HealthyGamerGG - Can You Diagnose Yourself With a Mental Illness

Episode Date: October 28, 2022

Today, Dr. K dives into self-diagnosis, what a diagnosis actually is, differential diagnosis, and more! Support this podcast at — https://redcircle.com/healthygamergg/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy Learn more about your ad choices. Visit megaphone.fm/adchoices

We may know more than the patient about diagnoses, but it's still really, really important because as a doctor, what's your best source of information? Your best source of information is actually the patient. Change my view. Self-diagnosing a mental illness is not valid. I'm in high school, and I see people do this all the time. They say they have ADHD, and I ask why I can't focus. People say they're depressed.

How do you know? I'm sad today. It's honestly just a cycle of people self-diagnosed. themselves without proper research slash medical diagnosis. I understand sometimes we know ourselves the best, but whenever it comes to something serious that you need an actual therapist specialist, self-diagnosing can be so harmful. Self-dying can be so, so harmful. For example, there's a girl in my class and she told me she has autism and ADHD. Then she told me she hasn't actually gotten checked, but she still knows. Afterwards, as I spent more time with her, she started diagnosing me with autism

is also. She told me I have the symptoms and I asked her how she knows and she told me she looked online and I follow exactly what it says and that she has it too. I'm not mad at her, but I do think it is ignorant. Self-diagnosing cannot only be harmful to yourself because you might be wrong, but harmful to others because you might spread wrong information. I understand U.S. healthcare sucks and getting therapy and everything is so expensive, but that doesn't mean people should be telling others what they think they have. Edit, when I say valid, I mean, end result, people shouldn't be saying they have this and that and then call it a day. Self-diagnosis should only be a basis in order to seeing if you need specialist help or not.

Many people I know self-diagnose and don't seek further help and then they end it on the self-diagnosis, therefore it's not a valid conclusion. Okay. So this is something that I'm seeing a ton of nowadays, by the way. So we're seeing a ton of self-diagnosis on the internet, right? where people will like say, oh yeah, I have autism, I have ADHD, I have this, I have multiple personality disorder, things like that. Like people will diagnose themselves with all sorts of things. And is that kind of valid? Well, I know this is going to sound kind of weird.

My short answer is no, it's not, but there's a pretty big but in there as well. So what I'd love to do is share with y'all why I think, first of all, it's so easy to diagnose yourself on the internet. Secondly, why people diagnose themselves from like research on the internet. Third, what's actually wrong about it, right? Because we'll see, they're actually quite logical in the way that they approach it. But really what the shortcoming to self-diagnosis is and actually what's hard, the hard part of being a physician, which we'll get to, is not in diagnosing someone. Diagnosing someone is actually not the hard part. It's very easy to come up with a diagnosis. We'll actually share with you all why I think what's the main thing that's missing with self-diagnosing.

on the internet, which happens to actually be, in my opinion, kind of the biggest value add that doctors bring to the table. And then we'll talk a little bit about what's the big caveat, right? So, and how to approach this if you're someone who has diagnosed something on the internet or if you think you have something, how to approach that. So let's do each of those kind of in order. So the first is that this generation is the best generation in terms of like the digital generation is the best in terms of being able to find answers for themselves. So we're like more effective at it than any generation prior to us. There's also more high quality information.

So for example, if you look at Wikipedia, Wikipedia is more factually correct than encyclopedias, which is what I grew up with. When I was like a 10 year old kid, we used to have like, you know, a pile of encyclopedias. And if I needed to know something, I would go like look it up in the encyclopedia. So we're like actually really good at finding information. There's actually a lot of high quality information out there. And even if you look at some of these things, like, you know, people will look at Mayo Clinic or Cleveland Clinic or whatever for like information on ADHD or autism. And they'll sort of find that, okay, like, oh, this really does sound like it fits me.

So it sort of makes sense because there's actually good quality information out there. The last thing is that you tend to know yourself in a way the best, right? So you know what you experience. You understand subjectively what it's. like. And so if you kind of know what your day to day is like and you read something from the Cleveland Clinic, like that's sort of, that's a high quality source, right? And you can kind of end up making a diagnosis because at the end of the day, the list of diagnostic criteria is boxes. And you check a lot of those boxes. So it sort of makes sense that here's a reputable source that

gives me a set of check boxes. I check a lot of those boxes. This is my experience. So this is what the diagnosis is. Kind of makes sense. Another big driver for this is that a lot of people are looking for insight into their lives. So one of the most amazing things about receiving a psychiatric diagnosis, for some people, by the way, for some people it's stigmatizing, but for some people, it's liberating. Because for some people, I've struggled my whole life, and I haven't understood why. Am I cursed? Is this just like, am I broken? Am I messed up in some way? And for some people, getting a diagnosis is liberating because it offers an explanation. Now I understand. Now I understand. why my life has been this way. Now I understand why I behave this way. Now I understand why my mind

behaves this way. And that understanding that you're not fundamentally broken, but rather that you have a particular diagnosis, which is more responsible for your situation, can be incredibly liberating. In some cases, it can be so liberating that it leads to a lack of responsibility on the patient's part. Right. So this is something that we also see is that when people get diagnosed with mental illness, especially, a psychiatric diagnosis, that being sick entitles you to particular benefits. Now, I know this may sound a little bit weird, especially if you're suffering from mental illness, you're like, there's no way that this is like worth it. It doesn't entitle me to anything. It just makes my life objectively worse. We're not disputing that it is a net loss or net negative.

But what we do know on research on people who get diagnosed with things is it's not just mental illness, that once you get some kind of diagnosis, people essentially, cut you some slack, hopefully. Right? So we know that, for example, if you get diagnosed with cancer, bosses tend to be kinder to you, things like that. Mental health is a tricky situation, because a lot of times when you get a diagnosis, people actually discriminate against you. But sometimes people with mental diagnoses, especially, like ADHD, they feel like they have a good reason for their lack of performance. And sometimes people will even like cut them some slack, right? oh, I'm sorry, I'm late today. I've got ADHD, and it's really hard for me to get organized and out the door.

And as people are becoming more and more compassionate, as we're actually destigmatizing mental illness, what we actually discover is that there's more latitude given to people who have diagnoses. I'm not saying that that's right, wrong, or indifferent. I'm not passing a moral judgment on that. I'm just making an observation about what I see. So as we can see that there are good reasons and good sources to make diagnosis. Now what we're going to get to is I think the core reason why it's just, generally speaking, not a good idea to make a final diagnosis about yourself. And the main reason for this actually has to do with what doctors do. So the hard part about being a doctor is not making a

diagnosis. So if we think about what is a diagnosis, let's say there's five features. And if you check three out of five boxes, you have the diagnosis. And so if you go to like Cleveland Clinic and you look at their website on, let's say, bipolar disorder, there are going to be nine diagnostic criteria, and you need more than three, but let's just assume three out of five. So what people will do is they'll see, like, oh, I check these three boxes, so I must have this thing, right? So like, I check the boxes, so it sort of makes sense. There's a reputable source that says that if you check A, B, and C, you have the diagnosis. Now, the challenge is that this is actually not what makes being a doctor hard because let's say that I have a diagnosis like hypothyroidism.

Okay. And hypothyroidism has features like hypersomnia, sleeping too much, low energy. Sometimes it can have cognitive changes. It can also have increased weight. So we'll see weight gain. So these are all features of hypothyroidism. And what I could do if I'm a doctor is I could get people who have, let's say, major depressive disorder for whom diagnostic features include hypersomnia, weight gain.

Oh, by the way, decreased mood is also over here. So low mood. Cognitive impairment, low energy, and low mood. Right? So these are both features of all this stuff. So what could happen if you were a bad doctor is that if you were an endocrinologist and 100 patients with MDD come into your office, what you would do is diagnose all of them with hypothyroidism.

If you're a psychiatrist and 100 patients come in with hypothyroidism, you could diagnose them with MDD. So the hard part about being a doctor is not making a diagnosis. The hard part, what we really study for and work towards, The reason that we order tests is not to make a diagnosis. The reason that we order tests is to rule out diagnoses. And the hard part of being a doctor is the differential diagnosis. And this is the big problem that I see with self-diagnosis is that people don't construct differentials.

You may check three out of these five boxes, but like you can check literally all five of these boxes in both of these situations. And depending on what pops up on your Google search, you'll diagnose yourself with MDD or hypothyroidism. Does that make sense? So I'll give you all just an example of how complex differential diagnoses. And this is why we do diagnostic interviews and diagnostic tests and diagnostic exams and physical exams. Because we'll ask a thousand questions that the person themselves won't ask themselves because they don't know to ask it. So let's say that I have difficulty with focus and I'm on the internet. And then I conclude I can't study. I'm having trouble with studying. I conclude I have ADHD.

Easy, right? Because I have difficulty focusing. I can't study. My mind wanders. But if we really look at the differential for difficulty with focus, there's all kinds of other things. Like you may have a vitamin deficiency, right? So like, for example, B12 deficiency, iron deficiency, what else? vitamin D deficiency. These could all lead to problems with focus. Other examples are like there are other psychiatric illnesses which can lead to a lack of focus. So like, for example, major depressive disorder. So you could be depressed.

People have difficulty studying when they're depressed. You could even be hypomanic, right? Usually those people study better, but not always. There are also other things like maybe you have an anxiety disorder. So like when you're anxious, you're going to have difficulty focusing because your mind is racing a thousand miles a minute. And you're thinking about all kinds of things. You can't focus on your school because, oh my God, what's going to happen if I miss my package? I won't have my package.

I'm going to go home. I won't have the gift for Christmas. If I don't have the gift for Christmas, people are going to get pissed at me. It's going to create so much drama. I can't miss the package. I can't miss the package. How are you supposed to study for your final exams when you're paranoid about what's going to happen at Christmas? Other examples include things like PTSD.

Oh yeah, like I can't focus on school because I'm having nightmares and flashbacks. And that goes to like other stuff as well. In a world where everyone was forced to leave the comfort of their homes to get drinks, one hero emerged. Its name was Drizzly, the number one app for alcohol delivery. And it allowed everyone to compare prices on the biggest selection of beer, wine, and spirits and get them delivered in under 60 minutes. All they needed to do was download the Drizley app,

go to Drisly.com. That's D-R-I-Z-L-Y.com to take destiny in their hands. D-D-D-D-D-D-D-A. What about sleep disorders? Maybe the reason that I can't focus is because I have sleep apnea. I'm literally having 60 apnic episodes, which creates a stress response similar to drowning. That's what my body thinks is going on. So I drown for 90 seconds, 60 times a night. and then my sleep is all messed up.

Maybe that's why I can't focus. Or we have something like a circadian rhythm disorder. And what does that mean? Well, that means that when I try to study, when I go to class at 10 a.m., my biological clock is messed up and my body thinks it's three in the morning. So it's like half asleep.

Like, can you imagine for the average person going to class, like chemistry class at three in the morning when you're dead tired and your body's telling you to go to sleep and you're struggling not to pass out? Very hard. And then what happens is maybe you pound the caffeine, but like your body still thinks it's the middle of the night and you have a circadian rhythm and it's all out of whack.

So you have difficulty focusing. Other things that we don't even really think about, substance use. This is huge for lack of focus. Because if you're drinking or using pot on a regular basis, like that's going to impair your focus. That's what it does. Even things like caffeine dependence can alter your focus. Oh yeah, you don't have ADHD at 5 p.m.

You're crashing. from a combination of a circadian rhythm disorder with pounding too much caffeine in order to stay awake. Right? And then we'll even have things like narcolepsy, which people don't, yeah, usually people know when they're narcoleptic. And then there are other things as well, like what are other factors that are even non-diagnostic, or not even illnesses that you can diagnose that may impact your focus? So things like technology usage. So we know that, for example, short form consuming large amounts of short, form content and highly dopaminergic content negatively impairs your attention span. So like as you watch more and more clips of stuff, your brain gets used to holding its attention

on one thing for 30 to 90 seconds. And so then what's happening is like people are learning. Okay, so like since the attention span is shortening, what we're going to have to do is make things more dopaminergic. We're going to have to make them more clickbaity. And so the more dopaminergic, we keep it, like if something super intense happens at the 60 second mark of a video, then someone will stay. But if we bore them a little bit, they're going to click on something else. And so these kinds of things could be shaping our focus as well. So now this is something that when I see most people diagnosing themselves on the

internet, they don't go through this process of differential diagnosis. and this is where I think most people make their mistakes. And this is what doctors are trained to do. So when someone comes in, like the whole point of being a psychiatrist is when someone comes in and they say, hey, I think I may have ADHD. I'm having difficulty focusing. I'm not going to jump straight to this.

The whole point of my training is that I've been trained as a medical doctor, so I'm going to think about sleep disorders. I'm going to think about substance use. I'm going to think about other psychiatric diagnoses. I'm going to think about vitamin deficiencies. And then I'm also going to think about other stuff, like autoimmune disorders, like hypothyroidism, like lupus, right? So when someone comes in with ADHD, I'll ask them, hey, you have any rashes? They're like, what?

No. Like, okay, cool. Probably not lupus. And so this is really what, you know, being a good clinician is about. it's about doing a good differential diagnosis. Because as we illustrated here, you can check the boxes very easily. This is what I think is the major shortcoming of self-diagnosis on the Internet. Is that you're not accounting for all the other stuff that it could be.

Now, why is it, why do we see so much self-diagnosis and is self-diagnosis necessarily bad? Now, this is where it's going to sound kind of weird, right? Because I just spent so much time telling y'all, oh, like, this is why you can't diagnose yourself on the Internet. So why does this happen so much? I think that this is where I'm talking about the value that doctors bring to the table, but I think it's also fair to talk about our shortcomings as doctors. So one of the biggest mistakes that we make as doctors is that we're arrogant, right? Because we do know all that kind of stuff.

So what happens is sometimes we'll have patients who come in and they'll say, hey, I think I have cancer. I, the doctor, will ask them a handful of questions, and I'll all determine sometimes what will happen is I'll go through a process called premature closure, where instead of considering a good differential, all jump to conclusions, and doctors fall into that as well. And then what ends up happening is a lot of times

patients don't get listened to. And doctors will actually like make diagnoses and jump to conclusions and not actually like listen to or perform appropriate diagnostic workups. Or in some cases, what they'll do is actually appropriate diagnostic workups that won't detect the condition.

So it's not that the patient is wrong or the doctor is wrong. where both happen to be right, it's just the patient could be in the exception, right? So like not all diagnoses appear the same way. At the top of the list, a great example of this is endometriosis. So endometriosis is something that's actually quite common. So what endometriosis means is that there's endometrial tissue outside of the uterus. So generally speaking, women will go through a menstrual cycle where their uterine lining grows,

and then as they get on their period, as their period starts, as menstruation starts, that tissue necrosis, so it dies off, and then they sluff it off, right? So this is what happens when you have your period. Now, the challenge is that sometimes endometrial tissue can be outside of the uterus. And the thing is, we're supposed to sluff off our uterine linings during menstruation, and that's designed. The body is designed for that. The challenge is that if you have endometrial tissue outside of the uterus, it's not supposed to be there. And so when you go through this necrotic process, it's incredibly painful. And the challenge, though, is that oftentimes doctors will be very dismissive of this pain.

So this is the real challenge is that, you know, should you diagnose yourself? I don't think so. But I also think it's very, very important that if you do go see a doctor and you do believe something and you have instincts about what's wrong with you, that you try to make that as clear as possible. And if the doctor's diagnosis of you feels premature, incomplete, or doesn't really account for what's going on, you don't have a good explanation that ties up what you're experiencing with what they're suggesting, then I think that's really worthy of further discussion. And this is where, frankly, a lot of my colleagues and I myself have made this mistake as well will be kind of arrogant about it, right?

We start to think we know better than the patient. We may know more than the patient about diagnoses, but it's still really, really important because as a doctor, what's your best source of information? Your best source of information is actually the patient. And what I tend to see that's kind of disturbing is that a lot of doctors are not paying attention to patients. And so that's where I sort of like get that, you know, I think you should do your research. I think you should develop hypotheses and then go in and talk to a medical professional about it. But be a little bit careful because unless you're trained in differential diagnosis, the challenge of self-diagnosing on the internet is that there could be a thousand other things that create this constellation of symptoms.

And if you really want to make an accurate diagnosis, a part of that is ruling out all of that other stuff. So can you diagnose yourself on the internet? Generally speaking, I wouldn't recommend it. But I do think it's a good idea to educate yourself, formulate hypotheses, and try to share those as transparently as possible with a particular medical provider. And hopefully they'll incorporate your information into their diagnostic experience, and that's usually when you arrive at the best diagnosis.

Questions? You've seen arrogant and unconfident doctors. It's tough. Yeah, absolutely. So SACO5 is saying yes, but doctors don't necessarily care about feelings. I would say the good ones do. So Rogue Weird Wolf is saying, would it be reasonable to refer to old medical files about yourself? For what?

For self-diagnosis? It can be. But I think especially when we're talking about psychiatric diagnoses, psychiatric diagnoses have a way of piling up. Right? So what happens is like no one, it's very hard for someone to remove a diagnosis from your chart. like that takes a lot of work. It's really easy to give someone a new diagnosis. So that's where I think you've got to be very careful about some diagnoses. Because just because it's in your chart doesn't

necessarily mean it's correct, especially for mental health stuff. Can becoming a parent bring on symptoms? Sure. So the most, I want to say, not most common, that's not correct, but a very common a very common first episode of mania for bipolar disorder is post-pregnancy. So we'll see oftentimes in the postpartum period that people who are bipolar will discover they are bipolar. And then what happens is the stress of pregnancy and delivery like triggers a full-blown mania. And then as you talk to them and hopefully treat them, what you discover is that there were

a lot of warning signs, like a lot of yellow flags in their history that show. sort of like a cyclic mood, but that never sort of like that they were able to cope with or like didn't really impair their function quite as much or they just kind of like rode it out where like so you sort of see that it was always there and then the first episode of mania is postpartum. What if my family doctor doesn't listen to what I say? Do I just get a different doctor? I would start by talking to the doctor, right? So if you all have a problem with your doctor, I think the first step is always just talk to your doctor because they're supposed to be on your side and sort of say like, hey, I'm feeling like you're not really listening to what I'm

saying. Just talk to him about it. Can I diagnose my doctor? Probably not. Do you feel like many Gen Zers are carelessly self-diagnosing themselves? What I think is careless about this generation is there's a balance between destigmatizing and like overgeneralizing. So for a long time, there was, there still is, a stigma against mental illness. So, we did is we took all the people at psychiatric diagnoses. We bundled them up and we pushed them off to one corner of society. And we discovered, hey, that's really harmful. Right. So like unlike cancer where it's like, oh, you've got cancer, let's everyone support this person because cancer is hard to deal with. So when cancer happened, we took people who are in the corner and we brought them in

and we're like, hey, we're going to take care of you. If someone has like an accident, right, where they like are handicapped afterward, let's say they like lose a leg. Everyone, like comes around and we support that person through their illness. But if you have depression or schizophrenia, if you've got major depressive disorder or schizophrenia like them, don't tell anyone. So that was harmful. Then what happened is now that we have social media and stuff and we're in the process of destigmatizing mental illness, we're showing how common mental illness can be.

The challenge is that sometimes we cross a line into like really generalizing into like normal features and calling it an illness. So I'll see all kinds of things that I think are essentially within the realm of normal behavior, like difficulty with focus, that people will automatically jump to ADHD or automatically jump to autism or autism spectrum disorder. Right? Well, they'll be like, oh, like this is a feature of autism. Like, I have trouble studying for organic chemistry.

This is what it's like to have ADHD. Can't study for organic chemistry. It's like organic chemistry is hard to study for whether you have ADHD or not. not. So sometimes I think what we're ending up doing is pathologizing normal behavior.