We’ve all been there. We feel distressed, burdened by too many symptoms, and turn to Google with the hope of learning our ailment. We know “don’t go on WebMD” but do it anyway, and soon enough our somewhat mild anxiety spirals downward into the worst-case scenario; that catastrophic condition. We attribute a headache to an aneurysm, a persistent cough to lung cancer, or chest pain to a heart attack. Sometimes this investigative work is a good idea -- it may be that there is in fact a serious medical problem, and now that you are aware you are seeking immediate medical attention. There are times, too, where researching mental disorders can be beneficial as well if it warrants the desire to get a professional diagnosis, thus allowing for treatment.
However, as the mental health crisis among American youth intensifies, more are utilizing the internet for information rather than turning to trusted people in the past, such as health teachers. They are seeking out answers on social media platforms, particularly TikTok, to self-diagnosis with severe mental health problems. The video-makers may have no training or education in psychopathology, and even if they do, the viewers may not understand the subtle differences that come with formal diagnosis.
Social media-based psycho-education
Until somewhat recently, I was overall in favor of social media-based psychoeducation. And even now, I still do think this platform for psychoeducation has its purposes… but when done right. There are some clinicians who pioneered it, such as Kati Morton, LMFT, a well-recognized therapist on YouTube who has made dozens of relevant, accurate, well-researched videos on everything from coping skills to bereavement, generalized anxiety disorder to schizoid personality disorder. You name it, Kati has a video. And with over 15 years of impressive clinical experience, she knows her stuff!
But times have changed. Suddenly, the clinicians like Kati are not getting the ratings they once did. No longer considered viral, their approach to psychoeducation is now considered dry, boring, and just too long. Some youth do not want to watch 15 minutes of a clinician explaining every symptom of a disorder in the DSM-5 and getting into the nuances. They would prefer to see borderline personality disorder or schizophrenia explained by anyone – anyone – in a mere 15 to 30 seconds.
Concerns As I See Them...
One of the greatest concerns is when questioning who is explaining these diagnoses to youth. Often it is a person with a casual interest in psychopathology who bought a copy of the DSM-5 (Diagnostic and Statistical Manual, the bible of psychiatric diagnoses) and read through it. The problem is that the DSM-5 was never meant to be used as the one and only source of information on mental disorders, but only as a reference for clinicians. It is much like holding onto a textbook from a college biology class – sure, the text will provide reliable, accurate information, but it is not meant to be considered the only source for knowledge. Much like it would be wrong to call oneself a biologist for having read one book on the subject, so too is it wrong to act like a clinician for reading the DSM-5.
Diagnosis is an artform as much as it is a science. It is taught through knowledge, then refined through experience and keen observation. Like it takes a pianist years of practicing the piano rather than only reading music theory, it is the same as a clinician. Practice is paramount.
You may be thinking, “I get what you’re trying to say, but surely, it’s not that big of a deal, right? I mean, it’s not like psychotherapists are diagnosing something like cancer. And it doesn’t seem like therapists really know all that much.”
In short, it takes a long time to be considered a mental health professional. The process varies by the profession itself, but for the purpose of this writing, let us examine the journey from a social work student up to a licensed clinical social worker (LCSW).
So you think someone on TikTok knows more than a licensed professional? Consider the following…
To be recognized as a licensed clinical social worker (LCSW) in New York State, which allows a person to diagnose, assess, and treat a mental disorder, one must have completed the following in this order:
1) Have an education that includes a master’s degree in social work (MSW), not a similar degree, with at least 12 semester hours of clinical coursework acceptable to the New York State Education Department (NYSED). The MSW must from a school accredited by the Council on Social Work Education (CSWE).
2) Next, pass a standardized, costly exam to become a licensed master social worker (LMSW). **A LMSW is unable to diagnose or treat a mental disorder unless under direct supervision.
3) After, accumulate at least 3 years of post-MSW supervised experience in psychotherapy, diagnosis and assessment-based treatment planning acceptable to the NYSED. This supervisor must be the person’s employer (no “outside” supervisors), and the supervisor must be a LCSW, psychologist, or psychiatrist. The 3 years is considered 2,000 hours, but the person must still wait 3 years even if they gain the 2,000 hours first.
4) Complete additional trainings, such as the identification and reporting of child abuse.
5) Take the clinical social worker exam, another expensive standardized test.
6) After becoming a LCSW, the person must then complete 36 hours of acceptable formal continuing education during every 3-year registration period.
In other words, being able to truly comprehend the DSM-5 from reading up to practice is a long, lengthy journey!
Knowing this now, can you see why clinicians raise their eyebrows when a 16-year-old on TikTok is providing psychoeducation and self-diagnosing themselves?
Self-Diagnosis can be beneficial… Sometimes
As a clinician, I have witnessed an uptick in adolescents and young adults who have fallen into the self-diagnosis trap. This can be a good thing -- the newfound information can direct them toward getting professional help.
Additionally, turning to TikTok and social media in general can be psychologically positive for youth because it can remind them that they are not alone in their struggles. It can validate their experience by putting a label to it.
Self-Diagnosis can be harmful
Even though there can be benefits to self-diagnosis, it is a slippery slope. It may cause people to incorrectly diagnose themselves, which in turn can make them avoid a professional assessment and turn to the wrong treatments.
I can attest that during some intakes, clients have told me they terminated with their previous therapist and psychiatrist because they were in very strong disagreement with the diagnosis. (There is the occasional case where a diagnosis can in fact be wrong since unlike medicine, behavioral health is based on observation, not something black-and-white such as an MRI or bloodwork.)
TikTok and social media can provide false information since they do not tend to consider the subtleties of diagnosis and assessment. As I previously said, the time limits only allow for the symptoms to be bullet-listed at best. Yet even still, another alarming reason for the argument against self-diagnosis is due to biased self-perception – that is, we tend to think and believe differently about ourselves than what is observed, since it can be hard to have complete self-awareness.
Furthermore, diagnosis is further complicated by the fact that the same condition can present itself differently in a child, adolescent, or adult. Put simply, the same symptoms may not apply to every developmental stage or age bracket. To provide an example, it is considered premature and reckless to diagnose a 13-year-old suffering from mood swings with borderline personality disorder or bipolar disorder. Rather, it must be considered that it is normal for a young adolescent to experience shifts in emotion. And there is a pediatric disorder to account for such mood swings in their most extreme form, known as disruptive mood dysregulation disorder (DMDD). Adolescent depression is another excellent example; its symptoms and presentation can be different from that witnessed in adult depression.
When it comes to diagnosis, therapists must consider the spectrum of experiences a person is experiencing, along with when they happen, the severity, and the duration. Mainly, how all these issues come together to impact someone in their daily living.
What to do if you’ve fallen into the self-diagnosis trap
First, this is nothing to be ashamed of! It is normal for people to want to learn more about themselves. Developing a core sense of identity is a developmental goal to achieve throughout adolescence and young adulthood, and with that desire comes introspection. You are not “odd” for wanting to discover yourself – you are doing exactly what you need to do.
But if you have turned to TikTok as the authority for anything on mental illness, and you have found yourself thinking “yep, I have this… and that… and that…” ask yourself, “so what is keeping me from a formal diagnosis from a clinician?” or “so why do I not trust in my clinician?”. Listen to your intuition. Dive deeper. Perhaps you are in denial about something suggested to you about yourself by your clinician. It could be you are fearful to know what a healthcare professional has determined. Maybe you find having a self-diagnosed condition makes you feel included into a part of a community; it brings words to your experience. Whatever the reason, you are not at fault. You are only trying to make sense of things.
But maybe, just maybe, consider that TikTok should be for entertainment purposes only – not the replacement for professional help! If you are ready to seek help from a licensed professional our team would love to assist you. Contact us today.
- Valerie Smith, LMSW