Down The Rabbit Hole of Self-Diagnosis in Mental Health
Written by Jessica A. Jaramillo, MS, LPC. Interim Crisis Coordinator and Clinical Supervisor at the Counseling CenterApr 10, 2023
As we often discuss in this blog, we must start by embracing the premise of a nuanced and complex reality. One that is rarely limited to a single absolute, but rather a collection of simultaneous truths influenced by context. Such will be the basis for the conversation to follow: What is happening with the exploding phenomenon of the “mental health self-diagnosis”? Is it helpful, dangerous, or both? Let’s dive in!
What does it actually mean to self-diagnose? In the simplest terms, it occurs when we assert that we have a mental health condition without confirmation from a mental health professional. With the rise of information-sharing platforms such as TikTok, this can be done through the anecdotal experiences of others that relates to our own, by looking up the symptomatology, or even by taking online assessments and quizzes. This type of casual diagnosis can even extend to those around us by automatically assuming certain labels on our peers, family members, partners, or co-workers based on the behaviors we observe. A common example is how many of us have heard someone conclude that their ex-partner is unequivocally, irrevocably, a narcissist. Or how more recently, every experience we’ve ever been through appears to be trauma.
As a mental health professional myself, the last thing I want is to get “stuck” in unhelpful beliefs or assumptions within our field. Instead, I hope to continuously grow with the ever-changing landscape in mental health. This means stepping outside of what I know to be true and asking myself, "Is there anything else we are missing?" as well as listening and acknowledging the diverging truths and experiences of people outside of my professional bubble. With that thought in mind, let’s analyze some of the potential benefits and risks of self-diagnosing.
Differential Diagnosis and Comorbidities
We’ll start by explaining this concept from the physical health standpoint. Who hasn’t had the WebMD “you’re deadly sick and you have 2.5 days left before you self-implode” experience? (If you haven’t, consider yourself lucky; 0/10 would not recommend). It can be a wild self-reinforcing rollercoaster of health anxiety with confirmation bias, only to find out you slept with the wrong pillow and you’re experiencing “the pains and aches of life" (as one doctor gently explained to me when I discovered that getting older comes with a certain amount of random and non-threatening “bodily malfunctions”).
One of the causes of this common adventure is that even a cluster of symptoms can be explained by a vast multitude of factors, and it can take years of training and continuous exposure to recognize and differentiate the presentation. This is not to say that your experience is any less valid or true; the symptoms are just as real. It is simply that the cause(s) may be different from what is initially assumed.
This brings us to one of the biggest disadvantages and limitations of self-diagnosis: it can fail to accurately assess for a differential diagnosis or comorbidities. In other words, the effective process of being able to rule out conditions that present very similarly or understand how overlapping conditions work and/or mimic others. I would go as far as asserting it is common for a diagnosis to come accompanied by others (since one thing can lead to another and so forth). For example, someone with a panic disorder that starts feeling hopeless about their quality of life can develop depression as well. A mental health professional must be able to discern, rule out similarities, and identify comorbidities that may further complicate the diagnosis (including all medical, social, environmental, cultural, and contextual factors); this is absolutely crucial to create an effective treatment plan and course of action.
These are some very common examples of things that can easily get misdiagnosed:
- Borderline personality disorder (BPD) and Bipolar: both can create impulsivity, risky behaviors, suicidal ideation, mood swings, and irritability.
- ADHD and BPD: despite being very different in nature, both can present with impulsivity, interpersonal difficulties, and emotional sensitivity.
- Schizoid Personality Disorder and Autism: both have significant overlaps in the social domain.
- Anxiety/Depression and almost everything else: A lot of the basic symptoms in both anxiety and depression overlap with other presentations, lack of energy, motivation, difficulty concentrating, high irritability, insomnia, eating fluctuations etc.
- Trauma vs everything else as well: Trauma seems to be a common label nowadays to describe an ever-growing list of symptoms and experiences.
It is also important to recognize that most of us will struggle with some, if not most, of these symptoms at some point in their lives (being impulsive, irritable, depressed, anxious, experiencing mood swings, lack of concentration, having low motivation, etc); but duration, frequency, intensity, the amount of co-occurring symptoms, and to what extent it impairs function are all pivotal factors when diagnosing. Mental health conditions are complex and often require specialized knowledge to be understood, and a self-diagnosis may lead us to overlook or misunderstand important aspects of the mental health experience.
For Most, It's A Relief to Know
Simply finding an explanation can be cathartic, and it can create access to communities that provide normalization, support, and validation. However, to obtain professional care (such as medication management) you’ll need an official diagnosis. The good news is is that by knowing where you stand, you can advocate for your care and needs, and back-up your conclusions with informed opinions.
Access to Mental Health Care and Professional Diagnosis
A very real issue to consider when discussing the pros and cons of self-diagnosis is recognizing that a significant part of the population, unfortunately, does not have access to mental health care, let alone the option to get professionally assessed. Without providing a medium for all people to receive care as needed, we can’t dismiss the validity of a self-diagnosis as the only tool to understand present struggles and seek solutions. If mental health care is inaccessible or unaffordable, self-diagnosis can be a necessary and valid option.
Overly Identifying with A Diagnosis
Social media often veers into the path of glamorization and/or justification. There is a very fine line between understanding something through an appealing lens versus the much more raw and unpleasant reality of what it looks like. Sometimes, a self-diagnosis does not lead to a path for self-improvement, but instead creates a safe and comfortable framework with which to justify all behaviors without a desire for change or accountability (and without a professional to challenge this, it can be easy to become stuck). At other times, we can misdiagnose ourselves due to the social discourse attached to a label at the moment. This can manifest as either avoiding or denying a diagnosis due to the shame/stigma attached to it, or on the flip side, making ourselves fit a description because it has been glamorized in certain ways or is more socially accepted. In short, overly identifying with a diagnosis can inadvertently engulf our whole sense of self, leave us stuck, lead us in the wrong direction with no effective solutions, or prompt no desire for change.
Anecdotal Information Vs Evidence-Based Criteria
Part of the problem with the current trend of self-diagnosis is that it is driven by anecdotal information. This automatically creates a snowball effect in the way a disorder is understood, making it incredibly broad with almost any behavior being a qualifier; accuracy, reliability and validity all suffer. Emerging research has observed this phenomenon on platforms like TikTok, noting that a large amount of anecdotal evidence in mental health is being used as a metric for self-diagnosis, making it almost inevitable to be belief we have multiple conditions. One analysis found that almost 83% of the mental health videos being shared are misleading, with most of them coming from individual experiences rather than verifiable sources. While this certainly increases awareness and destigmatization (very much needed), it can also be a double-edged sword by fueling and perpetuating big amounts of misinformation.
Mental Health Professionals Who Just Don’t Get It
It happens. As in any other field involving humans, we make mistakes, fall victims to biases, misconceptions, lack of knowledge and expertise in certain areas, and burn-out. Striving to be a good therapist requires us to constantly work on ourselves, both personally and professionally, and to recognize our own limitations. However, as with everything, it is not a perfect system. Some mental health professionals may be lacking in continuous education, be unaware of some of their biases coming into play, or even miss things due to burn-out. This can lead to people feeling dismissed or invalidated in their assessments, reporting they disagree with the diagnoses provided by their psychologist/psychiatrist or feel like the experiences they shared were not heard or taken seriously. Our work as mental health professionals is to ensure we recognize the client as the expert in their own lives, since no one knows you better than yourself. In this sense, finding your own way to a diagnosis that feels accurate can be incredibly validating and liberating; and as mentioned before, a powerful tool to advocate for yourself in the future and help guide your treatment in the direction it needs.
Criticisms on the Diagnostic and Statistical Manual of Mental Disorders (DSM)
The DSM, our ultimate guiding resource, is both loved and hated depending on who you ask. It is is the leading book in diagnostic criteria created by the American Psychiatric Association for mental health professionals. Nevertheless, it is not free of criticism, and while it is true that it consistently undergoes revisions to update itself with the latest research, disagreements persist in terms of how it classifies things. This means that sometimes criteria for a disorder may feel too broad or too narrow, some may argue it doesn’t fully account for social and cultural biases and explanations, or that it is missing the input and voices of people with those lived experiences, etc. Therefore, it is fair to say that even diagnostic criteria within the field is an ongoing, ever-evolving concept, not to be perceived in black-and-white terms (absolutely wrong or absolutely right), but more so acknowledging that a diagnosis can be nuanced, and the criteria for it can potentially change as we learn more about mental health.
Factoring in Cultural Differences
Finally, cultural differences warrant a separate category when it comes to diagnosing. As mentioned earlier, social, environmental, and even medical factors are all crucial for an accurate evaluation, but among these, cultural differences stand out for their intricate interplay. A self-diagnosis may overlook this nuance, as it often relies on a generalized and simplified understanding of the issue. Cultural factors play a significant role in how mental health symptoms are both expressed and perceived. For example:
- Stigmas related to mental health can influence the way we understand our own symptoms.
- Cultural expressions of distress vary drastically; some cultures manifest more somatic symptoms, presenting physical manifestations of psychological distress. A mental health professional should be able to account for these differences when diagnosing.
- Social support expresses differently depending on whether a culture is individualistic or collectivistic, valuing different social dynamics. This can impact social dynamics and limits, the perception of personal responsibility, and the impact our behavior has on our community, family, and friends- all factors that affect our presentation.
- Current psychology is still predominantly influenced by Western views and beliefs, which can create a diagnostic bias.
- Cultural beliefs about the causes of behaviors can influence an individual’s understanding and interpretation of their symptoms.
In conclusion, mental health is complex, diagnosing is complex. Beginning the process of understanding and identifying our struggles can be empowering, normalizing, and sometimes necessary when no other options are available. If access to mental health care is a possibility, always seek a professional opinion to support your understanding of yourself and help you determine the causes. Moreover, a self-diagnosis will not give you access to treatment, as it needs to be confirmed by a professional, but it can help you get started. A good diagnosis is a collaborative process, with expertise and lived experience meeting in the middle. Find a professional who makes you feel heard, understood, and validated, and be open to alternative explanations! Don’t become fixated on a single cause—as appealing as it may be sometimes—since most things tend to be multifactorial. Mental health, like any other science, continues to grow and change as we expand our understanding of it. This means that even our current diagnostic criteria gets continuously revised to account for emerging research, so what is true now may not be tomorrow.
Lastly, remember mental health is a journey, and finding the right answers and appropriate support can make a significant difference in your overall wellbeing.