An Interpretative Phenomenological Analysis exploring how psychiatrists conceptualise conduct disorder and experience making the diagnosis

Abstract

The way professionals conceptualise CD likely impacts the identity of children given the diagnosis, yet how psychiatrists conceptualise CD, and experience making the diagnosis, is under-researched. Interpretative Phenomenological Analysis explored how psychiatrists conceptualise CD and experience making the diagnosis. Semi-structured interviews captured participants’ lived experiences and associated meanings. Four superordinate themes emerged: ‘Parents and professionals are overwhelmed by their struggles with CD’; ‘What is CD? Uncertainty regarding the cause, but clarity that it is a severe problem’; ‘CD as a controversial construct’; and ‘Whose issue is it anyway? Battles with blame and responsibility’. The emerging problem-saturated narrative is discussed. Clinical implications include increased training, reflective practice and using a formulation-based approach.

A mixed‐method systematic review of the perspectives of young people, carers and professionals on psychiatric diagnosis in childhood and adolescence

“…Some studies identified that when a YP has a formal psychiatric diagnosis, it is easier for their caregivers to explain the difficulties they're experiencing, and makes treatment planning less complex, with one study recognising that a diagnosis helped 'galvanise people into action' (Staniford & Lister, 2021, p.249) (Danielson et al, 2019;Kelly et al, 2018;Koehne et al, 2013;Papadopoullos et al, 2022). Staniford and Lister (2021) also identified that diagnosis can aid families in increasing the support of services already working with them, and Danielson et al (2019) identified that some professional participants believed it was appropriate to provide a clinically inaccurate diagnosis to a YP to support their access to services. Although some studies identified that diagnosis improved understanding of mental health difficulties, one study also found that this was hampered by a reluctance to accept the diagnosis (Viduani et al, 2022).…”

“…Avoidance of a diagnosis was discussed in five studies; three qualitative (Koehne et al, 2013;Papadopoullos et al, 2022;Staniford & Lister, 2021) Despite the confidence of psychiatrists in their role, discussions with wider professions place some doubt on that authority, often resulting in a 'powerful tension' within teams (Papadopoullos et al, 2022, p.5). This tension seems to be misunderstood by psychiatric colleagues who identify conflict as a 'sign of a healthy team' (Papadopoullos et al, 2022, p.5).…”

“…Whether a psychiatric diagnosis contributed to people's understanding and perception of themselves was discussed across five studies; four qualitative(O'Connor & McNicholas, 2020;Papadopoullos et al, 2022;Staniford & Lister, 2021;Viduani et al, 2022), and one mixed methods study(Brand-Gothelf et al, 2021).O'Connor and McNicholas (2020) reported that YP and caregivers often feel relieved due to their diagnosis. Some studies (O'Connor & McNicholas, 2020; Viduani et al, 2022) also found that being given a diagnosis supported other people in understanding the YP, 'Mum seemed to, all of a sudden seemed to have some sort of huge idea of what actually I'm going through…I was just used to her kind of not really understanding me' (O'Connor & McNicholas, 2020, p.17).…”

“…'(Papadopoullos et al, 2022, p.5), despite the consensus that diagnosis is valid in an adult population(Griffiths, 2011;O'Connor and McNicholas (2020) identified mistrust and annoyance following diagnosis, and when a diagnosis was changed, removed, or never given. Caregivers also discussed that the diagnostic label changed their parenting style, which subsequently failed them when that diagnosis was rescinded or altered (O'Connor & McNicholas, 2020).T A B L E 3 "It's not a death sentence, it's a diagnosis that has treatment and options"(Staniford & Lister (2021), p.248). Understanding of self 'I was at the same time happy that I finally knew what was going on…And you get that sort of a relief.'…”

“…had some input into decisions regarding diagnosis, although this was often informal and based on what professionals felt the families would want(Brand-Gothelf et al, 2021;Papadopoullos et al, 2022;Vickers et al, 2022) Brand-Gothelf et al (2021). andStaniford and Lister (2021) noted that professionals make assumptions about what family members want to know based on their clinical and personal experience, 'it's sometimes … it just someone needs to say it, and … I'm very happy to say it is that's relevant. And that feels um … helpful'(Staniford & Lister, 2021, p. 249).The argument regarding how having a psychiatric diagnosis can impact understanding of a YP's difficulty is complicated by the difference in sample sizes of the studies.…”