Diagnostic Labels Part 3: Navigating Mental Health Treatment without Labels is a Good Choice

six hands of different shapes, sizes, colors joined together at the wrist

Introduction to the ABAI Practice Community Blog and Practice Board member co-author bios. Please note that this blog is co-written by members of the ABAI Practice Board. 

ABAI Practice Board website.

In mental health, labels refer to diagnostic categories or classifications based on symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TRTM) and the International Classification of Diseases (ICD-11). Mental health professionals use these labels to describe and categorize a person’s mental health status. Similarly, research funding to generate empirical support for assessments and interventions used to be exclusively organized around these categories. The U.S. health system is set up such that access to services is contingent upon these categories. Labels are commonly used to organize and provide care recommendations. In the U.S., we cannot interact with the healthcare system without being influenced by these labels.

Labels in mental health can have positive implications for treatment and the continuity of care. For example…

  • Labels can improve access to care – Specific diagnoses might be required prior to accessing mental health services, insurance coverage, and disability benefits.
  • Labels can improve the treatment planning process – Different mental health conditions may benefit from different treatments, and labels can help narrow down the list of available, effective treatments providers might employ.
  • Labels can serve a communicative function – Professionals can identify and understand specific mental health conditions through labels. This common language can facilitate more efficient and precise communication across providers, which can improve interdisciplinary efforts and client outcomes.  

Labels in mental health can also have negative implications for treatment and the rights of individuals. For example…

  • Labels imply etiology – Labeling mental health experiences as “conditions” encourage members of the verbal community to treat these experiences as “things” that are unique in their relationship to a person’s biology. This can focus individual and care setting efforts toward addressing presumed personal biological factors rather than contextualizing the person’s lived experiences associated with the label and addressing these with contextual behavioral supports and interventions. 
  • Labels can create stigma – Labeling someone or oneself with a mental health condition can lead to social and internalized stigma, unfair judgment or treatment, reductions in self-esteem and self-worth, as well as hinder the trajectory of recovery.
  • Labels can oversimplify the human experience – Mental health experiences are diverse and complex, and vary among people. Labels typically fail to capture the entire individual and their experiences and tend to suggest mental health labels reflect homogeneous group membership.
  • Labels can lead to overdiagnosis and misdiagnosis – Labeling behaviors as “mental health disorders” can pathologize normal variations of human behavior, including emotional behavior, which can lead to overdiagnosis. Likewise, mental health professionals might apply labels when not all behavioral conditions are met, which can result in misdiagnosis and mistreatment.  

The vast majority of mental health professionals who have diagnostic determination within their scope of practice lean into labels during the assessment and treatment process. When presented with two options, labels vs. no labels, the professional picks a response that aligns with the current contingencies of the healthcare system. As noted above, in the US, the infrastructure for treatment involves labels. 

Alternatively, professionals can (and should) be reminded that navigating treatment without labels is not impossible, nor doomed to fail without a guiding label to show the way. Such an approach takes person-centered planning and attention to the pertinent variables that impact the behavior of interest and does not rely on the label to stand without individualized contextualization. This is a hallmark of behavior-analytic practice. Instead of solely focusing on categorizing individuals based on specific conditions, mental health professionals can prioritize understanding each person’s unique strengths, needs, and preferences, even in cases where labels are needed for access purposes. The tail need not wag the dog. 

With respect to the “how,” the goal is to focus on function and progress from there. Treating the label as a generalized tact rather than the key behavior(s) of interest, the professional seeks to understand the context that maintains the tact. Client and professional collaboratively explore the person’s life circumstances and establish hypotheses regarding environment-behavior relationships. Once identified, the client and professional set goals, select interventions and implement them, and evaluate the outcomes over time. Treatment packages such as motivational interviewing, acceptance and commitment therapy, and behavioral activation are just a few examples that can be incorporated into such a function-based approach.

By de-emphasizing labels in the treatment process, professionals create a therapeutic environment that is less stigmatizing and more focused on overall wellness. The use of labels in mental health is not the only path to effective treatment. A person-centered, function-based approach can provide a more holistic and individualized perspective, emphasizing a deeper understanding of the individual. 

References & Resources:

For more: https://www.psychologytoday.com/us/blog/escaping-our-mental-traps/202307/rethinking-mental-health-challenging-the-dangers-of-labels

For more: https://psycnet.apa.org/fulltext/2020-10232-001.pdf

For more: https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.15177#:~:text=The%20term%20’labels’%20is%20used,any%20negative%20appraisal%20or%20outlook.

For more: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181189/

For more: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027356/