Can Self-Diagnosis Be Legitimate?

Don’t I know myself best?

Yes- you do. And here’s where it gets tricky. While you may know yourself quite well and only you have access to your external experiences, sometimes it is challenging to have an objective viewpoint in terms of external behaviors and interpersonal relations, especially as it pertains to obscure and complication diagnoses with potential bias and subjectivity. That being said, there are many limitations and complications to formal diagnosis that the general public should be aware of.

Almost every “mental disorder” can have very different etiologies and thus very different presentations, sometimes co-occurs with more significant genetic/medical conditions, either congenital or acquired (TBI, epilepsy, ASD etc). Moreover, any disorders are described in behavioral terms but claims a neurobiological etiology. As such, there is significant overlap with brain structure/neurochemistry as other disorders. For example, let’s take ADHD, which can have significantly discrepant variables: extremely fast processing speed OR extremely slow processing speed, listlessness OR hyperactivity, high achieving OR low motivation, sluggish cognitive tempo OR flight of ideas, strong working-memory capacity OR limited working-memory capacity.

Many notable psychiatrists have written about or publicly stated that they no longer agree with the way many diagnoses are classified in the DSM-5. It was noted that for ADHD specifically, there were “loose boundaries of ADHD in DSM-4 and 5.” In fact, Per the research, low reliability between clinicians on ADHD and ASD diagnosis, low predictive validity as well as low specificity (commissions for those who are normal) as the DSM-5 has tendency to false positives with “arbitrary thresholds.” Many different professions diagnosing ADHD with little regulations or agreement. Brief assessments can be helpful and increase access but sometimes results in misdiagnosis. Additionally, some childhood-based disorders that are diagnosed later in life, such as “Adult ADHD” and “Adult ASD” often have many confounding factors to explain symptoms, subjective symptom reports.

Moreover, there are some barriers to traditional diagnosis including: long wait time for comprehensive evaluations, so many seek quicker less comprehensive option. Biased classification, both over- (white, high SES, complex history, seeking services) and under- (girls, BIPOC) diagnosis for different reasons as well as misdiagnosis (ASD, anxiety etc.). Girls are often less likely to be diagnosed with behavioral disorders, largely because of behavioral factors. People of color and those with financial challenges are more likely to be both under-diagnosed and misdiagnosed as well as less likely to be provided with services in educational settings.

Lack of material at easily digestible levels and in different languages. Diagnostic inflation because of insurance and desire for access to benefits. Some feel validation from labeling/diagnosis, some revel in “sick” identity. Many disorder over-diagnosed for secondary gain (services, validation, pressure from parents, financial gain, insurance, etc.), though some are diagnosed accurately that would have been missed, overlooked, or misdiagnosed in the past. Many people self-diagnosing or seeking new diagnosis secondary to tik tok or other social media platforms. The concern is that the information on social can be inaccurate or incomplete. One study- over half videos about ADHD show misleading info on TikTok. Often times easier to access information misinformation or biased information about ADHD (or funded by Pharma companies).

So all this to say, that it is certainly understand to have reservations about a formal diagnosis by a psychiatric professional. However, it is important to keep in mind that professionals do obtain credentials for a reason, and having education and clinical experience still holds significant value. Everyone is certainly entitled to label and characterize themselves and many seek validation and understanding through the communities they align themselves with. It is so important to be careful when consuming information on social media that you are aware of misinformation and social contagion, though there is also much helpful information and validation via specific communities. I think it’s important to understand why diagnosis is even of value to people. For some, a big part of it is to feel heard, validated, and empowered. Additionally, for a child especially, a formal diagnosis can be beneficial for services, validation etc. but can affect appropriate treatment, serve as excuse, adjust others or self expectations etc.