Presenting problems and diagnosis

Abstract

As an object of widespread criticism, psychiatric diagnosis has amassed a voluminous body of literature, most of it being focused on questions of validity, reliability, and consistency. Even though germane to the issue, less attention has been directed to the process of diagnostic decision making, i.e., how such assessments are made, what identifiable factors they are based on, and so forth. The work of Gauron and Dickinson, 6 Petzel and Gynther, 4 Sandifer et al., 5 and Kendall 7 are among the few studies addressed to these questions. This paper continues this line of inquiry by exploring psychiatric diagnosis in relation to presenting problems. At times a presenting problem is simply a short-hand verbal account of a person's “story”. Generally, however, it is a composite presentation that also includes accounts about his condition made by “significant others” acting as complainant and/or concerned party, as well as the clinician's gross observations. Except for the work of a few investigators, 8–10 presenting problems remain a relatively unexplored area. Taken at face value, without interpretation or inference, presenting problems provide a unique body of information. As such, they constitute one of the few variables that stand at the interfaces of demographic, psychosocial, and clinical data and can thus provide a fruitful, empirically-grounded research tool. Accordingly, data and findings are presented from a recent community-wide survey of psychiatric utilization, 11 i.e., specifically, the presenting problems of a 1-year adult population of applicants (unduplicated count) who sought psychiatric care from either a large urban mental health center or from the private sector (i.e., the office and hospital clientele of psychiatrists in private practice; 86% of the private psychiatrists cooperated and participated in the study).