When I was twenty, I knew I had ADHD (Attention-Deficit/Hyperactivity Disorder). My head felt like a constant buzz of loose ideas, I couldn’t sit without bouncing my legs, I had at least five unfinished projects buried around my cluttered dorm room, and I forgot my keys and jacket so often I thought I was missing a sense of object permanence. At the time, I was meeting with a therapist at my college’s counseling center, and we spent a session ticking down the list of ADHD diagnostic criteria; I checked nearly every box. So, my therapist referred me to a clinic for a robust battery of psychological assessment.

For a full eight hours, I took cognitive tests, personality inventories, symptom checklists, and even a projective assessment (like the Rorschach inkblots). The psychologist overseeing my case even spoke to my parents to explore how my symptoms had presented in childhood; she covered all bases thoroughly. After a few weeks, I met again with the doctoral student who conducted these assessments so she could go over the half-inch-thick packet of my results. As I joined the Zoom meeting, my heart was beating out of my chest and I could feel my cheeks flush, an embarrassing contrast with my assessor’s calm, reserved expression. She greeted me gently, shared her screen, and promptly dismantled the entire diagnostic identity I had constructed for the past six months.

Challenges to My Self-Concept

I do not have ADHD. As that doctoral student kindly explained to me, cognitive tests had shown that my brain had none of the functional deficits that show up for someone who meets ADHD criteria. However, I was putting “yes” and “strongly agree” on every test that looked for symptoms of anxiety. I was experiencing anxiety chronic and intense enough that it caused persistent difficulties with focus and physical stillness in a way that felt very much like ADHD.

At first, I struggled to accept this challenge to my self-conceptualization; I saw myself as a carefree, adaptable person, and the diagnosis of generalized anxiety disorder I received felt like a contradiction of the traits I liked about myself. ADHD, on the other hand, fits my narrative far better. If I had ADHD, I felt like I got to be “absent-minded” instead of “distracted by constant worry,” or I could be “energetic” instead of “tightly-wound.” However, it was hard to argue with the hefty chunk of paper telling me otherwise. I decided to meet with a psychiatrist and start medication, and I started meeting more frequently with a new counselor. After some time, hard work, and positive changes in my circumstances, I found that not only was I able to focus and remember the things that mattered to me, but I was also much more aware of the ways anxiety affected my life and was able to take more control of when and how it impacted me.

Who’s Right?

So, I self-diagnosed, and I was wrong. Or, at the very least, a couple psychologists disagreed with me. However, in another sense how could I be wrong? It’s not like that doctoral intern spent eight hours with me and suddenly knew me better than I knew myself. My self-perception was accurate; I did indeed have trouble concentrating, difficulties with absent-mindedness, and all the rest. Furthermore, I had always tried to approach my life with a certain flexibility, a phlegmatic attitude if you will (we’ll talk about that in a second). Instead, that PhD student challenged the language I was using, because in her circles, ADHD means something beyond self-concept; it means medication, specialized treatment, even academic accommodations. If I got it wrong, I just needed more accurate ways to describe my experiences, but if she got it wrong, I could get risky access to amphetamines. That’s my thesis: when someone self-diagnoses, they are capturing something honest about how they experience themselves and their life. They may not understand a disorder in the same way as a mental health professional, but they are always sharing something real about who they are.

When we frame the issue this way, debates about the “validity” of self-diagnosis are unimportant. How can someone describe their subjective experience invalidly? That said, it would also be unwise to suggest that someone who spent over half a decade earning a doctorate in psychology is as good as anyone else at identifying disorders from the DSM. How do we hold personal expertise and subject-matter expertise in tension like this?

A Therapeutic Approach

Speaking from the position of a mental health professional, each side of this equation needs to understand and respect the specialized knowledge of the other. My clients always have the final say on themselves, and I get to decide what diagnostic code I put on their medical record. Whenever it feels like we’re contradicting each other, I need to take a step back and explore what isn’t lining up. And, when a client tells me they’ve self-diagnosed, I don’t immediately send that information to their insurance, but instead explore what that particular label speaks to them. Sometimes they’ve described a disordered experience in the same way psychologists would. Other times, I can explore with them to find a term that better represents this person to insurance companies or other mental health professionals and informs an effective treatment plan. When we meet each other with respect and dignity, conversations about self-diagnosis help me get to know my clients better and strengthen our sense of trust in each other.

Sometimes, too, the psychologists might be wrong about how they classify disorders. Every edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders) has corrected unhelpful diagnoses or filled in gaps where a diagnosis could be helpful. For example, the DSM 5 (published in 2013) was the first edition of the DSM with no diagnosis for homosexuality, since it is now (finally) widely accepted that being gay is not a mental disorder. Gender dysphoria, too, is a controversial diagnosis; gender is fundamentally an issue of identity, not pathology. Although healthcare professionals must carefully consider risks and side effects when prescribing medical procedures, no doctor, psychologist, or therapist can determine whether someone is transgender. Gender dysphoria is simply a quantifying label for someone’s distress about gender incongruence, not a gatekeeping method for an identity. All that to say, we mental health professionals must exercise humility when listening to our clients and the zeitgeist; diagnosis is a dialogue, not a sentencing.

There is No Shame in Self-Diagnosis

Sometimes clients are embarrassed to tell me when they’ve developed a diagnostic suspicion about themselves, but I love those conversations because they always teach me something new and important about the person I’m meeting with. Even if someone hasn’t assessed themselves accurately in a clinical sense, they’ve still touched on something true about their experience and identity. I don’t need to “correct” my client, and they don’t need to defend their self-concept; instead, we have productive discussions that prioritize the client’s well-being and understanding above all else. Just like when I thought I had ADHD, diving deeper and assessing further allows everyone to get the help they need.

Reach Out

If you can relate to my scenario, please don’t hesitate to reach out and schedule an appointment with me today – it would be an honor to meet with you. Consider searching for a therapist here today!