The Problem with Self-Diagnosis

I talk with people all the time about mental health diagnoses, mostly because it’s my job. Most people who make use of community mental health agencies have absolutely no idea what constitutes a proper diagnosis, but that doesn’t stop them from being experts in the field. I blame the Internet.

Just like anything else, information can be abused. Websites like WebMD and
PsychCentral and that one run by the Mayo Clinic certainly have their place, but people really need to stop using Google to diagnose themselves with severe and pervasive psychiatric disorders. Google didn’t go to grad school. Google doesn’t have a professional license. Google doesn’t answer to clinical supervisors, or ethics boards, nor does it take a nuanced and contextual approach to symptomatology. It just kinda spits out data based on algorithms and ad revenue.

Google, in this regard, cannot be trusted.

I also blame professionals who ought to know better. ER doctors are some of the worst offenders. Contrary to popular opinion, just because you have an M.D. behind your name does not make you an expert in psychiatry. If you’re a psychiatrist, that’s another story. But an internist or a trauma surgeon or a resident — sorry, no. Not without requisite training.

I used to work at an opiate treatment facility. I did comprehensive clinical assessments, and part of my job was to get a complete bio-psycho-social history. One interaction with a woman in her mid-20’s stays with me. At the conclusion of a 5 day meth-binge, she was admitted to the local ER, because 5 days without sleep kills most humans, and she was, to use her words, “acting like a god damned psycho.” So the ER doc diagnosed her with Bipolar Disorder and wrote her a script for Depakote (a mood stabilizer) and sent her on her way.

The first thing you’re supposed to do before making a mental health diagnosis is eliminate any medical conditions that could be the real culprit. By any objective measure, five days with no sleep, plus IV methamphetamine use, constitutes a significant medical condition. Totally inappropriate to diagnose someone with Bipolar Disorder in that context, but it didn’t stop that doctor.

This was not an isolated event. Over a two-year period, I kept a running tab of similar situations. My findings were disconcerting — this nonsense happens with frightening regularity. I estimate that 60% of my clients who reported a diagnosis of bipolar had received said diagnosis when they were blitzed. The other 40%? Well, some just assumed they had it, because someone else in their family did. Some were told they had it by family members and friends. Most couldn’t remember the origin of the diagnosis. The majority had never actually taken a mood stabilizer, because most of these folks are poor, and medications are expensive.

According to the National Institute of Mental Health, Bipolar Disorder affects about 2.6% of the adult population of the United States. By way of comparison, Major Depression affects 6.7% and PTSD 3.5%. There is absolutely a correlation between substance use disorders and mental illness, so I have no doubt that many of these clients honest-to-God were suffering from that affliction. But the sheer volume of bipolar diagnoses just blew my mind.

And what about the clients who weren’t bipolar, but were told they were? What purpose does it serve for a person to believe, falsely, that they suffer from a serious mental illness? How do you suppose that affects their self-esteem or their own sense of self-worth? To what degree might that belief contribute to their substance use? To put it another way — if someone incorrectly believed they had leukemia, how might that affect their quality of life? Would they even have any?

My point is two-fold. First, it’s a bad idea to self-diagnose. It’s fine if research prompts you to see a professional, but diagnosis is more than a catalogue of symptoms. You won’t find auditory hallucinations or paranoid ideation on any list of criteria associated with PTSD, but the DSM-5 specifically cites them as associated features.

These are the actual criteria for PTSD. Note that paranoid ideation and hallucinations aren’t listed:

ptsd

My second point is that diagnosing people is really hard. Even doctors and other healthcare professionals screw it up. If you don’t have the proper training and experience, why on Earth would you do it? I get that people are curious, but mental illness is not an amateur hobby.

One of the big reasons why diagnosis is hard is that all mental disorders exist on a spectrum. Think of a rainbow, and all the colors and shades you might see. That’s a spectrum. So, too, is the way mental disorders can present.

In recent years, mental health professionals have started using the term “spectrum” to describe the presentation of mental disorders, because all of them can manifest in myriad ways. Depression, for example, is not a finite construct. An obvious symptom is depressed mood, but for many the chief feature is anger, difficulty concentrating, or irritability. Some people lose weight when they’re depressed. Others gain weight. Some struggle with suicidal ideation and feelings of hopelessness. Others deal with insomnia. Frequency, duration, and intensity are factors to consider as well.

Context is important, too. If your dog just died and you find yourself crying,that is NOT clinical depression. If a bear busts through your tent and starts mauling you, the fear that grabs your heart is NOT Panic Disorder. Nervousness before an important job interview does not constitute Generalized Anxiety Disorder. One instance of fasting does not constitute anorexia.

And the difference between post-traumatic stress and Post-Traumatic Stress Disorder can be the difference between a pothole and the Grand Canyon. Disorders, by definition, cause impairment in your life, be it cognitive, social, emotional, or occupational. If you are in a car accident and you think twice about driving for a few days, that’s post-traumatic stress. If you find yourself having flashbacks, avoiding cars and struggling with intrusive thoughts about car crashes to the point where it’s impaired your ability to function, that’s a lot closer to actual PTSD.

While the DSM-5 provides a checklist of criteria, it is important to note that people are more than the sum of their symptoms. So much more can and should be part of a mental health diagnosis, which is why I plead with my clients to never self-diagnose. If it was that easy, anyone could do this job.

But it’s not about professional pride. It’s about your well-being. It’s about your safety. It’s about your life. Mental illness is a complicated and serious matter. If you really want answers, seek a professional evaluation. Use Google for celebrity gossip and movie spoilers. Your life will never, ever be the results of a search filter.

Randy Withers, MA, NCC, LPCA, LCAS

Randy Withers, MA, NCC, LPCA, LCAS

I'm a dually-licensed in Mental Health and Substance Abuse Counselor, specializing in Co-Occurring Disorders.
Randy Withers, MA, NCC, LPCA, LCAS

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