis it is important your notes explain how you arrived at the diagnosis. This could be by reference, for instance, to the diagnostic criteria of either the DSM-5 or ICD-11, and/or the use of a diagnostic instrument consistent with these classification systems.

Psychologists are at risk of having complaints against them in the area of diagnosis upheld when doing the following:

• proposing a diagnosis that does not exist in the DSM-5 or ICD-11;
• providing a diagnosis without substantiating via reference to the DSM-5 or ICD-11 diagnostic criteria;
• relying on a screening instrument for diagnosis, e.g., using a depression screener that rates someone high on depression and providing a diagnosis of depression on the basis of that score, when that score could also be explained by sadness, miserableness, and grief;
• using the results of a personality assessment (e.g., PAI) to provide a diagnosis without further assessment;
• providing a diagnosis where an examination of the symptoms may be more suggestive of a different diagnosis;
• diagnosing or reporting someone has a diagnosis on the basis of an historical diagnosis. Previous diagnoses may have been wrong, may have changed, and/or may now be wrong; or
• diagnosing a person they have not met and assessed. It is not entirely unusual to find diagnoses of current or ex-partners in the file of a current client despite the fact that the psychologist has never met the (ex-)partner.