Patients can diagnose too: How continuous self-assessment aids diagnosis of, and recovery from, depression

Abstract

Background: A dichotomous ICD-10 or DSM-IV diagnosis of depression does not fully capture its natural phenotype: a dimensional continuum of environmentally reactive fluctuations in mood. Therefore, ICD and DSM labels of depression, although useful from a service perspective, fail to help patients directly. This paper will show, using the author's experiences as an example, that patients with mood disorders can “diagnose” the natural phenotype, in the sense that systematic recording of painful fluctuations in environmentally reactive moods by the patient him- or herself may: (i) not only provide an accurate assessment of depression, but (ii) result in a process of conscious awareness of aberrant responses to the environment − a first step on the way to recovery.

Method: The author developed a rudimentary but useable method to diagnose his dynamic mood fluctuations over the years. The continuous assessment method allowed him to systematically score his mood and activities every day, enabling him to study and analyse in detail the course and context of mood symptoms over time.

Results: With time, this initial strategy evolved into a new, more informed, more empowered diagnosis of his problems and ultimately contributed to a more resilient mind set with regard to mood changes and ways of active rather than avoidant coping with them.

Conclusions: Many people with mood problems receive a DSM label but are not taught to engage in diagnosing what depression is: a dynamic pattern of environmentally reactive mood responses. Continuous diagnostic self-assessment strategies may help patients to learn, adjust and cope with their emotional vulnerabilities expressed as dimensional and reactive variation in mood. Patients can be empowered to diagnose experiences as a means to understand the sources and consequences of continuous mood variation over time.

Keywords:

• Depression
• diagnosis
• self-help groups
• self-help devices

Acknowledgements

With thanks to Prof. Jim van Os, Department of Psychiatry and Psychology, Maastricht University Medical Centre, The Netherlands and King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK, for comments and help with drafting the manuscript.

Role of funding source: Not applicable

Declaration of interest: There are no relationships that potentially could have constituted a conflict of interest. The study has not been supported by any commercial or non-commercial enterprises or institutions