How Do Psychiatrists Diagnose Conditions? A Root-Cause Approach
When most people think about psychiatric diagnosis, they imagine a checklist of symptoms. You describe your behaviors, the psychiatrist matches them to a label, and you walk out with a prescription. But what if diagnosis could go deeper, exploring not just what you’re experiencing, but why your brain developed these patterns in the first place?
The Traditional Approach vs. Root-Cause Diagnosis
Traditional psychiatric diagnosis relies heavily on observable behaviors. A patient presents with certain symptoms (difficulty concentrating, mood swings, intrusive thoughts) and those symptoms get matched to diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). While this system provides a common language for clinicians, it often falls short of capturing the full picture.
A diagnosis like “generalized anxiety disorder” or “major depression” tells you something about what a patient is experiencing, but it reveals little about their sleep patterns, diet, relationships, or the formative experiences that shaped their brain’s current orientation. It’s a starting point, not an endpoint.
“Diagnosis narrows down the questions we ask, but it doesn’t tell us what’s really going on with the patient. It’s just a method to speed up the conversation.”
- Dr. Abdullah Sallaj, M.D.
How Early Experiences Shape the Brain
A more comprehensive approach to psychiatric diagnosis examines how a patient’s early life experiences ingrained certain patterns in their brain. The brain doesn’t develop in isolation. It’s shaped by every interaction, trauma, and environmental factor a person encounters, especially in childhood.
Consider vigilance. A child who frequently gets in trouble learns to stay on high alert. Their brain develops enhanced threat-detection systems and escape-planning mechanisms. As an adult, this person walks through life in a constant state of readiness, always watching, always anticipating trouble. This orientation becomes entrenched, influencing how they perceive situations, plan their days, and relate to others.
Or consider the child who experienced abandonment or emotional neglect. This brain learns that mistakes lead to catastrophic outcomes such as loss, isolation, and irrelevance. As an adult, this person may hyper-fixate on small errors, convinced that any misstep will result in disaster. This pattern can manifest as OCD, but understanding its origin changes how we approach treatment.
“Interactions people have growing up tilt the brain in a particular way, and we consider that tilt just part of the diagnosis. We also need to look at the why. Which early experiences shaped these patterns?”
- Dr. Abdullah Sallaj, M.D.
The Same Psychiatric Diagnosis Can Have Different Origins
Here’s something that traditional diagnostic categories miss: the same diagnosis can emerge from entirely different developmental pathways. OCD rooted in fear of abandonment feels different from OCD rooted in fear of punishment. Both may involve compulsive checking behaviors, but the underlying anxiety has a different texture and responds to different therapeutic approaches.
Similarly, some patients who present with bipolar-like symptoms may have grown up in environments where play and self-expression were severely restricted. They were told to be quiet, to suppress their natural energy, to contain themselves. The parts of their brain responsible for exploring and enjoying remained underdeveloped, preserved at a toddler level. When they finally leave home, these suppressed capacities emerge in ways that can look like mania, but the treatment implications are quite different from classic bipolar disorder.
“You can have two people with OCD who look the same on paper, but one got that way from being abandoned, the other from being punished. You should treat those two people very differently for optimal healing.”
- Dr. Abdullah Sallaj, M.D.
Beyond Psychology: Physical Factors That Mimic Mental Illness
A thorough diagnostic approach also considers physical factors that can masquerade as psychiatric conditions. Sleep is a prime example. A patient with undiagnosed sleep apnea (snoring, gasping at night, never achieving restorative rest) may present with symptoms that look exactly like ADHD and depression. Their brain becomes “twitchy and irritable,” struggling to transition smoothly between active and restful states.
Without investigating the sleep issue, a clinician might prescribe stimulants for attention and antidepressants for mood, missing the root cause entirely. Treating the sleep disorder could resolve what appeared to be multiple psychiatric conditions.
When Too Many Diagnoses Point to One Answer
Some patients arrive with a constellation of diagnoses: POTS, IBS, food sensitivities, chronic pain, jaw clenching, heartburn, and several psychiatric conditions. They’ve seen multiple specialists, tried numerous medications, and still feel unwell. When a patient has an unusually long problem list, it often signals that something more fundamental is being missed.
In some cases, conditions like hypermobility spectrum disorders (including Ehlers-Danlos syndrome) can explain this entire cluster. These connective tissue conditions affect multiple body systems and frequently co-occur with anxiety, depression, and autonomic dysfunction. Identifying the underlying condition changes the entire treatment approach and gives patients a coherent explanation for their suffering.
What This Means for Patients
If you’re seeking psychiatric care, understand that diagnosis is just the beginning of the conversation. When choosing a psychiatrist, look for one who uses diagnostic categories as a guide for asking better questions, not as a final answer. They should be curious about your history, your sleep, your physical health, and the experiences that shaped how your brain processes the world.
The goal isn’t just to match your symptoms to a label. It’s to understand why your brain developed these patterns in the first place, because that understanding shapes everything from medication choices to therapy approaches to predicting how you’ll respond to treatment.
Start Your Path to Healing with the Right Psychiatrist
At Able Psychiatry, we believe psychiatric diagnosis is less about categorization and more about comprehension. Instead of asking “What do you have?”, we focus on a root-cause approach that asks “How did your brain come to work this way?” The shift in perspective opens up more nuanced, effective, and ultimately more hopeful paths to healing. We would love to hear from you if you’re seeking psychiatric care in Chicago, IL.