Beyond the Boxes: Why Your Mental Health Is More Than a DSM Code

Friday, August 8, 2025. This is for Andrew Rozsa

Someday, the Diagnostic and Statistical Manual of Mental Disorders will sit in a museum, next to a rotary phone and a butter churn. The plaque will read: “Once believed to capture the human mind in tidy categories.”

Until then, we play along. Insurance companies demand DSM-5 categories. Schools want a formal mental health diagnosis before offering help. The mental health system—like any bureaucracy—loves nice and easy paperwork.

But human beings nevah evah do anything nice and easy…

The DSM: The Map, Not the Territory

The DSM was created to bring order to mental health—a way for clinicians in New York and Nebraska to speak the same language. But those categories are the result of committees, politics, and compromises, not divine revelation. It’s not a law of nature; it’s a filing cabinet.

Life doesn’t file well.

The DSM’s categories—Major Depressive Disorder, ADHD, Borderline Personality Disorder—are blunt tools. They tell you, “You have it” or “You don’t.” They rarely tell you why you think the way you do, or what might actually help.

Talking in Systems, Not Labels

When you sit down in my office, I’m not counting symptoms to see if you hit a magic number. I’m looking at emotional regulation: how you handle frustration, loss, and uncertainty.

Take Erin, a 39-year-old parent who came in convinced she had “failed” every treatment for anxiety.

She didn’t fit the checklist for generalized anxiety disorder.

But she couldn’t sleep, her heart raced in crowds, and her thoughts spiraled at the slightest change in plans. The real issue wasn’t whether she met DSM criteria—it was that her nervous system had been on high alert since childhood. Once we treated that, things began to shift.

I want to know about your executive functioning: how you plan, follow through, and recover when the plan falls apart.

Mark, a software engineer, thought he might have ADHD because he couldn’t stay on task.

He didn’t “qualify” for the diagnosis, but the problem was still real—burnout, perfectionism, and chronic sleep debt had been quietly dismantling his focus. Addressing those was more useful than chasing a label.

I want to hear about cognitive dysregulation—the brain fog, the static, the mental gusts that scatter your thoughts. I care about reality testing: how you decide whether your mind’s story is the truth or just a rerun from your past.

If your behavior disrupts your relationships, I’m not assuming “oppositional” or “defiant.”

I’m wondering about stress, sensory overload, attachment injuries, or a nervous system locked in fight-or-flight.

If trauma is driving the engine, we’ll use trauma-informed care. Not because a code says so—because that’s what works.

Sidebar: The DSM in a Neurodiverse World

The DSM is built on a categorical model: you have it or you don’t. But neuroscience is shifting toward a dimensional model:

• How often does this happen?

• How severe is it?

• What triggers it?

• How does it interact with other traits?

In a neurodiverse world, this really matters.

Because you can have ADHD traits, anxiety symptoms, and sensory differences without qualifying for a single DSM label. Under the categorical model, you might fall through the cracks. Under a dimensional approach, you still get seen—and treated.

The DSM isn’t useless. It’s just an old map. Modern mental health treatment needs something kinda like a GPS.

Why This Matters for Real Folks

If you’ve been told you “don’t meet criteria” while barely holding it together, you already know: the DSM is binary. Life is not.

People don’t come to therapy for a code.

They come because they can’t sleep. Because their marriage is splintering. Because their kid won’t talk to them.

They come for a life that works—not for an entry in a manual.

So yes, I’ll keep filling in DSM codes when the system insists at my role in public health.

But in my private practice, the real work happens in conversation, not classification. Healing comes from understanding the shape of your life, how your brain works, and how your history still hums in your nervous system.

That’s not a category. That’s a relationship.

And relationships will always matter more than the box you’ve been checked into.

Be Well, Stay Kind, and Godspeed.