It’s a diagnosis of inclusion now, whereas it used to be a diagnosis of exclusion. We changed the diagnostic criteria in the DSM-5 so that now clinicians can use signs on their exam that are inconsistent with known neuroanatomical neurophysiological pathways. Now we can actually make the diagnosis with a definitive position, rather than just guessing or hedging as it used to be done in the past...
It’s a diagnosis of inclusion now, whereas it used to be a diagnosis of exclusion. We changed the diagnostic criteria in the DSM-5 so that now clinicians can use signs on their exam that are inconsistent with known neuroanatomical neurophysiological pathways. Now we can actually make the diagnosis with a definitive position, rather than just guessing or hedging as it used to be done in the past.
What it means is diagnosis is the first step in treatment. An accurate diagnosis is essential. To do that, we use the history, we use the examination, and we use the relevant diagnostic labs. So, when you know what you’re treating, then that informs what direction you’re going to be going with the appropriate treatments.
Often we’ll see co-occurring illnesses. In fact, comorbidities are the rule, not the exception. So, when you see somebody who has functional neurological disorder, conversion disorder, or some type of a manifestation, be on the lookout for co-occurring depression, anxiety, post-traumatic stress disorder, characterological diagnoses such as personality disorders. Many times it’s going to be really important also to look for a history of prior life experiences, adverse life experiences. That doesn’t mean everybody has had a history of trauma or abuse, but it means some people will, and it’s important for the diagnostic formulation to understand that’s part of who that patient is, where they’re coming from.
