Abstract
BackgroundThough the socio-emotional significance of psychiatric diagnoses and the frequency of transitions between diagnostic classifications are widely acknowledged, minimal research reveals how “diagnostic shifts” are subjectively experienced by psychiatric service-users.AimThis study investigated how adult service-users make sense of diagnostic shifts and their impacts on one's life.MethodsTwenty-seven people with self-reported experiences of diagnostic shifts opted into this qualitative study. Virtual narrative interviews invited participants to share their “diagnosis stories.” Interview transcripts were analyzed using narrative thematic analysis to identify common and divergent experiences across participants.ResultsDiverse experiences of diagnostic shifts were related: diagnostic shifts could both promote and undermine clinical trust, therapeutic engagement and self-understanding. The analysis suggested that shared and divergent experiences could be attributed to two dimensions of narratives: participants' Interpretations of Diagnostic Shifts and Diagnosis-Specific Factors. Regarding the former, analysis produced a typology of three possible interpretations of diagnostic shifts, which were linked with consistently different antecedents, experiences and consequences. The latter dimension captured how experiences of diagnostic shifts also hinged on the unique meanings ascribed to the specific diagnoses gained and lost, particularly in relation to their perceived severity, stigma, personal associations, and related communities.ConclusionsFindings revealed how diagnostic shifts can be experienced as both traumatic and life-enhancing, depending on their social and subjective context. Understanding the range and predictors of variable experiences of diagnostic shifts is vital for sensitive clinical practice and communication.
Highlights
Mental health and neurodevelopmental difficulties manifest on a continuum, with considerable individual variability in the severity and expression of symptoms experienced
A narrative approach to conducting and analyzing interviews was employed [26, 27], in recognition of the role diagnosis plays in shaping biographical narratives [13]
The analysis identified two thematic dimensions of participants’ narratives: experiences differed according to participants’ Interpretations of Diagnostic Shifts and Diagnosis-Specific Factors
Summary
Mental health and neurodevelopmental difficulties manifest on a continuum, with considerable individual variability in the severity and expression of symptoms experienced. Most mental health science and practice depends on classification of psychological difficulties into discrete diagnostic categories, which typically have poor temporal and inter-rater reliability [1]. One byproduct of these categorical systems of diagnosis is the movement of a subset of mental health service-users between different diagnostic classifications over time. Research with clinical and community samples shows most psychiatric diagnoses have limited longitudinal continuity [2,3,4,5,6] This means that during a person’s experience of psychological difficulties, a diagnosis once received can transition into a different diagnostic classification or be lost entirely. Though the socio-emotional significance of psychiatric diagnoses and the frequency of transitions between diagnostic classifications are widely acknowledged, minimal research reveals how “diagnostic shifts” are subjectively experienced by psychiatric service-users
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