9. Describing Your Symptoms

When you say “I’m depressed,” you could mean many things. Maybe you’re having a bad day, but maybe you’re on the verge of attempting suicide.

Talking to your doctor or another provider about your mental health is not easy. Given that most doctor’s appointments are short, being able to proactively, concisely, and precisely describe your symptoms is challenging but critical. Don’t assume that when you use a word that your doctor will understand it the same way you do. Don’t count on them to ask further questions to clarify. As an active part of your healthcare team, it’s your responsibility to clearly communicate your symptoms.

Medicine has its own complex and specialized vocabulary. Ask anyone who has ever seen “SOB” written on their chart and felt offended (in medicine, it’s “shortness of breath”). You don’t need to learn to speak this foreign language. But you must keep in mind that what you say may not be heard the way it was intended. People often have trouble describing their mental health symptoms clearly. It’s time to fix that.

Organize Your Thoughts

You’re sitting across from a doctor who has just asked, “So, what brings you in today?” This is not the ideal time to start thinking about how to put your experiences and concerns into words.

Planning ahead greatly increases the likelihood that your doctor understands what’s going on and why it’s a problem. Writing down what you’re experiencing in your notebook is a useful approach. Journalling about your symptoms each day and later summarizing them can help clarify your mental health concerns. Try to put into words what you’re feeling, what’s changed over time, and how it’s affected your daily routine or the lives of those around you.

Speaking of which: your family, friends, and others close to you can be invaluable when trying to describe your symptoms. Often, they can articulate how you’re acting or what’s changed far better than you can. Ask them for feedback. They may identify patterns that you’re missing.

From all this input, briefly summarize your concerns. Write them down, even in point form. If there are several different issues, pick the ones most concerning you or affecting your daily life. That way, you’ll be prepared when asked, “So, what brings you in today?”

Terminology

There are hundreds of different mental health symptoms and many different ways to describe each one. We’re not going to list them all here.

The important thing is to communicate each one clearly. Ideally, your descriptions should be concise—perhaps a few sentences. A lengthy and convoluted story with an evolving plot, an inspiring character arc, and several exotic locations is not a concise way to explain a symptom. Your provider may ask you to tell the story to clarify something, but don’t open with it.

After listening to you describe your symptoms, your provider might say something like “Ok, that’s what we call ‘anhedonia.’” Great! If not, you might ask if there’s a term that describes what you’re experiencing. If they give you a word or phrase, fantastic! You now have some shared language. From then on, when either of you uses the word, you’ll know what the other means. Write it down.

Measuring Severity

Describing your symptoms precisely is important, e.g., “low mood” versus “lack of interest” versus “suicidal.” Describing the severity is equally important. A mild symptom may be barely worth mentioning, while a severe one must be addressed. You can describe severity in many ways, such as by labelling symptoms “mild,” “moderate,” or “severe” as we’ve done here.

Have you ever gone to the doctor with physical pain? They’ve likely asked you to rate your pain on a scale of 1 (barely there) to 10 (the worst pain you can imagine). That’s a useful way to describe the intensity of mental health symptoms, too. It’s also a convenient way to track them over time.

Another measure is frequency. How often does the symptom affect you? Say that you’re more tearful. Does this happen once or twice a week for five minutes at a time? Or is it for three hours every morning? If you’re anxious, is it all the time, in particular situations, or at certain times of the day?

Finally, you can describe the impact that your symptom is having. How much is it getting in the way of your life? What is your symptom preventing you from doing? Going to work? Being in crowds? Attending your kid’s soccer games? Leaving the house at all? Or, what are you doing that you usually wouldn’t? Be specific. “I might be spending a bit more money than usual,” is not as clear as, “I bought a boat yesterday” (assuming that is a major, unplanned expense).

Self-Rating Scales

Rating scales are a common tool used by mental health professionals. They ask you if you are having symptoms and how severe those symptoms are. Scales may come in the form of a paper questionnaire, or they may be completed via apps or on websites.

There are two types of rating scales. Clinician-rated scales are administered by a mental health professional. The professional asks you questions and writes down your answers. Usually, some interpretation is required on their part. In contrast, self-rated scales are designed so you fill them out yourself. Examples are the PHQ-9 (depression) and GAD-7 (anxiety), the latter of which is shown in Figure 1.

If you see your family doctor about your mental health, they may ask you to fill out one of these scales first. They use it to guide further questions or treatment options. While scales don’t by themselves provide a psychiatric diagnosis, many are based on the DSM-5 (or the previous DSM-IV) criteria for different disorders. They still need to be interpreted by someone trained in mental health. You can’t diagnose yourself through a questionnaire you found on the internet!

You can be proactive. You may be experiencing a variety of symptoms that suggest a particular disorder. You may have found and completed one of these self-rating scales for that disorder. Bring it with you the next time you see your doctor or other treatment provider.

You’ll find links to some of the most common, freely-available self-rating scales on our website (see Appendix A).