What Is a Presenting Problem?

What Is a Presenting Problem?

A presenting problem is an initial symptom that causes a person to seek professional help from a doctor, therapist, or another mental health provider. While it's normal to experience up and downs in your mental health, you may find that you need additional support for a particular symptom or set of symptoms. This concern is the presenting problem you'll share with your healthcare provider.

To a patient, the presenting problem is the reason you're seeking professional help. To your healthcare provider, the presenting problem is one initial piece of information they will use for evaluation. As such, the presenting problem is often a key section of an intake and inquiry form mental health professionals write up and save as part of your medical record.

When discussing your primary concerns with your therapist during the initial patient interview, you will explain your symptoms and your healthcare provider will further assess you to make a diagnosis.

Symptoms

Some of the mental health-related symptoms that might lead to a person to seek help from a doctor or therapist may include, but are not limited to:

• Anxiety
• Depression
• Mood changes
• Trouble falling or staying asleep
• Mood swings
• Social withdrawal
• Changes in eating habits
• Feelings of anger
• Negative thoughts 
• Confused thinking
• Irritability
• Loss of interest
• Fatigue or low energy
• Difficulty concentrating
• Delusions
• Hallucinations
• Substance use
• Stress
• Trouble coping
• Feelings of fear
• Poor grades
• Poor work performance
• Excess worry
• Thoughts of suicide or self-harm

Diagnosis

Before you make an appointment to seek your doctor or therapist, you might already have an idea of what your symptoms might mean. While your self-diagnosis might provide some clues, it is up to your provider to evaluate your symptoms and determine what might be causing them.

Your self-described presenting problem—what motivated you to seek help—can provide valuable insight for your provider, but it alone does not lead to a diagnosis. Your provider will use the presenting problem as a jumping-off point for digging deeper into your experience and your symptoms.

• In order to come to a correct diagnosis, your provider will need additional information provided by you in the form of spoken answers, written explanations, and/or medical tests.
• A physical exam, lab tests, and medical history may also be used to help rule out any underlying medical conditions that might be contributing to your symptoms.

Causes

There is no single factor that causes mental health problems. The underlying causes of mental health presenting problems often depend on the nature of the problem itself. Some of the potential causes include:

• Situational factors like stress or trauma
• Past experiences including abuse, trauma, or neglect
• Coping abilities and stress management skills
• Biological factors such as genetics and brain chemistry
• Family history
• Medical conditions
• Substance use
• Environmental factors such as poor nutrition or exposure to toxins
• Lack of social support or poor quality social connections

Types

There are a number of mental health conditions that can contribute to the presenting problems that lead people to seek help. Doctors and therapists often use criteria established by the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) published by the American Psychiatric Association (APA) to diagnose different mental conditions.

Some types of mental conditions that might cause symptoms:

• Neurodevelopmental disorders
• Bipolar and related disorders
• Anxiety disorders
• Trauma and stressor-related disorders
• Dissociative disorders
• Somatic symptom and related disorders
• Feeding and eating disorders
• Sleep-wake disorders
• Disruptive, impulse-control, and conduct disorders
• Depressive disorders
• Substance-related and addictive disorders
• Neurocognitive disorders
• Schizophrenia spectrum and other psychotic disorders
• Obsessive-compulsive and related disorders
• Personality disorders

The DSM-5 also outlines features that can be used to gauge the severity of the symptoms, although each of these varies by condition. These features may include the number of symptoms, the level of distress, or the degree of impairment that the symptoms cause.

Treatment

While the presenting problem that leads you to seek help from a professional may be one symptom of a broader underlying diagnosis, it is often the point of distress that is most worrisome or disruptive for you at the time. Often, the presenting problem has a major impact on your life. It can affect your ability to function at work, school, and relationships. In many cases, it may interfere with day-to-day tasks and make self-care difficult.

Your main symptoms may also have a ripple effect that contributes to other problems as well. For example, problems with sleep can lead to changes in mood, fatigue, irritability, and increased stress.

Psychotherapy

There are many different psychotherapeutic approaches used to treat mental health conditions. Some of these options include:

• Cognitive behavioral therapy (CBT)
• Dialectical behavioral therapy (DBT)
• Psychodynamic therapy
• Exposure therapy
• Interpersonal therapy
• Eye movement desensitization and reprocessing therapy (EMDR)

Some forms of treatment may be more appropriate for certain conditions. For example, specific phobias are often treated with exposure therapies. PTSD, on the other hand, may respond well to EMDR therapy. Talk to your doctor or therapist about which option might be best for your situation.

Medication

Your doctor may opt to prescribe a medication to address your symptoms, either on its own or in conjunction with psychotherapy. Some of the mental health medications that may be used to treat your presenting problem include:

• Antidepressants: These include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and atypical antidepressants.
• Anti-anxiety medications: These include benzodiazepines such as alprazolam, lorazepam, and clonazepam.
• Stimulants: These medications may be used to treat conditions such as ADHD and are designed to increase alertness and attention.
• Antipsychotics: These medications are used to treat symptoms of psychosis such as delusions and hallucinations as well as in certain mood disorders.
• Mood stabilizers: These medications, such as lithium, are used to treat mood swings associated with conditions such as bipolar disorder.

Coping

In addition to seeing professional treatment for your symptoms, there are also things you can do to cope with what you are experiencing. Some strategies that may help with different presenting problems include:

• Stress management: Practicing stress relief techniques such as mindfulness, visualization, deep breathing, and progressive muscle relaxation.
• Exercise: Regular physical exercise is linked to better mental health. This can be a challenge, however, if your primary symptom is fatigue, low energy, depression, or if you have a physical limitation.
• Social support: Social connections are linked to better mental health. Reaching out to friends and family for support may help you better cope with the symptoms of your condition.