What Is a Presenting Problem?

You may have heard your doctor (or a doctor on a TV show) refer to what are known as 'presenting problems.' As the name suggests, these are the initial symptoms that you have that lead you to seek help from a medical or mental health professional. 

Presenting problems can help doctors and therapists make a diagnosis, but they often don't tell the whole story. Because of this, your doctor will likely perform other assessments—such as giving a physical exam, running lab tests, and asking you questions about your symptoms—to get a clearer picture of what's happening with your health.

What Are Presenting Problems?

Presenting problems are the initial symptoms that cause a person to seek professional help from a doctor, therapist, or another mental health provider. While it's normal to experience ups 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.

Common Symptoms of Presenting Problems

There are several symptoms that might lead you to talk to your doctor or therapist. Such symptoms can range in terms of how severe they feel and how much they affect your life. Even if it seems like a symptom isn't 'serious' to you, it's worth mentioning to your doctor or therapist so they can get a better view of your overall health.

Examples of some common presenting problems include:

• 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

How Are Presenting Problems Diagnosed?

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 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 you provide 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.

What Causes Presenting Problems?

Once your doctor provides a diagnosis, you might wonder what exactly is causing the symptoms yo presented with. The fact is that there is no single factor that causes mental health problems. \

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

While you may never know the exact factors or combination of factors that led to the problem, understanding some of your risk factors can be important for developing a treatment plan. Your doctor or therapist may look at your medical history and ask you questions to better understand some of the potential causes that might be contributing to your presenting problems.

Types of Mental Health Conditions

There are a number of mental health conditions that can contribute to the presenting problems that lead people to seek help.

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 for Presenting Problems

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)
  

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 Xanax (alprazolam), Ativan (lorazepam,) and Klonopin (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 and 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 With Symptoms of Presenting Problems

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. Starting slowly, enlisting the help of a workout buddy, and engaging in activities you find enjoyable can help keep you motivated.
• 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.