The Problem with Self-Diagnosis and Labeling Others with a Mental Health Condition
This recent trend can affect how you view yourself…and how you view others
Self-diagnosis and a casual attitude toward diagnosing others pervade our culture. Social media influencers challenge “experts” and conventional wisdom about mental health diagnoses and confer misinformation. Pop stars and politicians are diagnosed from afar. Struggling teens self-identify with a mental health label of their choosing. Diagnostic labels are lobbed toward others in conversation: condescending, angry, or at best, pitying.
“Formerly, social stigma and personal shame clipped the wings of many who wanted to discuss their mental health experiences,” writes psychiatrist and Wise & Well contributor, John Kruse, MD “Now people flock to the internet to share stories of living with mental health conditions.”
In my daily life and in my work as a practicing psychologist, I see how diagnostic terms are often used incorrectly in conversation. Moodiness is sometimes characterized as “bipolar.” Forgetfulness or a messy desk (and even low self-esteem) are attributed to ADHD (Attention Deficit Hyperactivity Disorder). A propensity toward neatness and organization is labeled as OCD (Obsessive-Compulsive Disorder). Accurate diagnoses convey specific information about symptoms and suffering; using these terms incorrectly can obscure or minimize another person’s (or your own) struggles.
Complicating matters even further, some who self-identify as neurodivergent eschew mental health professionals or researchers who might label their neurodivergence (a term used to describe cognitive functioning that differs from the norm) with a diagnosis. People with suspected neurodivergence sometimes adopt the label as part of their identity and bristle if anyone questions their self-diagnosis. Debates are battled online about whether someone is autistic or has autism, and whether self-diagnosis is even more valid than a clinical assessment by a professional. There’s a lot to sort out below, but first…
Why are labels and self-diagnoses so often embraced?
Labels often feel good; they provide a feeling of security and make meaning out of what is messy and confusing. Labels create a sense of identity and a connection to what we value most. We are members of families and nationalities and cultures, and may develop a fierce allegiance to political parties, local sports teams, or religious doctrine.
When we encounter troubling behaviors in others (or struggle with our own distress or differences), it can be comforting to summarize symptoms and wrap observations up into a neat package. Many of us are drawn to scientifically validated and even just plain fun categorizations that make meaning out of chaos. The popularity of astrology, personality typing systems (such as the Enneagram or the Myers Briggs Inventory), online personality quizzes, and even some questionable tests used for job-applicant screening all attest to the widespread interest in labeling and diagnosis.
When we identify with certain personality descriptions, we feel part of a group — and can then readily explain how we differ from others.
While labels offer reassurance, clarity, and camaraderie with like-minded peers, they also create division and separate you from others. Labeling, lay diagnoses, or even a strong identification with what you value most can lead to conflict and a rush to judgment; a person’s intentions are overlooked and the label or diagnosis obscures their sense of self.
How diagnoses help… or hurt
Struggling with complex emotions or distressing behaviors can lead to a quest for a tangible explanation — something that describes and summarizes what is most troubling. As a clinical psychologist, I understand the benefits of an accurate diagnosis. Clients are often relieved when they learn there is a label that characterizes their experience. Psychology researchers Neil Craddock and Laurence Mynors-Wallis describe some of the benefits of mental health diagnoses:
“A diagnosis provides reassurance that their situation is not unique, mysterious or inexplicable and that there is a body of knowledge and experience that can be brought to bear in providing help… Diagnosis can help an individual make sense of being different or of not functioning like most others and challenges the feelings of shame, loneliness and low self-esteem that may otherwise occur.”
Accurate mental health diagnoses also provide a language that helps professionals quickly summarize and communicate complex information. Many people do not realize the extensive training and experience needed to grasp the nuance and depth of meaning inherent in any diagnosis. When properly used, diagnoses can inform treatment approaches, guide prescribing physicians in decisions about medications (if needed), and support access to disability accommodations at school or work.
When diagnostic labeling becomes a problem
Unfortunately, the careless use of diagnostic terms in the media and routine conversation can lead to labeling others based on conjecture and unfounded assumptions. It also opens the door for self-diagnosis. Sometimes you might be right. But other times, you will get it wrong. Certain elements of diagnoses or symptoms can be overinflated, ignored, or seen without understanding the context for their relative significance. As Kruse pointed out, the terminology we use affects identity and society’s perceptions of others. “In a world where the internet seems to encourage divisions and tribalism, words can hurt,” he wrote.
A recent example includes the trend toward self-diagnosing or labeling others with a diagnosis of autism spectrum disorder (ASD). People who are quirky, uncomfortable in social situations, or highly focused on their work may be quickly labeled as autistic. In some cases, the assumption may be correct; however, those symptoms alone are not sufficient to warrant this label.
A diagnosis of ASD requires careful consideration of historical information as well as present-day functioning, and the clinical skills to differentiate some of the hallmark features of autism from other factors. Despite the use of screening questionnaires, findings must be considered within a broader context by a skilled clinician. For example, difficulties in social relationships could stem from a range of conditions: social anxiety, developmental delays, and intellectual abilities well above the norm… or could be a consequence of life as neurodivergent where rejection from peers occurs regularly. Basing a self-diagnosis on a list of possible symptoms or popular online questionnaires misses these distinctions. In fact, as psychiatry professor and researcher, Eric Fombonn has cautioned:
“Attributing [social] impairment specifically to ASD symptoms in the context of comorbid [co-existing] presentations requires clinical acumen in autism, in general psychopathology, and experience in the differential diagnosis.”
Neurodiversity implies that some people think differently than the norm; they process information, respond to social situations, and experience sensory input differently, and feel like outliers in a world not quite built for them. Feeling misunderstood and so different from others causes understandable distress, and some of the presumably diagnosable conditions clinicians might see in their offices (e.g., depression, social anxiety) might stem directly from a client’s troubling encounters with the world at large. A missed diagnosis of autism is troubling; however, a rush to label has consequences, as well. As Fombonne has pointed out: “…carrying an ASD diagnosis may unduly constrain one individual’s range of social and educational experiences and have long-lasting effects on his/her/their identity formation.”
As a clinician, I see this in my niche specialty of giftedness (identified by an IQ at least two standard deviations above the norm), where gifted children and adults experience the world quite differently. Many struggle with “asynchronous development,” where their emotional maturity lags behind their intellectual strengths. Many feel misunderstood, are bored in school, and have difficulty finding like-minded peers. Like everyone else, though, gifted folks possess a range of strengths and challenges. Giftedness is not a diagnosis; it is a conceptualization that describes an individual’s level of cognitive functioning and is identified through a careful assessment. Yet, I am often approached by parents of gifted children who worry that their child might be “on the spectrum” because they exhibit social anxiety and quirky interests –- when other factors (such as anxiety or asynchrony) might better explain their child’s differences.
When the experts get it wrong
Mental health diagnoses are serious business. They should not be taken lightly, tossed about casually, and presumed to be easily understood. In the U.S., psychiatrists, licensed psychologists and other licensed mental health and medical practitioners are the only professionals legally permitted to diagnose a mental health disorder — and only if the condition in question is within their area of expertise. Training, experience, and an appreciation of the complexity and nuance inherent in human nature are essential. Otherwise, misdiagnoses, missed diagnoses, and misinformation abound.
Unfortunately, even the “experts” can get it wrong,
Labels can minimize, devalue, and inaccurately pigeonhole people, and they can cause immeasurable harm — especially when delivered by an authority figure. Most people have endured situations where they have been mislabeled or misdiagnosed by a physician, mental health practitioner, or educator — and treated accordingly.
Years ago, emotionally expressive women were frequently labeled as “histrionic.” Autism was blamed on “refrigerator mothers,” whose distress about their child’s behavior was misinterpreted as a lack of warmth, which was then presumed as causative. Energetic and non-conforming students were viewed by their teachers as “oppositional/defiant,” rather than just plain bored.
Once a label or a diagnosis is planted in a patient’s or student’s or parent’s mind, it can be devastating, even if it is eventually discounted. Diagnoses remain in a patient’s medical record, and sometimes, as a result, applications for health, life, or disability insurance are denied. Labels can follow a student throughout school, passed from teacher to teacher, affecting their expectations of said child. Even when medical or mental health symptoms or learning problems are accurately diagnosed by a trained professional, there are sensitive and useful methods for conveying that information. Many folks still reel from memories of harsh, condescending (and sometimes untrue) words spoken with impatience by an authority figure.
While traditional diagnostic formulations often rely on the DSM (the Diagnositic and Statistical Manual of Mental Disorders used by psychiatrists and other mental health professionals), the DSM has a long history of growing pains and outright mistakes. Despite improvements in each of its revisions, the most recent version still has some glaring limitations. For example, the DSM criteria for a diagnosis of ADHD is more fitting for children and not readily applicable to the signs of ADHD in adults, says psychologist, author, and ADHD expert, Russell Barkley. In fact, most seasoned therapists use discretion with diagnoses, consider diagnosis in light of their clinical experience, and view each person as unique. People are not their diagnoses.
We all make mistakes. At best, though, conscientious physicians, psychiatrists, psychologists, and teachers continue to learn, train, and question their assumptions. I know a lot more now than I did 40 years ago. And I am fairly clear about how much I still don’t know. A commitment to learning and growth as a professional is not only best practice, but it supports those in the helping professions to embrace the work they do.
How to make sense of a mental health diagnosis
If you or your child receive a diagnosis or label that seems misguided, ask the professional offering this label more about it and consider looking for a second opinion. If you believe that a diagnosis was overlooked, seek additional advice as well. Seeking guidance from others you trust can help to clarify or dispel your concerns. Ideally, the professional you work with has extensive training and experience with the condition in question.
Before you rush to self-diagnose or diagnose others from afar, pay attention to the validity, utility, and overall benefit of the label. Is it true? Is it based on data or conjecture? Is it necessary? Is it helpful? Does it provide clarity and greater understanding or does it distance you from other people, creating stereotypes and dissonance in your relationships? Personal struggles warrant guidance and support; however, using diagnoses incorrectly obscures individuality and can lead to false assumptions, worries, and divisiveness.
Even when a diagnosis is accurate, it is essential to recognize the whole person, including all of their strengths, interests, abilities, and what makes them unique. No adult or child is their diagnosis.