The Ethics of Diagnosing
Written By: Cassy Schraft, LPC
When individuals seek therapy, they often wonder whether they will receive a mental health diagnosis. For some, a diagnosis can provide clarity, validation, or relief, helping them understand their struggles and find meaningful, effective treatment.
For others, however, the label may carry stigma, limit how they view themselves, or fail to resonate with their lived experiences.
Therapists must navigate this delicate balance—ensuring that a diagnosis is used ethically and with the client’s best interests in mind.
This blog explores how diagnoses are made, their benefits and drawbacks, and what you, as a client, should know about the intricate world of diagnosing.
How Diagnoses Are Made
Diagnoses are made by mental health professionals who are trained in the Diagnostic and Statistical Manual of Mental Disorders (currently the DSM-5-TR). This manual outlines the diagnostic criteria for psychiatric conditions, differentiates between similar disorders, and provides insight into variations in presentation based on factors like sex, age, and cultural context. Providers may use structured assessments, questionnaires, and interviews with clients (or collateral sources) to gather information about symptoms, symptom history, and the level of distress or impairment. This comprehensive process aims to create an accurate picture of what you're experiencing. It’s important to remember that diagnosing isn’t just about placing you in a category—it’s about understanding your unique experience and determining the most effective path forward in treatment.
Additionally, it's important to note that diagnoses are not set in stone. Mental health professionals may be required to provide an initial diagnostic impression after the first meeting, but this doesn't capture the full picture. Given the limited time of an initial session, it's common for a diagnosis to evolve as therapy progresses. What fits your symptoms at one point may change as you and your provider gain a clearer understanding of your experience. As treatment progresses, it’s possible that your diagnosis may shift to better reflect your needs and progress.
Why Do Therapists Make Mental Health Diagnoses?
It’s crucial to recognize that therapists do not take diagnosing lightly. We understand the weight that a diagnosis carries, especially when it involves certain conditions. Within the mental health community, there’s ongoing dialogue about the need for diagnosing and whether it should even be done. While therapists hold varying opinions on the matter, there are several significant reasons why making a diagnosis is often necessary and beneficial.
Insurance Requirements
Though it’s frustrating, insurance companies require a diagnosis to justify covering therapy, psychiatry, or other mental health services. The rationale is that a diagnosis demonstrates a medical need for treatment. Without one, insurers argue that the services provided are not medically necessary. This becomes especially complicated when someone doesn’t neatly fit into diagnostic categories or seeks therapy for purposes such as self-reflection, confidence building, or other personal growth—not because of any “deficit” in their mental health.
Treatment Planning
Most mental health diagnoses come with supporting research that identifies which treatments are most effective. This evidence-based approach helps guide therapy and allows therapists to implement interventions that are backed by research. Knowing which treatments are likely to alleviate symptoms can make the therapeutic process more meaningful and focused.
Communication with Other Providers
While every individual’s experience of a diagnosis is unique, mental health conditions often share similar symptoms. Much like how a stomach bug or migraine might have common, recognizable symptoms, mental health conditions tend to manifest in predictable ways. This consistency makes it easier for providers to communicate and collaborate when discussing a patient’s care. Although every person is unique, having a shared language for diagnosis can make consultations more efficient and ensure that everyone involved is on the same page.
Providing Clarity
For some, a diagnosis provides clarity. Throughout my career, I’ve had many clients respond with relief after learning their diagnosis. They often say, “That makes so much sense!” It’s not uncommon for individuals to feel isolated or like they’re “crazy” due to their experiences. A diagnosis can help normalize their symptoms, illustrating that their struggles are valid and that others have faced similar challenges. It’s a way of saying, “You’re not alone,” and that what you’re experiencing has been understood and named by the clinical community.
Why Therapists Are Cautious About Making a Diagnosis
Despite the benefits of a diagnosis, therapists must also consider the potential negative impacts of labeling a client.
Stigma
Even with the growing awareness around mental health, stigma still persists, particularly with certain diagnoses. For example, individuals diagnosed with schizophrenia are still unfairly viewed as “crazy” or dangerous, while those with bipolar disorder may be seen as irresponsible or unstable. The stereotypes are untrue for most with those conditions. And while research and evidence show that these conditions can be well-managed and individuals with them can lead productive and normal lives, the stereotypes surrounding them can be damaging. Not only do they affect how others perceive the person, but they can also shape how the individual sees themselves.
Shame
One of the most challenging aspects of receiving a mental health diagnosis is the shame that can accompany it. For some people, a diagnosis doesn’t just feel like an explanation for their symptoms—it can feel like a reflection of their worth; as if it is a personal failing and they are to blame for their struggles.
For example, someone diagnosed with depression might think they’re not trying hard enough to be happy or grateful, even though depression isn’t about willpower. Similarly, parents of children diagnosed with autism might feel guilty, wondering if they caused it through their choices during pregnancy or early development. This misplaced guilt can add an unnecessary emotional burden to an already difficult situation. It’s important to recognize that diagnoses aren’t about personal shortcomings—they’re simply a way to understand and address symptoms.
Self-Fulfilling Prophecy
Receiving a diagnosis can sometimes lead individuals to internalize it in a way that limits their potential. This can create a self-fulfilling prophecy where individuals behave in ways that align with the limitations they believe are imposed by their diagnosis. For example, a person diagnosed with ADHD might believe they are incapable of focusing or succeeding in life, and as a result, they may avoid trying altogether. This avoidance only reinforces their belief that they are incapable, trapping them in a cycle of self-doubt and stagnation.
Misdiagnosis and Over-Diagnosis
Not all mental health struggles neatly fit into the categories outlined by diagnostic criteria, and many symptoms overlap between different conditions. When therapists face difficulty differentiating between conditions, they risk misdiagnosing a client, which could lead to overdiagnosis.
A common example of this is the overdiagnosis of ADHD in children. A pediatrician might diagnose ADHD when symptoms like inattention or hyperactivity could be more indicative of anxiety, depression, or trauma. While ADHD is a legitimate and important diagnosis, it’s often misapplied when other underlying conditions haven’t been thoroughly explored.
Additionally, sometimes a client’s symptoms don’t fit neatly into the formal diagnostic criteria. This forces therapists to make tough decisions: Should they apply a label that the client doesn’t technically meet, but which might be the closest match? Or should they classify the client as “Unspecified” or “Other Specified”? These catch-all labels are sometimes used when a client’s symptoms don’t fully align with diagnostic criteria but still point to a specific issue. However, these terms can be problematic, as they might make clients feel that their struggles are somehow “not enough,” or that their experiences aren’t being taken seriously.
Pressure to Diagnose
Therapists often feel pressure to diagnose in specific ways, especially when a client needs a particular diagnosis to qualify for services like an IEP, disability benefits, or insurance coverage. The financial pressures associated with mental health services also add complexity. Therapy is expensive, and most people rely on insurance to help cover the cost. This can create an ethical dilemma for therapists, who may feel compelled to give a diagnosis that helps their client access these services, even if it’s not a perfect match.
Pressure for Specific Treatment
While the choice of treatment should always be voluntary, a diagnosis can sometimes create an unspoken expectation for certain types of therapy or interventions. For example, a diagnosis of ADHD might lead to suggestions for medication, or PTSD might prompt certain trauma-focused therapies. For individuals who may not align with these treatment options—whether due to personal values, past experiences, or preferences—the pressure to follow a prescribed path can feel overwhelming or even dismissive of their needs. This can make accepting the diagnosis more challenging, as it may seem tied to a treatment plan that doesn’t feel right for them.
Impact on Life Opportunities
A mental health diagnosis can have unintended consequences that limit a person’s access to key life experiences. Certain diagnoses—or even just having a diagnosis—can disqualify individuals from opportunities like serving in the military or obtaining a pilot's license, which can be devastating if those goals were central to their life plan. In some professions, especially high-stakes roles such as law enforcement or firefighting, a mental health diagnosis may disqualify someone, even if their condition is well-managed. Additionally, career opportunities may be affected if specific certifications or licenses require a clean mental health history. Mental health diagnoses can also influence access to insurance. Life or disability insurance may come with higher premiums or even be denied, and in some legal cases—such as custody battles or gun ownership—diagnoses can play a role in decisions that impact rights and opportunities. If looking to move to a different country, individuals with certain mental health conditions may even be denied immigration or residency status due to concerns about healthcare infrastructure and perceived burden on public services.
The Ethical Dilemma
The ethical dilemma surrounding diagnosis is complex and reflects the core values in the American Psychological Association’s ethical principles:
Beneficence and non-maleficence: Striving to do good and avoid harm
Fidelity and responsibility: Developing trust and accountability in relationships with clients
Integrity: Practicing honesty, transparency, and truthfulness
Justice: Ensuring fairness and equality in the provision of services
Respect for people’s rights and dignity: Recognizing the inherent value of all individuals
These principles are essential, but they don’t always provide clear-cut answers. What happens when being honest about a diagnosis causes emotional harm to the client? Or when a therapist adjusts a diagnosis slightly to help a client access necessary support? The conflict between competing values can make these decisions challenging, even for experienced therapists.
This is why therapists are required to complete continuing education on ethics every two years and should regularly consult with colleagues to navigate these difficult situations. While most therapists have the best intentions, these well-meaning actions can sometimes lead to negative outcomes. Consulting with other professionals helps reduce the potential for harm and ensures that decisions are made thoughtfully and with the client’s well-being in mind.
What This Means for You as a Client
As a client receiving mental health services, it’s important to feel empowered in how you approach conversations about your diagnosis.
It’s okay to ask questions about your diagnosis. Your therapist is the expert on diagnostic criteria, but you are the expert on your own experiences. It’s important to ask questions like, “What diagnostic criteria have I met for this diagnosis?” or “Why did you choose this diagnosis over others?” These questions can open a dialogue and help you better understand how your therapist is interpreting your symptoms. It also provides an opportunity for you to share your perspective, which could influence how your therapist views your condition.
Understand that a diagnosis is a tool, not an identity. A diagnosis does not define who you are and diagnoses can change over time as you and your therapist work together to gain clarity on your symptoms and experiences. I encourage clients to use “person-first” language, such as saying, “I am someone with depression” rather than “I am depressed.” This emphasizes that the diagnosis is just one part of who you are—it doesn’t encompass your entire identity.
Consider whether alternatives to a diagnosis are appropriate. If the presence or absence of a diagnosis is important to you, it’s essential to discuss this with your therapist. There may be valid reasons for not including a specific diagnosis in your chart. For example, if you’re paying out-of-pocket for therapy, your therapist might opt for a non-billable code rather than the formal diagnosis an insurance company may require. Alternatively, if a diagnosis isn’t relevant to your treatment goals, your therapist might choose not to include it.
Conclusion
Navigating the world of mental health diagnoses can feel complex, but it’s essential to remember that a diagnosis is just one tool in the therapeutic process. It helps provide clarity and guide treatment, but it doesn’t define who you are. As a client, it’s important to maintain open communication with your therapist about how a diagnosis impacts you—both in terms of treatment and the emotional significance of the label.
By approaching the diagnosis process with curiosity and self-awareness, you can ensure that it’s used in a way that aligns with your values and goals. Ultimately, the goal of therapy is to support your journey toward a fulfilling and meaningful life, and a diagnosis should be just one part of that process—not a limiting factor.
