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Why Self-Diagnosing with the DSM-5 is Harmful — and What People Should Do Instead
By Dr. Christina Abby, Clinical Programs Manager
What if I told you that mental health has “gone mainstream” for better and worse?
In February 2022, my colleague wrote about a disturbing trend in which teenagers and young adults use TikTok videos to self-diagnose mental illnesses. Months later, Axios discovered that the newly revised fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 TR) had become a certified bestseller, and not just among psychiatrists — everyday people are buying it, too.
Why is this a problem and what’s causing it?
The COVID-19 pandemic, isolation and boredom during quarantine, societal and political stressors, and constant news coverage have impacted the harrowing state of mental health in America. People need help now more than ever, but stigma and a record shortage of mental health providers have prompted many to take matters into their own hands — including self-diagnosing with the DSM-5 TR.
It’s encouraging to see mental health conversations are evolving and becoming more widespread. However, self-diagnosing is dangerous — and potentially lethal — and should be left to licensed professionals. As Clinical Programs Manager and a licensed clinician at evolvedMD, my role involves developing clinical and educational curricula, and I’d like to take this opportunity to explore the dangers of self-diagnosing and why people should seek professional help.
The Dangers of Self-Diagnosing
The DSM-5 is extremely complex
Recognizing warning signs is an important first step to identifying mental illnesses. From there, people should share their concerns with a licensed professional to get an accurate diagnosis. Consulting the DSM-5 TR instead, like Googling your symptoms, may result in under-diagnosing, over-diagnosing, or misdiagnosing.
For example, let’s say someone is worried about an upcoming presentation and fears losing their job if they give a poor presentation. Knowing Generalized Anxiety Disorder (GAD) is common, they consult the DSM-5 TR thinking they’ve identified the problem. However, the DSM-5 TR is a complex and thorough resource with specific criteria for diagnosing mental disorders. The diagnostic criteria for GAD includes but is not limited to:
- Excessive anxiety and worrying, more days than not for at least six months
- The anxiety and worry are associated with three or more of six symptoms (with at least some symptoms having been present for more days than not for the past six months)
While reading, the person may see the words “anxiety” and “worrying,” and jump to conclusions, diagnosing themselves with GAD even if they don’t meet the specific criteria. In this case, they should consult a professional instead. Among mental health professionals, there are more advanced levels of licensure that require hundreds of supervision hours from individuals already licensed at the independent level.
Many diagnoses are closely related
There are more than 200 classified forms of mental illness and thousands of diseases affecting humans. Because physical and mental health are interconnected, this makes it nearly impossible for the everyday person to accurately self-diagnose when multiple disorders share similar symptoms — even something as common as Generalized Anxiety Disorder.
In the differential diagnosis process, licensed professionals identify the proper diagnosis from overlapping symptoms between competing diagnoses. While many diagnoses are closely related, an alternative may fit someone better. For example, someone may be concerned whether they have Generalized Anxiety Disorder, but anxiety is also commonly associated with pheochromocytoma (tumor of the adrenal gland). If not diagnosed or appropriately treated by a licensed professional, pheochromocytoma can prove fatal.
Recognizing the differences between pheochromocytoma and other stress-related conditions, such as GAD and panic disorders, can be difficult. Seeking professional help — especially in integrated healthcare settings — can help to not only accurately diagnose but effectively treat each diagnosis.
Self-treatment may complicate actual condition
Self-diagnosis may inevitably lead to self-medicating. However, by self-treating, people run the risk of treating conditions they may not have and potentially make the actual condition much worse.
Even though the DSM-5 TR does not provide guidelines for treatment, using this resource to self-diagnose may then lead people to research treatment options online. For example, if someone self-diagnoses themselves as having Generalized Anxiety Disorder, they may go online and read an article to find over-the-counter solutions. They see that taking magnesium supplements may reduce symptoms, and then purchase a bottle from the pharmacy to take daily. Knowing most people get more than enough magnesium from foods and don’t need to take magnesium supplements, excessive use can be toxic and cause nausea, abdominal cramping, and diarrhea.
Essentially, self-treating by using over-the-counter medications, making radical changes to one’s diet, etc. can cause harm and complicate the actual condition.
Ultimately, Treat Your Mental Health as You Would Your Physical Health
If you’re concerned that you may have a mental illness, I implore you to seek help from a licensed mental health professional or a psychiatrist. Think about the actions you typically take when you have a fever, a sore throat, headaches, and fatigue — you would go to urgent care or schedule an appointment with your primary care provider knowing it may be coronavirus, the flu, or a common cold. The same goes if you needed major surgery — you wouldn’t take matters into your own hands.
Mental health should be treated exactly the same. Instead of self-diagnosing with the DSM-5 TR and self-treating, take your concerns to a licensed professional to get an accurate diagnosis and the appropriate treatment plan.
Solution: Collaborative Care for Both Physical and Mental Health Conditions
Having a primary care provider (PCP) and a therapist you trust are among the best practices for living a happy, healthy life. Primary care and behavioral health have historically been separated, but many leading companies, like evolvedMD, are integrating behavioral health services at modern primary care practices to treat the whole spectrum of physical and mental health conditions.
What does behavioral health integration look like for patients? It means having a collaborative care team at your side at the primary care practice you trust, including your PCP, an onsite mental health therapist, a Psychiatric Consultant, and more.
For example, if you think you may have an undiagnosed mental health condition like Generalized Anxiety Disorder, you can first share your concerns with your PCP, who can then collaborate with the onsite therapist and a Psychiatric Consultant to get an accurate diagnosis. From there, this collaborative team can address both your physical and mental health conditions before symptoms become severe.
At evolvedMD, I’m proud to have a platform where I can not only educate the therapists I work with, but everyday people, too. If you think you’re struggling with an undiagnosed mental health condition, I hope this piece illuminated the dangers of self-diagnosing and encouraged you to take the appropriate next steps for your health.