Living with a Diagnosis on Your Record

Reader’s Question

Six months ago, I elected to see a psychologist after moving back to my hometown (after a decade of academics), ending a relationship, and starting a new job. At the time, I had some mild to moderate anxiety (soon after I ended the relationship), but it was not interfering with my daily life (job, exercising, sleep, social involvement), and I was not taking any medication. I wanted to gain insight into healthier relationships, professional development, higher self-awareness, and potentially past parent-child issues. I wanted to understand why I was feeling a certain way, and what positive changes I could make. The psychologist told me I did not have a personality disorder and that our “work” would be considered preventative. A few months later I received a statement from my insurance company with co-payments (6 sessions). After a little research, I realized I was given an Axis 1 diagnosis (Adjustment Disorder). I was under the impression that my diagnosis is more appropriately on Axis V (preventative).

That diagnosis is now on my record and potentially can cause problems with the underwriting of my disability and life insurance policy. I understand that this probably was an insurance reimbursement issue. Consequently, I have been self-paying ever since I discovered this. However, I am now concerned about this diagnosis, and am looking for advice on what I should do.

Psychologist’s Reply

Most insurance companies require that a diagnosis be provided in order to receive reimbursement for counseling services. Of course, there are many problems inherent in that rule, the most pertinent ones being that psychological preventative services are not covered, and that people seeking counseling for things like healthy relationship skills — something we all should obtain — are now considered ill (because they have a mental health diagnosis). This is very problematic.

On the ‘plus’ side, Adjustment Disorder is one of the mildest diagnoses in the Diagnostic and Statistical Manual (DSM). Adjustment Disorder is characterized as the development of emotional or behavioral symptoms in response to an identifiable stressor. If you have to have a diagnosis, this is one of the better ones to have, because there doesn’t even have to be significant impairment in functioning in order to have it. Thus, the mild nature of it may help if you need to argue about it with the life insurance company.

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As you are no doubt aware though, the fact that you now have a diagnosis can be troublesome. We have come a long way in that mental health is no longer viewed with the same level of suspicion that it once was. Research definitively supports the idea that mental health and physical health are intricately linked, and that one significantly affects the other. However, we still have a long way to go before going to a psychologist is as widely accepted as going to a medical doctor. That is why Bill Clinton had to seek only spiritual counseling instead of the regular kind while he was President, but physicians were expected to give him regular check-ups.

As for what you can do about your diagnosis, I honestly do not know. You can try talking with your insurance company about taking it off your record, but it’s extremely likely that it is on there permanently. These days, everything tends to be electronic, so hardly anything is truly erased. If that is indeed the case, it seems like the best path to take is to find the research that supports the link between mental and physical health and then present it in any life insurance discussions you may have to have. Hopefully this will be unnecessary, as the recognition of the psychological field by insurance companies has advanced, but if it hasn’t, it may be time to educate them further.