We were a year into the pandemic when a friend's teenaged daughter announced decisively that she had ADHD and needed medication. Her mother had shared the news with me during an anxious, socially distanced morning walk — along with her private concern that it wasn't the correct diagnosis. The girl, however, was convinced. She'd been researching it online, and she didn't see the need to entertain any other possibilities.
American teenagers and college students are facing a deluge of mental health crises unprecedented in modern history. Contrasted with the clenched determination of prior generations to never admit when there's a problem, Gen Y's hunger to identify and treat its emotional challenges isn't just understandable, it's pretty commendable. It's vital, however, for them to be able to distinguish between self-labeling and professional help, especially because neither is 100% accurate or effective.
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Humans are highly suggestible creatures — as we have all learned from two years of nervously swabbing the insides of our noses. It doesn't negate the reality of what we may be feeling at any moment; it does however create a need to understand that sometimes belief can create or accelerate symptoms that defy diagnosis. And that adolescents, with their developmentally appropriate need for peer group identification and their upwards of seven hours a day spent on social media, are unique.
In a recent post for Banner Behavioral Health Hospital, psychiatrist Dr. Adeola Adelayo noted a striking rise in "physical and verbal tics" in teen girls. "We've seen an explosion of Tourette-like tics in our unit and every single case has been linked with watching countless TikTok videos about people with Tourette syndrome," she said. "These kids don't have Tourette's, but they aren't pretending either. They have a functional movement disorder as a result of stress, and possibly underlying anxiety or depression, which may or may not have been properly diagnosed."
Similarly, a December Wall Street Journal feature explored why "Doctors around the country say they're seeing more teens coming in with self-diagnoses derived from TikTok," including rare mental health issues like borderline-personality disorder and multiple-personality disorder. Evan Lieberman, a Minneapolis clinical social worker, also noted another aspect of the phenomenon. "There seems to be a trend," he said, "of using mental-health diagnoses as a social currency."
When the algorithm rewards even a casual search for information with recommendations for more and more of the same, within a system that is rife with a mix of legitimate and dubious self-described mental health influencers, it can be tricky for anybody to differentiate between what's real and what's the so-called "horoscope effect" of taking generalized information as personal insight. And the fact that the Diagnostic and Statistical Manual of Mental Disorders — the Bible of psychiatry from which most of our modern terminology springs — is a wildly imperfect, frequently arbitrary document only adds to the potential confusion here.
Among professionals, opinions about the convergence of social media and mental health are mixed. Dr. Michael J. McGrath, a psychiatrist and the medical director of the Ohana Luxury Alcohol Rehab in Hawaii, says, "Self-diagnosing a mental health disorder based on social media is a very dangerous trend. Many mental health disorders can lead to fatal outcomes if not diagnosed and treated properly. A person should never use information that they see or read about online to determine if they have a mental health disorder or to determine what treatment they need."
He adds, "It's great that there are online creators who are shining the spotlight on mental health conditions. That is great to raise awareness and reduce the stigma associated with mental health conditions. However, it's vital to regard the information that you see or read as informational only."
But Manhattan psychotherapist Z Cordero points out that access to resources varies incredibly, and notes the "lack of readily available appropriate and inclusive information" for many. "Visits to therapists, psychiatrists, and neurologists take time, money, and transportation access," says Cordero, "all things that teens and college students may not have readily available to them. A lot of mental health providers do not accept insurance, and that number will probably grow. Even if young people have access to all these resources, the professionals that they can work with may not be the right fit for them. Is the young person Black, Indigenous, Queer, Trans? What is the professional's level of cultural awareness around these areas?"
And Dr. Holly Schiff, a doctor and licensed clinical psychologist in Greenwich, Connecticut, advises everyone to be a smart consumer. "Usually the credibility of the source is your first clue to whether the advice will be helpful versus something that has no merit or that could potentially be harmful," she says. "There are some users that are part of a community that actually encourages unhealthy behaviors and they share tips and tricks of how to self-harm and hide it from others, or strategies to maintain your eating disorder and lose weight faster. These are dangerous and harmful and can be triggering for those who come across these posts. If they don't have any credentials or their posts are sponsored or they are partnered with brands and products, I would be wary of any advice they post. Social media is a complex tool that can exacerbate anxiety or promote unhealthy habits, but it also positively contributes significantly to the ongoing dialogue surrounding mental health." She advises, simply, "Don't try everything you see!"
Of course, it's not just teens and college students who are self-diagnosing, and it's not just for mental health or neuro-developmental conditions. I recently attended a medical conference, and one of the biggest frustrations doctors there expressed had to do with adult patients who arrive in their offices certain about both their pre-existing conditions and current complaints, without prior testing or confirmation. We all could use regular reminders that the internet is just a component of information gathering and support, just as providers — and parents — could frequently do a better job of building collaborative, empathetic treatment plans together.
When it comes to talking to our kids, the most important thing is keeping an open mind. If your kid comes to you with a concern or even a strong declaration of apparent fact, start first by taking it seriously. You want to build a trusted team of helpers, not shut down a line of inquiry. When I asked my own teen why she thinks so many teens are self-diagnosing on social media, she told me bluntly, "Because adults don't believe them." That strikes me as incredibly sad — and wildly dangerous.
A full dozen years ago, Dr. Srini Pillay warned in Psychology Today that that "One of the greatest dangers of self-diagnosis in psychological syndromes is that you may miss a medical disease that masquerades as a psychiatric syndrome. Thus, if you have panic disorder, you may miss the diagnosis of hyperthyroidism or an irregular heartbeat. Even more serious is the fact that some brain tumors may present with changes in personality or psychosis or even depression."
In addition to keeping the lines of communication open, we can remind our kids and ourselves that having a word for something is less significant that having a plan for addressing it. Author Sarah Fay recently reminded in a Salon interview, "There isn't a single DSM diagnosis that has an objective measure." And a 2021 Psychology Today feature on the rise of TikTok diagnoses pointed out the need to be mindful of "the central idea of traits and states, with the former being more stable and enduring and the latter a temporary way of being." A teen may be eager to lay claim to an "I am ___" identity without considering the possibility of being more in an "I currently have ____" situation. That doesn't diminish the reality of anxiety or depression or distraction, it simply reframes them as not always chronic or defining.
I don't know if my friend's daughter has ADHD, or even if she ever got a professional diagnosis. Shortly after that conversation, we lost touch. I do know the girl was wise enough to recognize she was struggling with something, to seek information, and that she had enough trust in her parents to talk to them. That's a better start than a lot of kids get. "Social media platforms offer a place for healing and fosters a sense of community, as well as reducing stigma," says Dr. Schiff. But she encourages young people to take the next step and "Tell an adult or talk to their parents. Seeking professional help," she says, "is the first step into figuring out what you are experiencing, and getting yourself on track to feel better."
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