Why you shouldn’t self diagnose (Mental Health)

[@Foxbeep_]

man going from no preston to all preston all the time is baller I like this side of your content a lot thanks for being genuine

[@pathurd9595]

I agree it super helpful having someone in the med influencer space that isn’t all about their image and is genuine

[@itspresro]

Thanks foxbeep and pathurd, means a lot y’all 🥲

[@glitchyrhythm6749]

@@itspresroExcuse me?! It’s not about you it’s about them! These are real people were talking about here!

[@bosstowndynamics5488]

In fairness, some laymen wind up using the term "self diagnosed" even what they really mean is self identified, particularly with neurodivergent traits. I think the things people are doing in those cases are generally valid even if the term isn't the best description, in that self labelling can lead to access to social support one might not have otherwise sought and better self understanding if done carefully, and in that particular instance it's usually not being framed in the context of pathology so it isn't serving as a direct substitute for mental health care anyway. It's more along the lines of how you don't have to get diagnosed with being gay either because that's just a different way of being a human. Of course, that validity gets stretched when you act as if self identification is the same thing as a medical diagnosis, that your self label describes the pathological state rather than just the presence of associated traits, and expect formal treatment accordingly, but there's still nuance here.

[@itspresro]

Self identifying is fine and shows you’re being introspective. I’m addressing the phenomenon (mostly on tik tok) where people segue that self diagnosis is as legitimate than using a psychiatrist

[@cameronschyuder9034]

@@itspresroi think (you’ve probably seen this argument) it’s because so many psychiatrists are just… bad. You’ve made a video saying why it’s so easy to be a bad psychiatrist. People have said you can go to four different psychiatrists and get four different diagnoses. There are still many older folks in psychiatry who do not brush up on their info and believe in old content of previous DSMs that no longer apply. Though this happens in the larger doctor community as a whole, it’s particularly bad because of how much our knowledge of psychology has changed over the latest decades relative to other medical fields (not saying all older people are like this, or that younger psychiatrists are by default more reliable than an older one, but merely describing one thing I’ve seen that seems to be a pattern). And, of course, there is the expense. Not everyone wants to shell out $100 for a 30 minute appointment that lasts 15 minutes because the psychiatrist thinks the patient has depression and/or anxiety (much more common) than perhaps something more nuanced if they cared to probe deeper. Many people in their fields do not care, but it shows more strongly in psychiatry because, as you’ve said, they’re supposed to be the scanner and analyzer and everything else in their field. It’s a big responsibility and not enough meet where the bar should be. Now, I’m aware that “self diagnosis” is not technically a “real” thing because diagnosis is not just seeing what traits of what thing you think you have, but also ruling out all the other things it could also be, which folks may or may not be considering in their self analysis. But, I think it occurs often enough that people’s gut reaction that their psychiatrist is wrong, turn out to be right when they seek a second, third, fourth opinion. But that, of course, requires more resources than just seeing the one, which can already be challenging to begin with. I can see why “self diagnosing” feels better for some than “self identifying” or “suspecting” or another term that would be more accurate to describe what they’re doing - because “diagnosis” feels more legit in a society that still heavily stigmatizes mental health and would prefer to blame it on an individual’s “personality” or their own lack of effort. It’s liberating. TikTok counters that notion hard (from what I hear, anyway; I hardly use it myself), but TikTok, no matter its popularity, is just one niche of the internet, that hardly spills into the real world (as far as majority opinions go). For some (sorry if this example is too graphic, it’s the first that came to mind), self diagnosis is like using toilet paper as a gauze for self h*rm cuts. Yes, the pulp can get inside your wound and make it worse. Yes, it can still get infected. But it’s better than just bleeding (depending on how deep they are, of course) - not for the actual wound, but for other concerns like not wanting to stain your clothes or anything else, or have it bleed and show itself outside of your clothing where others can see it. The real solution would be to have more access to quality psychiatry, but that’s demanding for two things that are long term goals, and not what people can act upon in the short term. I’m glad you made this video because different perspectives are important; I just hope/wish that when people say “don’t do x,” they give an alternative to do instead that is actually feasible, because everyone has reasons for doing x. And maybe it’s okay to say you don’t know the right answer. The people that self diagnose are oftentimes hurting for validation of their struggles, and self diagnosis seems like a legitimate thing to someone in need of that which they cannot have otherwise, so I would suggest if you make a follow up to this, to perhaps consider that. You mention your own example where you are able to see a psychiatrist; not only that, but you got one that heard you out and actually made a better call for what was actually up, and already I can see people not resonating with that even if you are looking out for their wellbeing. Because, again, no access. Personally, my suggestion would be that it’s okay to do your own research, but to be open to and expose yourself to different diagnoses and different opinions, as the person you responded to said, so that your “diagnosis” is more objective (or less biased, anyway) To have their own “self diagnosis” not set in stone, just like being skeptical of a psychiatrists opinion if you think they’re missing the overall picture. Being more objective about yourself is hard, but surely that’s more feasible than getting the resources to get an actual diagnosis, right? At least for some, anyway. It’s something that is self-actionable for more people than actually good psychiatry.

[@lyrablack8621]

I like this thread

[@lailanitukuafu]

​@@cameronschyuder9034 You worded that perfectly, thank you. I completely agree

[@fulltimeslackerii8229]

I think what you said about having anxiety being weakness really underlies the stigma about mental health as “you wouldn’t feel this way if you developed coping skills”

[@itspresro]

I was basically telling that to myself. Even I can’t escape the stigma

[@AnnaleishaMae]

Completely agree!

[@eliad6543]

You made a good argument for why self-diagnosis is still harmful when a professional diagnosis is unavailable, but didn't offer any alternatives.

[@Vercanya]

I agree that just saying "This doesn't work" isn't enough. There must be guidance too. Also it must be properly acknowledged that self-diagnosis can be the only available option to someone. There's also a difference between someone who does self-diagnosing for attention and someone who's genuinely looking for answers and working on themselves. - Patrick Teahan gives journaling prompts in his videos on trauma. - Pete Walker offers excellent tools in his book on Complex PTSD. - Heidi Priebe has excellent insight on trauma and self-help. - Barbara Heffernan educates and gives advice on this.

[@SilverSkitty]

Speaking as a mental health professional, this is a relatively recent issue and it’s difficult to address given the way the US healthcare system is set up and the fact that diagnosis and treatment is based in research, which can take years to produce results. We’re trying to help and working on alternatives but they take time.

[@eliad6543]

@@SilverSkitty I'm sure of that, I just don't think that *in the meantime* there's enough results to offer anything besides "self-diagnose responsibly and do your best not to be an attention-seeker". As the commenter above you pointed out, neither is optimal but there's a big difference. Going against that outright, before there's a "do this instead", feels wrong.

[@j.adamwegs2882]

I self diagnosed with depression and anxiety years ago, and the psychiatrist I saw didn't question it. I went through multiple different ssri's and benzos, which only made it worse. I gave up for years. Last year, I went to a therapist. In August, i accepted treatment for adhd. Now, I'm a pre-med psychology student, and am doing much better.

[@henriborsenberger934]

Full disclaimer : what i'm about to say has nothing to do with self diagnosis. That the first psychiatrist you saw missed your ADHD has probably nothing to do with self diagnosis and a lot more to do that you were accurate on either or both depression and anxiety disorder, which are so common with undiagnosed ADHD they might also be routine. Without treating ADHD they are also both untreatable. The problem with ADHD is that a lot of itssymptoms are also depression and/or anxiety symptoms on top of a very high co-morbidity. So you walk in to see your mental health professional, full to the brim with symptoms of depression and or anxiety that you also probably also have and you walk out with an incomplete diagnosis. Bouncing off psychiatrist and therapist to no avail is the most common way people who do or did not suck at school get diagnosed with ADHD. Generally, until you get to one who will bother doing a differential that start with "Patient has been diagnosed x times with depression and/or anxiety, yet doesn't respond to treatment". It is so common in people wth ADHD it might be a DSM-5 criteria at this point. There's an argument to be made that before even considering delivering depression or anxiety diagnosis just a quick quizz to check for the possibility of ADHD or ASD just to be sure something hasn't been missed might be in order. That or give proper statistics course to future mental health practitionners.

[@fisherbredrup]

I appreciate all of your content but this stuff that you have been putting out is really good for me to hear as someone in healthcare but also just as a person.

[@AnnaleishaMae]

Same

[@thelostremainunfound]

I think it is okay to walk in with something like "I think I have anxiety" but that you have to be willing to accept that your self diagnosis could be completely off. That said, that takes having a lot of trust with the person who is your mental health provider and feeling like they are not dismissing you if they think you do not have something. I was very lucky to have a provider in the past who I trusted to tell me if I was wrong without making me feel like she was brushing me off. I also think places like TikTok has poisoned the well by telling people they SHOULD be angry if a doctor says they don't have what they've self diagnosed with. People are too black-white about the issue of health and it seems to either be "doctor is always right or always wrong" when you really just need to find someone who you mesh and feel safe exploring with. I wish everyone could have that, I think it would really help improve outcomes.

[@LoneWolf343]

"You have too much skin in the game to give yourself a fair trial" is a good answer to most forms of self-assessment, actually. It would explain why people have such trouble evaluating their own traits and abilities in general.

[@ryanjohnson8960]

This is an amazing insight that I really needed to hear as a provider and as a patient

[@louiselafond1443]

Talk about the constant Dunning-Kruger effect I constantly play on myself. My therapist is so kind and I chose him as he cousels 2SLGBTQI+ refugees, and I knew I would have less of a chance of causing him trauma through confessing my own living through the overdose and covid-19 pandemics at the same time while being on the front line as an RN in the community. Thanks for this. Keep up the good work.

[@user-xy4ff5yp7b]

What does the 2S mean?

[@ollieq3150]

​@@user-xy4ff5yp7b I believe the 2S in that acronym is short for "two-spirit," which is a term sometimes used in reference to many different specifically-Indigenous experiences or expressions of gender variance. The full cultural breadth can't be boiled down into one KZbin comment, and the term isn't universally accepted, but that is a brief summation of the term from my understanding as a layperson (very imprecise).

[@saniarahim6661]

I cannot even begin to express my appreciation for this video and how it validates a recurring issue for me. It’s honest, touches on a topic that we as resident physicians come across all too often. As a pregnant ObGyn I cannot tell you how often I live in this space of feeling like I should have the ability to diagnose myself and objectively determine what I’m going through, only to doubt both my own medical training/lived experience, etc. There truly is no way to be a patient and provider for ourselves. Also, hope you’re doing well Preston! My husband and I always enjoy your videos and authenticity. We were all in the same class in med school!

[@madeleinewilliams4543]

Thank you!!! Finally someone in a position of authority on social media has said it explicitly. I’m just beginning a career change into psychology and I’ve been frustrated for a while with the TikTok self-diagnosis community, especially when it comes to high-profile disorders like Tourette syndrome, DID, ADHD, and ASD.

[@swissarmyknight4306]

If I hadn't "self diagnosed" why on Earth would I have ever asked for an assessment? It seriously cost me $2,500 and a six month wait to get assessed. That's one hell of a financial commitment for someone to make if they haven't even "self diagnosed", and a lot of people who are probably neurodivergent can't remotely afford that, so what are they supposed to do? At least online we can find each other for free and peer support and find community, but NT's who never passed the "high school mean girl" phase can't even let us have that. If you're bringing this lack of empathy to the profession, please don't become a psychologist.

[@anonymousfox7219]

When official diagnosis can cost a whole lot in some countries, and/or can lead to different treatment in the medical field and beyond (like how people with conditions like autism have been involuntarily been given do-not-resuscitate orders in the UK), *why* would someone who feels sure in their assessment of their condition go for an official diagnosis? When someone self diagnoses what they are ultimately saying is "I have these problems, I think it's this, I need certain accomodations/help". If they happen to the wrong about the specific thing that is causing their problems, it's still good that they are trying to identify their issues and seek understanding and assistance. What one gets from a clinician is a more official and possibly more educated opinion, but ultimately it's just another way to identify problems and seek help. Why should one way be barred and thus the other forced? So only clinicians control the language we use to describe various mental conditions? Clinicians get things wrong just as much. People who self diagnose are able to find community support because of it, are able to find ways cope with their conditions without breaking the bank or waiting years on a waitlist first. Why would you deny people that freedom?

[@INS4NE_ALI3N]

@@anonymousfox7219 Because a lot of people want it as an excuse not a reason also self-diagnosis can subconsciously make you act more like the thing that you’ve diagnosed yourself with

[@Thatsprettiemuchit]

I don’t think I would have ever gotten my bipolar 2 diagnosis if not for me recognizing the symptoms in myself. I had already been on meds and done therapy in the past for GAD and misdiagnosed unipolar depression. In a hypomanic episode, I decided to go off all of my meds, which intensified the mania and made me convinced that meds were evil. So I decided I was done with treatment. But I was still struggling so hard with weeks to months of depression followed by a couple weeks of reprieve where I was convinced I was god and cured my depression with my own mental fortitude. It took me a YEAR and then one day I had a brutal mixed state transition into hypomania. That’s when it hit me. What if I’m bipolar? My hypomanic self of course believed that I was so astute and intelligent and that empowered me to conclude that “another version” of myself was not okay and I needed to go back to treatment “for her” just in case she comes back, even though I didn’t believe in treatment. I don’t see any way a clinician could have identified me as bipolar because my friends didn’t even recognize my so-called “mood swings” which just looked like intermittent depression because I hypomania can be outwardly normal-seeming. If my depressed self sought out treatment, I would have reported that I am always depressed because that is genuinely how I felt. My hypomanic self was characterized by a belief that I cured my own depression and no longer needed help so we’re it not for this one moment of clarity, I would not have sought out treatment at all in a hypomanic state. What you described in this video is not an anecdote about self-diagnosis but about medication selection. Self-diagnosis is an important prerequisite step to seeking out treatment in the first place, so I’ve never understood the push against it. If you didn’t think you were depressed, why would you even bother to go through the arduous process of seeking mental healthcare? I love your videos and respect you so much, so I know that when I say this… when you say that self-diagnosis de-legitimizes diagnosed conditions, I think you have internalized mental illness stigmatization that you are projecting because you are new to perceiving yourself as formally mentally ill, if that makes any sense. The many layers of your mind are still negotiating the difference between you and your patients, who you have no doubt witness being stigmatized over and over in the healthcare system, and now you have to confront some of what it means-and doesn’t mean-to be both provider and patient. And you intellectualize a lot, which I’m sure you’ve realized in therapy. Anyway I hope none of this went to far and you find this comment at least gives you a perspective to consider.

[@Idran]

This was pretty close to my initial thought, but then another comment pointed out that a lot of the time self-diagnosis is conflated with self-identification (a term I hadn't heard before that comment); on reflection, that's a better description of what I had in mind, and I think the same applies here? My own personal experience, the experience you describe here, and Preston's experience as described in this video all seem more like self-identification (a.k.a., recognizing the presence of symptoms or traits in yourself that may or may not require further treatment) than self-diagnosis (a.k.a., asserting the existence of a _specific_ underlying condition or state causing those symptoms or traits). That is to say, it isn't stigmatizing mental illness, but rather recognizing that just as a person should seek a doctor because of specific physical symptoms they're feeling rather than attempting to pinpoint themselves the root cause of those symptoms and seeing the doctor for that specific condition, a person should also seek a mental health professional because of specific psychological symptoms they're feeling rather than attempting to pinpoint themselves the root cause of those symptoms and seeing the professional for that specific condition. It's putting mental illness on the _same_ level as physical illness.

[@Thatsprettiemuchit]

@@Idran I think those are really important points. I do also think that there are lots of things in psych that a patient wouldn’t know to offer as clinically relevant to their provider if they do not believe they have a particular diagnosis. I think there is little distinction between self-identification and self-diagnosis in psych. In many cases, the only symptoms the clinician will know about are the ones that are supplied by the patients. And if the patient doesn’t believe they are depressed, for example, they will not perceive their experience of depression symptoms as relevant enough to bring up to the provider, even if the provider asks questions about it. Yes, a skilled provider can help put the picture together but self-diagnosis, in my opinion, is still just a natural part of seeking psych treatment, and I don’t know what patients are supposed to make of the advice “don’t self-diagnose”. Especially when a big barrier to patients seeking treatment is the question of whether or not their experience is “bad enough” to seek treatment. And if you make the wrong self-diagnosis but then seek treatment as a result, should your provider not be able to identify the correct diagnosis? If people were ordering black market SSRIs en masse, I would see an issue. But even self-treatment with online CBT is not harmful. And frankly, I don’t think it takes a genius to accurately self-diagnose your own anxiety. Anyway. I think psych diagnoses are a team effort. A collaboration between the provider and patient. We all have access to the DSM-5. I think clinicians should go ahead and acknowledge that and work with the knowledge their patients already have instead of clinging to the idea that they are the only ones capable of diagnosing psychiatric conditions. A clinician has so much valuable insight to help patients understand to scope of experiences of different disorders to guide the patient to being able to identify what diagnosis best fits their experience. And then the provider can use their judgment to create a treatment plan. We don’t see dermatologists suggesting patients don’t self-diagnose their acne because it de-legitimizes dermatological care. There are contexts in which self-diagnosis is appropriate and psych is one of them imo.

[@andiehernandez1995]

I understand what you're saying, but self-diagnosing is actually a first step on some processes. For example, most self-identifying neurodivergent adults must convince professionals that they're neurodivergent. In order to do that they need to self-diagnose first. Or at least be almost sure they've got X and/or Y neurological "disorder". Then the professional can determine whether or not they're right, but the first step is basically self-diagnosis. Same thing applies for anxiety, depression, panic attacks, personality disorders, etc.

[@labeebahmad9690]

Preston you’re the GOAT. Amazing insight!! My brother just matched into Psychiatry at his first choice and we both love your videos.

[@cheetahgoldenfire]

It is so awesome to see mental health professionals being human and receiving the medicine and therapy we clinicians so often give. Courageous and brave.

[@tiffanyxie1396]

These videos are getting me through the end of third year, thank you and congrats on almost 1 year of being a doctor 🎉

[@ada5851]

I appreciate you being open and honest about your mental health. I think we need to see more doctors who are open about their struggles. I believe (perhaps ironically to some) it will improve patients' trust, especially in the field of psychiatry, knowing that those with the most expertise in treating them are also humans willing to confront their own struggles and weaknesses.

[@Vercanya]

*Informed* self-diagnosis is fine. My whole world changed when I found out about Complex PTSD. It explained to me why I acted the way I acted. It gave me the words to describe what I was feeling. It made it possible for me to shrink my Inner Critic and find healthier ways function. I now have PTSD and C-PTSD diagnosis and my MH professionals have been so important in my healing journey, but without doing some digging by myself I might have still thought that I was "just broken". Before my diagnosis, one MH professional suggested I "just" have GAD. Another wrongly suggested Bodily Distress Syndrome (BDS), and would have diagnosed me with it even though I didn't even meet the diagnostic criteria. Looking back, I had been describing her my dissociation and body armoring symptoms, which I now know are a huge part of Complex PTSD. So it also depends on the competency level of the MH professional and their pre-existing biases.

[@kierstanfaulks]

i had a similar experience where i didn't attribute anger to my anxiety and returning mood disorder. went back on the meds that i stopped taking and immediately I'm a much better person to be around

[@mustafabalsever4415]

As a 4th year student i just want to add, physicians also have a lot of skin in the game every patient does pertain to their values, beliefs and the feeling of power they derive from their position. It is important to not shy away from seeking help when you need it but as preston also said nobody knows you better than you do what you might be missing is the information which you can find online, it isnt easy to distinguish useful from garbage but a psychiatry degree takes more than 10 years, being expert enough on your condition could take less. Regardless of your choice, renting your responsibilties rarely produce meaningful benefits.

[@swissarmyknight4306]

$2,500 for my partial diagnosis, another round to try to get the full enchilada will cost me another $2,500. I think I'll "SeLf DiAgNoSe" and pay my bills and buy food instead. These people act like diagnosis is free and everyone has access. How wealthy do you have to be to not know how prohibitively expensive official diagnoses are? Considering that ASD/ADHD people are highly likely to be unemployed or under-employed, have you ever considered that that might possibly impact their ability to pay more than a month's rent for a goddamn assessment?

[@orpheus5670]

To all the people disagreeing with this video in the comments you should really use your critical thinking skills. Obviously the precursor to seeking out help to begin with is identifying problem areas. Preston is saying that putting that finalization label on a "disorder" or "behavior" being exhibited is wrong provided by the example given from his own appointment. "What happens when you throw a wild animal in a small box with a bag on its head? It growls. Do you think you might be growling?" Seek licensed outside help. Preston is the GOAT.

[@pothospathos]

Preston I've been watching your vids for a long time and I can say without a doubt you have never disappointed. Thank you for all of your insight and humor seriously

[@Artemis_the_gremlin64]

My parents “don’t believe” in mental disorders and my friends tell me I should go to a psychiatrist to get a diagnosis because a lot of people think I might have anxiety but I can’t get a diagnosis because I’m “too young”

[@lyndseyevans176]

I agree with all points here. The worst part is when patients become verbally aggressive and think that their TikTok diagnosis is more accurate than my PhD diagnosis

[@itspresro]

😔

[@Vercanya]

My first therapist wanted to diagnose me with GAD, back when I was still in an abusive relationship and was suffering from high anxiety and panic attacks. I've been told I was "overly sensitive". Another wrongly suggested Bodily Distress Syndrome (BDS), even though the symptoms I was describing didn't even match that diagnosis (I had talked about my dissociation, emotional symptoms, bodily armoring). I have now the correct diagnosis - PTSD and Complex PTSD. The people who gave my diagnosis and who I'm going to therapy with know so much about Complex PTSD, trauma and even neurodivergencies - but unfortunately not all MH professionals are actually properly informed or they let their own biases get in the way of listening their patients. The patient isn't always the problem.

[@meyr1992]

@nanajasmin1008and how are you so sure youre not misdiagnosed right now?

[@magicjohnsins]

I'm not trying to be a contrarian here but I've received 5 different diagnoses from as many psychiatrists. Why would a patient weigh the opinion of a psychiatrist greater than their own when psychiatrists themselves are inconsistent?

[@Stephen3482RD]

Im a pcp and my pcp was rx’ing stimulants and ssri and i was feeling burned out/anhedonia/low frustration tolerance. I saw a neuropsych and they felt I had adhd. I kinda took matters into my own hands and started Auvelity - met w psychiatrist - psychiatrist felt unspecified depression. I would say this med has been a game changer for me. Wayyyyy less frustrated, less agitation less anxiousness more calm more chill

[@10byrdie]

This is a great point but for ppl like me Black and a Woman self diagnosis can be the only option as we can present differently (underrepresented in research) and are often under diagnosed.

[@bell10877]

Amazing. Your honesty and sharing makes you an even better psychiatrist!

[@Ceej54]

As someone who is fortunate enough to see a psychiatrist and therapist, I couldn’t agree with this vid more. We honestly got way too much skin in the game to make a fair judgement and it’s much easier to consult with someone who has that skill set.

[@kristoffer6747]

See this is why my mind has been set on this train of thought: I don't care what specialty you are in, if you work or consult in a hospital( or honestly most of the medical field), therapy/counseling would be EXTREMELY beneficial to your mental health, especially if you work in mental health because you take on everyone's baggage whether you realize it or not. A saying I heard on TV, you can't take care of your patients if you don't take care of yourself. (Meanwhile, me over here knows I should probably get counseling/therapy [not in the medical field but have been through some things] and my best friend has recommended that I get it to help with some anxiety I have developed over the years in response to some I guess trauma in my life). If only there were actual resources to help me get it as I can't afford it and I don't have transportation to get there.

[@safaasgari3115]

I'm dying every day. I was on many drugs for my OCD and then they misdiagnosed me with bipolar put me on many other drugs my life is over. It's been six months. I am off my meds, but it's like nightmare😢 Akhatisia,anhedonia, cognitive impairment, insomnia, DPDR, racing thoughts, and severe mood swings،Hyper sensitive nervous system. Hyper salivation,horrofic nightmare. I'm getting worse every day. I can't take it anymore 😢😢 I really want to live, but I can't take it anymore. I am so close to suside everyday.

[@LittleMonstr16]

This was such a fantastic explanation, thank you! You verbalize and untangle complicated topics so well

[@ElijahKilstrom]

I definitely did not start this video agreeing with you. This nuanced argument definitely took me by surprise. I don't know if I completely agree with you, but you've made me think a lot. Thanks.

[@WillemPenn]

Counterpoint: After 30+ years of misdiagnoses that followed me around like a cobbled together Frankenstein monster, no treatment seeming to work for a variety of symptoms across disparate systems (neurological, GI, etc.) and decades of failed therapies, I randomly started to get “are you autistic?” videos suggested on KZbin. I initially dismissed them, but they kept popping up so I watched a few thinking I wiped not identify. But I did. And it really bothered me. Because I couldn’t be. Because somewhere along the line someone in my decades of extensive mental health treatment someone would have picked that up, right? Right?! So I brought it up to my psychiatrist. His jaw dropped. He had not even considered it because I came in with other diagnoses. Looking at me with fresh eyes it seemed very clear to him though. We did testing. Lots of testing. He referred me to a specialist. And guess what? I am, in fact, autistic. It was like the world finally made sense. But it was 30 years of my adult life with one wrong diagnosis during law school that led to another that led to another that led to another and no one thought to ever question if those diagnoses were correct. They just kept on tacking on diagnoses to explain symptoms and not listening to me. And Preston, here is the thing, it would be one thing if my story were unique, but it is not. So when you tell people self diagnosis is bad, *you* need to give us a reason to trust professional diagnosis in a system that is riddle with long wait times, woefully inadequate time spent with the patient, high co-pays, expensive treatments, guessing game mental health medications, barbaric attitudes towards MH that are still not much better than a century old (we are still using shock therapy and don’t get me started on the lack of long-term double-blind follow-up studies that show true effectiveness compared to say ketamine or long term memory loss issues), the undying discrimination that minorities (women, POC, LGBTQIA+, etc.) face simply reporting symptoms, etc. And Preston, I think you have good intentions, but you come across a bit like the doc you complained about in the last video who was dismissive of the resident who unalived - please do not use your reference point as a privileged white male-presenting late 20’s/early 30’s something who lacks a certain level of self-awareness to mean that all MH patients lack that level of self-awareness. Actually, not only does that live experience makes us better than our treating physicians at reporting our own symptoms (they are our symptoms FFS), the decades of CBT, DBT, IFS, EMDR, biofeedback, ACT, yoga, meditation, etc have made us experts at knowing ourselves. Trust that someone who has spent almost as long as you have been on this planet developing the detached skills of self-observation might actually have a self-observation skill that you do not, and that you may have patients like that. Because MH patients *have* to develop that skill to survive. So please do not condensed to us. Thanks. 🙏

[@SuperHappyNotMerry]

👏👏👏. exactly this! beautifully said!

[@keyc.1109]

I was 32 When I was diagnosed with ADHD and 33 when I was diagnosed with Autism. As a late diagnosed woman, self diagnosis saved me. I now know that I am not a broken human being. I was so good at researching my symptoms that I was practically diagnosed with autism before the first appointment (I sent the doctor all my findings).

[@swissarmyknight4306]

I feel you so much. Been diagnosed with everything under the sun, accurate diagnosis is probably PTSD (combat veteran) and ADHD (possibly AuDHD). Took me 25 years and a staggering amount of money to get any relief. I figured out I was neurodivergent on my own, and my health system outright rejected testing me. Paid for it on my own, came up clearly ADHD, possibly ASD (my ADHD was so out of control I blanked on all the ASD questions). The VA couldn't fathom the concept that a neurodivergent person could have survived the Army and combat, and also were profoundly ignorant about developmental/neuropsych stuff. They hear hooves, they thought "horse" and rejected the idea of "zebra". I literally told them "I'm sure I have PTSD and also something else" 10 years ago. If I hadn't "self diagnosed" I would have continued to deteriorate and probably would have un@lived myself (doing way better now that I know what I am and have the right medication).

[@Trexusable]

bro is on the solo run for "making psych competitive specialty in match any%" SHEEEEEESH

[@steggopotamus]

I feel like it's different for neurodivergency. Like studies show 80% of self diagnosis in autism is accurate and there's much better resources for diagnosing neurodivergency than not. for me, I realized I might have adhd, taking the nonstimulant meds and having them work betternthan anything rlse for my anxiety is what cinched it though. Haven't tried to get the autism diagnosis recently. I tried to trust the psychologist 10 years ago when I tried, i hoped that she would ask more indepth questions then decide to so an evaluation, she just believed my mask and sent me on my way. Most of my childhood, I would flip lightswitches and just spin the wheels of cars, but she'll never know. I'm a woman too, so I don't seriously blame her. But it's still making it hard for me to think going back for a real diagnosis is worth it.

[@itspresro]

Would love to see the papers on autism self diagnosis (not trying to be rude genuinely curious) if you have a link

[@steggopotamus]

@@itspresro i think the point I'm trying to make, the same one your trying to make but from the other side. It's what you said right, "patients are experts on their own experience". And adult diagnosis starts with self diagnosis, most of the time. Patient goes in and it's been weighing on their mind for decades. You're not against self diagnosis, you're against exclusively one-sided diagnosis. And I am too. Were both against patients ignoring science, but we're also against science ignoring the patient's experience. Honestly, I got the statistic off a recent video, by jeremy andrew davis. And I think he'd love to tal to you about it and get your opinion. I'm just a woman who feels I have to self diagnose because women aren't seen as neurodivergent. (Seriously though it was one of those things where in trying to look normal I didn't admit I had asthma "I just have trouble breathing sometimes and then everything else in my life was the same. Peace.

[@swissarmyknight4306]

@@steggopotamus I feel you sibling. This is my life as well. Psychologists and psychiatrists wasted over a decade of my life and never thought "nothing we're doing is working, maybe we should explore other avenues". The best part was when they blamed me for not getting better from their (mis)treatments. I had to go around them to get assessed ($2,500 and a six month wait, and I'm one of the lucky ones) and got the ADHD-I diagnosis immediately and conclusively. Stimulant medication has led to my first experience of relief. I'm "self diagnosed" with ASD, but I'm pretty on the fence about whether its worth another ANOTHER $2,500 to get officially diagnosed just so people like "itspreso" will give me permission to exist. I've been living as though I'm autistic, learning about sensory management and burnout, and doing a lot better, too bad I had to wait till I'm an old man to start to live life. These people act like diagnosis is free and everyone has access.

[@WillemPenn]

@@itspresro Dude, so many ppl have made similar comments and you can’t even acknowledge it. And then you posted a vid about properly commenting with the second point being “I have an ego and sometimes the comments hurt.” But you can’t even acknowledge how dismissing all the comments by the self-diagnosed autistic community in response to this video are extremely hurtful to that community. Jeeze. That’s why I unsubscribed from you. I thought you genuinely cared. But I realized you were just another egoist posting not for interaction or real discussion but applause. Must be a doctor. Thinks he’s God. No lay person could possibly understand medicine or read the DSM. It’s offensive Preston.

[@dansaintamour]

"Ya don't know whatcha don't know".

[@T123456788]

You are fucking crushing it recently

[@g-1050]

What a fantastic mustache.

[@Corihor]

These posts are really informative and helpful! Appreciate the new content!

[@alexsad24]

Love these new videos Preston! Thank you

[@neenasinghal2308]

I love these videos Preston. Can’t wait to start psychiatry residency soon

[@Diego-ce4bs]

Thank you for sharing your journey good sir

[@dnatortnator]

I've had this similar situation except it's been ADHD-inattentive vs. anxiety -- I basically self-diagnosed ADHD and the doc went along with it and gave me stimulants which have helped a lot. I can't tell if I have so much executive dysfunction and desire for video game escapism because I actually have ADHD or if I more likely have anxiety and resort to heavily avoidant behaviors as a coping mechanism. Or I just have neither and got used to coasting along until I hit med school and now have to undo it. Meh I can't tell. Idk, stimulants have helped me do really really well during 3rd year of med school so I'm just going to stick with it but I'm kinda like uhhh did I fuck up here by pushing for a potentially wrong diagnosis early in med school and the newish primary care doc was like "sure he probably knows what he's talking about, just give him the meth" also hot take: give every med student adderall and prozac day 1 until end of residency lol (jk in case not clear)

[@kidaz]

That last sentence. It poisons the well. So true.

[@benforno3354]

Mate - you're communicating the Psych 101 stuff real well here - tying the textbook's reasoning to your relatable experience and taking us through the story to the resolution. I'd love to hear you take the thought a bit further. You've proven the point, what's an implication of that which you find interesting?

[@javiboscaino]

Great wisdom, happy to see this on my feed

[@alexrogers777]

This might sound like a bad faith take but blaming self diagnosis for the public questioning the legitimacy of psychiatry is an absurd level of blame shifting. gee I wonder why the public might feel the need to self-diagnose, maybe it's because psychiatrists are damn expensive, or have extremely long wait times for appointments, or still have yet to come up with a single physical empirical test for mental illness.

[@alexrogers777]

Like you were saying about how it's impossible for you to be impartial when self-diagnosing yourself, it must then also be impossible for you (a psychiatrist) to be impartial about psychiatry and the issues that cause people to question its legitimacy.

[@Thatsprettiemuchit]

Also what harm is being done by the public questioning the legitimacy of psychiatrist? Isn’t self-diagnosis actually validating the legitimacy of mental illness as medical pathology? To me that line was revealing more of an internal conflict that Preston had than an observation about society. I think he is feeling his own internalized stigma working against himself and he is still questioning the legitimacy of his own clinical depression. I think the last line is projection.

[@swissarmyknight4306]

$2,500 for my partial diagnosis, another round to try to get the full enchilada will cost me another $2,500. I think I'll "SeLf DiAgNoSe" and pay my bills and buy food instead. These people act like diagnosis is free and everyone has access.

[@ratlord_ali]

Yeah I gotta say I have conflicting feelings on this one. I see that you're trying to make a point about people "deciding" they have a specific disorder and refusing to consider alternative explanations or becoming belligerent when a professional disagrees. But well-researched "self-diagnosis" can allow people to take important steps in developing coping skills or self-management techniques. I figured out I had ADHD when I was 12, and didn't get my official diagnosis until I was 19. I would have had significantly worse mental health and academic performance overall had I not determined that ADHD coping strategies were what I needed to persue, and done research into what exactly executive dysfunction meant to be able to better understand my emotions. Of course before I could be diagnosed, a diagnosis of GAD had to be made and addressed to see which symptoms were purely owing to anxiety- and had I not been patient and accepting of the diagnostic process, it would have been a very difficult thing for all involved. So I definitely 100% agree that patients need to be flexible and accepting of alternate or additional considerations. But it's hard to be flexible when you're desperate- which I would have been without the tools I developed as a result of my self-dx. Along the way, I had a good few medical professionals I knew socially discourage me from even considering I had ADHD until a doctor suggested it, saying that self-diagnosis was dangerous, or that they would refuse to consider ADHD on the mere basis of me bringing it up. So while I appreciate the need to discourage patients from investing themselves in a self-dx, I think it's also crucial to consider that the vehement pushback from patients is an overreaction to a genuine issue. If medical professionals refuse to engage with a patient's genuine concerns, and there is a general blanket vilification of self-dx'ing in the field, it does foster an adversarial atmosphere between patients and providers that just circles right back round to patients digging in their heels because they feel they're not being listened to. ...which is, I realize, beyond the point you were making in this video and kind of off on a tangent. Such is the way when you address controversial topics. Anyway, appreciate your level-headed commentary on this.

[@imdragonfruit6341]

Thank you doc P

[@itspresro]

You’re welcome imadragonfruit

[@thebeatles9]

I'm running out of nice things to say you keep posting so often

[@itspresro]

You flatter me

[@silly_jay]

Okay now make diagnoses affordable and accessible! Aww you can’t? Okay back to self diagnosing!

[@freebeerishere]

I think there needed to be some kinda definition in this of what self-diagnosis means and what most people think it means and what it means in different contexts. From what I understand this is a psych channel so I get that people aren’t gonna read this as info on tummy aches, so when I say different contexts I mean stuff like ‘neurodivergence’ (dyslexia, adhd, autism etc) and ‘mental illness’ (depression, anxiety etc). I appreciate the mention of money being a barrier but there are also factors like race and gender (which I’m sure you’re aware of) that probably needed to be considered. An obvious example is misdiagnoses and under diagnosis of autistic women and girls because of autism either being blatantly understood as a ‘boy thing’ or unconsciously understood as a boy thing due to the way it has been studied. ‘Self-diagnosis’ is obviously not perfect or an absolute as explained in this video. However self-realisation maybe the only option and even the better option for marginalised people. This is just a vibe not an actual thing but I get the sense that people who are likely to ‘self-diagnosis’ are deeply interested in psychology and more importantly, understanding themselves, thus would probably seek professional advice when they could. ‘When’ referring to when they have the money, safety, independence or understanding.

[@Ivy20242]

I get ur point but sometimes it s obvious. Like maybe someone binges than purges everyday for dsm criteria bulimia timespan. I think u can say someone can correctly say they have bulimia. They just might be having more than bulimia. Like maybe depression, adhd, schizophrenia AND that is contributing to the bulimia. So it s not all bad i think and for sure not all wrong. I feel like when u share with a psychiatrist things u share ur own experiences. So it could always be biased.

[@gerardmcateer4849]

Sleep is the best medicine of all. Regular rigid sleep routine. Routine strengthens the brain. Recreational drugs weaken it.

[@koko_24bun]

id love to have a chat with you on this, but i totally understand if you dont! i really like your example, showing how warped and wrong public perception and understanding of many mental issues and disorders are, and nicely portraying the potential misleading factors in self diagnosis, and even mentioning the true fact that it does have dangers if done wrongly. And while i do have understanding for this, since your video is short and likely addressed at the people who are more likely to fall into or observe tik tok self diagnosis, since i believe this even originally was a tik tok video, i dislike a lot how black and white you are about it. i disagree with self diagnosis based on public perception, and also tik tok and generally every form of short form and unscientific content without official sources, like the one in your example. but self diagnosis for me and many people ive met looked very different (please keep in mind that my experience comes mostly from autistic female people, who tend to have a high skill at analysing and studying topics properly allthough by themselves, which is a factor that definitely does impact the bias in my stand on this) the first difference being what its based on. that of the people ive met werent based on the public perception of the specific disorders or issues, but mostly on months of research with approved psychiatric resources and a lot of self reflection and documentation the second one is the way someone goes about it. in the cases i saw and deemed valid the people didnt see a disorder and try to diagnose themselves with that one, but researched which disorders and issues their specific problem or combination of problems might root back to, and research that general field. ive seen a lot more people self "diagnose" with a field of disorder than with a specific one, or at least at first, and especially those cases were most likely to be legitimate the third one is impact and future. the self diagnosis was done to find solutions, accommodations and explanations. the self diagnosis also wasnt treated like a last word, but more like a step in between. the people didnt tend to self diagnose and demand medication and therapy for what they self diagnosed with, but to self diagnose before getting an official diagnosis, and to survive the time being until then. the steps they took in between self diagnosis and official diagnosis generally were safe and reversible at the least, accommodations, example: self diagnosing with hypersensitivity and then accommodating by using ear protection and buying sensory friendly clothing my personal experience with self diagnosis involved many things, including a lot of research, but excluding tik tok. i never came to a conclusion before doing research on what i suspected having, and on what i need to rule out, and the conclusions werent solid stances but rather suspicions waiting to be confirmed. i know that my research was thorough, because i have experiences of suspecting a disorder but then doing the research and realising it was something else, proving that my baseline of research is pretty high and reliable. ive self diagnosed with 4 disorders in the past, which were all officially diagnosed, even in consideration of the fact that i might be malingering or showing false symptoms due to the amount of research i did. i dont want to get too personal, but i do feel the need to at least mention how incredibly beneficial and life saving some of this self suspicion and "diagnosis" was self diagnosis is always gonna happen, whether out of desperation or mere curiosity, and i feel like instead of looking down on it and invalidating it we should focus on spreading how to treat it and how to do it properly, and differentiate it from the genre of faking disorders

[@RedPepperyElk]

Preston: "Don't self diagnose..." Everyone else 🤔: "Oh I definitely have anxiety not depression - makes perfect sense..."

[@nicksears7734]

Hello Preston! Thank you SO much for sharing this! It's eerie--I actually find myself going through very similar things in my life right now as I'm finishing up my third year of medical school, and was actually considering making a telemed visit with a PMHNP next week to discuss starting Welbutrin, for reasons similar to what you described. Now after seeing this, I'm second guessing my insight and wondering if I should consider other perspectives. Just curious--what are your thoughts on PMHNPs and how they practice compared to MD/DO psychiatrists? Thank you!

[@DrSeaLionMD]

This post is brought to you by the Wellbutrin gang

[@J_MHequi]

👏👏👏

[@DennisBolanos]

Doc, what is your opinion of medical graduates who choose psychiatry to better understand their own minds? Is that a bad reason to choose a specialty?

[@itspresro]

I think that is a fine reason to choose a specialty

[@eliwhitehouse2104]

I don’t know exactly what you’re responding to, but truthfully I don’t see the difference between self-diagnosing and simply doing the introspective work your psychiatrist may not have the time or inclination to otherwise prompt you to do despite it being necessary for them to do their job. People can be obstinately unaccepting of the realities of their own health whether it’s physical or mental. Obviously, holding to a misconception of one’s health is counterproductive. But in no other area of medicine would we say “well some people have munchausen’s syndrome, or hypochondria, or deny the truth to avoid the conclusion that they have to make certain lifestyle changes. Therefore we should all abandon this pesky practice of ‘self-diagnosis’ that leads so many people to come in telling us they’re feeling dizzy, or fainted, or are having joint or organ pain and have a notion of what’s causing it that is serious enough to seek medical attention.” The fact is, you get treated for the problems you care about. Mental health treatment is hard enough to get that you won’t see anyone if you aren’t passionate about solving whatever you’re going through. You can’t do that without making some honest attempt at figuring out the problem; which is the process of attempting to characterize one’s illness. To me, the notion that you would follow through on getting psychiatric help, let alone actually accept a chemical intervention, without attempting to figure out what’s wrong on your own makes no sense. That’s like saying “well you shouldn’t think about why you might be having physical symptoms before going to the doctor about them.” What? Just keep an open mind and ask questions. In my experience, not attempting “self-diagnosis” is basically abdicating any attempt at understanding whether the doctor is asking you the right questions. I rarely trust a doctor to be as thorough in requesting relevant information about my own life as I can be in attempting to interrogate these same questions on my own (much cheaper) time.

[@peacefulwarrior9518]

I disagree with the idea that you CAN"T be self aware and objective. But I do agree that it is difficult and that you should find a second opinion.

[@user-bx7ek5dl5h]

Post match - I wish I would have applied psych.

[@FurkinAmazing]

That is one baller mustache

[@adegun10]

4 Preston videos in 48 hours 😮❤️

[@itspresro]

Dude more to come

[@clairbear1234]

I would really love to know your take. Is psychiatry just made up? Hear me out, serotonin hypothesis is a myth, and BPD often appears to be repackaged “hysteria” diagnosis, and trauma is often diagnosed as other things and buried under the rug by unskilled clinicians. It seems really flawed and I would love to know what you learn in psychiatry school regarding scientific basis for DSM diagnoses and medication

[@itspresro]

I’m working on a video to answer this question right now!

[@clairbear1234]

@@itspresro amazing! I’m an RN and I interface with so many psychiatric patients, it will be really helpful and informative! Looking forward to it

[@shaunzanyusof2102]

I just don’t understand how you can be so sexie

[@masterofdesaster8]

Isn't the delayed effect of many psychiatric medications part of the problem? SSRI take about 3-4 weeks of regular intake to effect mood. I'd assume many (non-healthprofessional) patients have difficulty managing their expectations or processing that information. In this age of instant gratification many people have never learned to exercise patience.

[@venetianskies]

at least some sanity, some of the more extreme self diagnosers try to weasel themselves into the autistic community

[@Lawlstube]

Finally some logic. So sick of these videos just promoting pseudo scientific lies.

[@abd-animation-22]

As a psychiatrist let's say u met 100 patients over a year How many of them did manage to cure/improve their life to the point of remission of their psychiatry disorder If the answer is less than 10% of them then that's why this specialty s*cks and frustrating

[@itspresro]

It depends on the illness. For depression it’s around 66% that go fully into remission after several med trials. For schizophrenia, 30% will NEVER respond to meds

[@itspresro]

Psychiatry is not as good as treating mental illness as antibiotics, that’s an undeniable fact. I would argue that depression is a much more complex and ambiguous diagnosis to disentangle and treat than e. Coli in your bladder and I think that deserves tolerance of a lower success rate

[@abd-animation-22]

@@itspresro 66% That's actually really good. Count me surprised I thought it was close to 10%

[@samkadel8185]

"in remission" is often a misnomer. For example, ADHD is a neurodevelopmental disorder. It physically can't go away with psychiatric meds, because medication does not change the fundamental structure of the brain. It can be improved with medication, but it physically can't go into remission. Many illnesses in other fields cannot disappear. For example, I'm a diabetic. Until recently, that was a death sentence. Now, I have to take on the role of controlling my insulin by hand. Turns out, that's really hard. I'll never be as good at insulin control as a functioning pancreas would be, but I can stay alive now.

[@keyc.1109]

I disagree as late diagnosed AuDHD woman who would have never gotten the diagnosis if I hadn't self-diagnosed first.

[@swissarmyknight4306]

SAY IT LOUDER, SAY IT UNTIL THEY LISTEN

[@disneyprincessintraining2725]

Maybe I’m misinterpreting, but I think his point is to be open to a good psychiatrists input and use their evaluation combined with your suspicions to get to the right answer and to get an appropriate diagnosis and treatment plan. In my opinion, there’s self identifying a potential cause and self-diagnosis. The difference for me lies in if you’re willing to be open to other answers as well

[@anonymousfox7219]

This is the first time I'm going to have to vehemently disagree with one of your videos. As you acknowledge, official diagnosis is a privilege. I'd like to add that it's not just one of wealth, but of race and gender too. The prevalence of misdiagnosis because of the gender and ethnicity of patients is huge. So I'm confused why on earth you would deny people the ability to seek support for their conditions if and when official diagnosis isn't available to them. Because they might get it wrong? Well, clinicians get things wrong too. Treating mental illness is often a trial and error thing, where you see what supports and treatments work for the individual with diagnoses as a guide more than the end-all be-all. That's not any different whether a person has access to a liscenced psychiatrist or is getting community support from people with the same condition who they found via self-diagnosis. It's hilarious to me you'd say that these people are "poisoning the well" as if the entire well isn't already mostly poison (look I believe in the good that mental health science has achieved but there's a spotty history and then there's being founded by fucking Freud and continuously influenced by other quacks for all of your history up to the present day.) You say a self misdiagnosis "might do more harm than good". Ok. How though? In what way? Please elaborate because personally I think in any case where official diagnosis is not available it is better to try and seek community support than to just go on suffering with a condition and no help at all. TLDR you're being paternalistic. Check yourself.

[@aydenr5467]

Why do we need to replace a patient's own story (narrative) with our own socially constructed one?

[@user-xy4ff5yp7b]

Cue everyone who has self diagnosed as autistic and ADHD from TikTok lol

[@plastictouch6796]

You have too much skin in the game to give an opinion on this. Sounds to me like you are huffing copium and trying to justify your existence. /teasing

[@kevingave3153]

Why waste all that medical training on this foolish field?