Diagnostic labels; what if there is none that fits?

This article is going to talk about the labels applied to mental health conditions. In particular, I want to talk about diagnostic labels you are familiar with, such as OCD and labels that are not accepted, such as Pure O or HOCD.

open book showing MoodSmith Pure OCD on page

Why do we need labels?

Labels and categories help you and me to understand each other. From an early age, we both discovered that things with four legs and a back and a flat surface on top of the legs are things we can sit on. We could label it as a chair.

We discovered the category of chairs differs from things with four legs and a back and a wagging tail.

Note. You would label this a dog, as you already have what we call a mental representation of a dog in your head. The only difference in my description of the chair and the dog was including the word ‘waggling tail.’

Being able to assign and categorise chairs makes communication easy between us. If you came into my office and I said take a seat on the chair. Even though it might look different from the chair in your home, you understood.

The ability to label and categorise our world is so much easier than identifying each new object we encounter. If you had to treat everything as a unique experience, me telling you to take a chair would be time-consuming. You would have to work it out. For example, it has four legs, a flat surface, but can I sit on it? It looks different from what I sit on in my home.

The labels people like myself use (psychologists and other mental health professionals) to categorise and diagnose mental health conditions are what I consider a necessary evil. Diagnostic labels can be both helpful and stigmatising.

The lack of a label can leave a person feeling that their experience does not arise from an accepted condition. Or they do not know how to access treatment, as they do not have a name for what they are going through.

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Are diagnostic labels helpful?

Diagnostic labels are valuable and helpful. For example, if you came to see me and said you have OCD, both you and I would know what that means. I may understand more about it on a professional level, and only you would know your personal experience of it. Still, we would have an shared understanding of what you felt because you used the label OCD.

Shared understanding of the label OCD

For me, that would mean.

I would expect you to tell me about uncomfortable thoughts and fears in your head.

For you,

Having the label OCD would be your personal experience of the condition. What fears you have and how you cope; the things you do to prevent the fear behind the thoughts from coming true.

For diagnostic criteria, that means

The presence of both obsessions and compulsions1

Without that label, you would have to describe the symptoms to me, which could invoke shame or guilt for the thoughts you have in your head.

OCD is a well-established diagnostic label. Someone suffering from it may know what is happening to them before getting a diagnosis, because of their symptoms.

What if your experience seems different? What if you thought you had obsessive thoughts but can’t find any compulsions?

What if you keep thinking that you have done something awful in the past, and you just can’t remember it? But the guilt is there?

Or you are considering leaving your partner of 7 years as you think can’t shake the thought that your sexual persuasion must have changed?

These types of thoughts are as debilitating as the ones that you can more readily categorise as OCD, but the sufferer does not get the same relief in knowing that it is a mental health condition that they can seek help for.

What they are feeling does not fit into a long-established category, and are too ashamed or scared to talk to anyone about it as they can hardly face thinking about it, let alone speak about it.

Internet searches might give some respite suggesting that they are intrusive thoughts, but you come to the conclusion that it is Pure O, and the internet tells you it is not an actual condition.

That does not validate what you are feeling, and will not lead you to seek treatment that will help.

Giving a label of Pure O

If you are reading material from a site that is written by mental health professionals, they may tell you Pure OCD is not genuine, or not a diagnosis. I am a Dr of Psychology, and here on my site, I am clear to point out that Pure O, or HOCD or other types of intrusive thoughts do not have a diagnosis in their own right.

But that does not mean what you are feeling is not accurate. It means if I met you in a professional capacity for assessment, Pure O or HOCD does not exist as in clinical entity in the manuals that we use to diagnose such as DSM5.

Is Pure O is a helpful label?

If you came to see me for therapy and said you had Pure O, I would find the label helpful, as again we would have a shared understanding. It may not be perfect, but it gives us a place to start.

I would assume from the label that you are having some disconcerting thoughts you cannot shake. I would also believe that you do not consider yourself to have any compulsions.

Hopefully, after our first meeting, and after exploration of what is happening for you, we would more often than not find hidden compulsions. These are the things you do to help with the thoughts in your head. These could be constantly trying to analyse what is happening. Trawling the internet or forums each time you get the thoughts. These types of behaviours; compulsions draw a picture for us that when you get an uncomfortable thought, you do things to ease it.

When we see it like that, we can then work out a plan of things to do to make you feel better, and that would work with the thoughts and things you do, the obsessions and compulsions, exactly the same as OCD.

What I hope you gain from reading this short article, is that even though your experience does not have a diagnosis that is found in diagnostic manuals, that does not mean your experience is invalid.

Footnotes

1.The Diagnostic and statistical manual of mental health disorders; DSM is used by mental health professionals to diagnose conditions. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

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