Is symptom-based diagnosis of mental health disorders doing more harm than good?

We need to abandon the conventional way of diagnosing mental health disorders by symptoms and instead look at root causes.

How can we come to understand the causes of mental disorders?

Despite decades of psychiatric research, we still lack a causal understanding of the majority of mental disorders. As a result, doctors group and treat disorders based on their symptoms rather than their causes.

Here, we discuss the harms of symptom-based diagnosis and the steps that can be taken to identify the root causes of mental health disorders.


Symptom-based diagnosis

Have you ever been diagnosed with a mental health disorder after only a brief test? If you have, perhaps you were left feeling under-evaluated, like your doctor just checked a few boxes and then assigned you into an all-encompassing diagnosis of something like depression or generalized anxiety disorder – a uniquely shaped peg fit into a round hole.

This is, in fact, exactly how psychiatric diagnosis currently works. Patients are diagnosed on the grounds of their symptoms, such as having trouble sleeping or a decreased appetite, rather than the root cause of their problem.


Why is a causal understanding better?

In the brain and the body alike, we need to understand the root causes of a disorder, not just its symptoms, to be able to truly treat it.

Take Covid-19 as an example. Covid-19 is identified by an antigen test which looks for biomarkers of the disease’s root cause (the virus). As a result, the disease can be quickly and precisely diagnosed.

If, however, we relied on a symptom-based diagnosis strategy, Covid-19 would be much harder to diagnose. This is because many other causes can produce the same symptoms that are associated with Covid-19, and, conversely, because not all patients with Covid-19 (i.e. with the same cause) show the same symptoms. As a result, patients with the same symptoms, but different causes, would be grouped into a diagnosis that could be called, for example, “body fatigue disorder”. So, while one patient has the Covid-19 virus, another has a bacterial infection, and another is suffering from environmental factors, all three show signs of “body fatigue” and would therefore be diagnosed identically. Problematically, they would of course require different treatments strategies because the underlying causes of their symptoms are different, making the symptom-based diagnosis ineffective.

This struggle is exactly what we’re seeing in the mental health world. Symptoms are being grouped to create diagnostic categories with little to no concern for root causes. Take, for instance, what we call depression. Patients are diagnosed with depression if enough symptom boxes, such as lack of interests, trouble sleeping or loss of appetite, are ticked by their doctor. However, a patient could be suffering from these symptoms for any number of different societal, environmental, or biological reasons, and therefore would require different treatment solutions. For these reasons, an approach that only looks at symptoms is just as ineffective with mental health challenges as it would be with physical challenges like Covid-19.

If psychiatry is able to shift to a framework of cause-based diagnosis, doctors can help patients by addressing the root causes of their disorder rather than playing whack-a-mole with its symptoms. Just as we must start to understand what the roots of a tree needs to thrive, rather than painting the browning leaves green again, we need to understand the roots causes of people’s distress, rather than just treating their symptoms.


What can be done? The answer lies in the data.

To develop a causal understanding of mental health disorders, we have to abandon the conventional groupings by symptom criteria and instead look at what the objective data is telling us. For years this wasn’t an option because psychiatry had been unable to gather enough data, but recently that’s changed.

Efforts like Sapien Labs’ Global Mind Project, which has surveyed over 1.4 million adults worldwide, are laying the groundwork for a data-backed approach to understanding the causes of mental illness.

With data-supported hypotheses that are tested against biological markers, we can enter a new era of psychiatry in which mental disorders can be identified, and subsequently treated, with much more precision and effectiveness.