Social media and mental health: The double-edged sword of self-diagnosis

Aqib Ahmed, a former student of Brac University recently diagnosed himself with Attention Deficit Hyperactivity Disorder (ADHD). 

"Everyone always tells me that I am too sensitive, stupid and lazy. My cousins used to make fun of me and call me autistic. My whole life, I have felt different from people around me," he said.

Aqib constantly felt inferior for not being able to do basic tasks that everyone else seemed to manage easily.

Things changed for Aqib when he started coming across ADHD content on Instagram. He started to relate to it. He learned the phrases, words and language to express his feelings in a way he was never able to previously.

"It was like a revelation. For example, I learned that one of the primary ways ADHD impacts productivity is through executive dysfunction. Due to a lack of dopamine production in the brain, certain menial tasks, no matter how easy to do, just start feeling impossible. 

My brain literally does not allow me to start working on it," Aqib explained.

"If they interact with social media posts about mental health, they keep seeing more posts about the topic, giving them constant exposure to these topics. This often causes an echo chamber which reinforces their beliefs about their mental health."

Dr Helal Uddin Ahmed, psychiatrist, National Institute of Mental Health

In recent years, social media has given rise to a new phenomenon among young people across the world — self-diagnosis of mental health issues.

The widespread use of social media among young people and an increase in digital content creators who speak on many issues including mental health awareness fueled this phenomenon in Bangladesh as well. 

Instagram and TikTok allow users to consume bite-sized mental health content regularly in the form of short videos or written content.

According to Dr Helal Uddin Ahmed, who works as a psychiatrist at the National Institute of Mental Health (NIMH), the main illnesses that he sees his patients self-diagnosing themselves with are adult ADHD, bipolar disorder, borderline personality disorder and depression.

Why people turn to social media for a diagnosis

"Self-diagnosing within the newer generations has increased due to the internet," said Dr Lipy Gloria Rozario, psychologist, founder and director of Healing Heart Counseling Unit. "People view social media content relating to symptoms associated with different mental illnesses and they become convinced that they also have the same illness if they find a couple of symptoms that match," she added.

Additionally, the more a user interacts with a certain type of content, the more the algorithm pushes similar content. As such, it has become all too easy to have your social media feed filled with mental health content.

"If they interact with social media posts about mental health, they keep seeing more posts about the topic, giving them constant exposure to these topics. This often causes an echo chamber which reinforces their beliefs about their mental health," explained Dr Helal.

However, in Bangladesh, there are other important factors as to why people may seek out self-diagnosis rather than expert opinion.

"Even though the stigma related to mental health has decreased somewhat in recent years, it remains strong within much of the population. Many parents refuse to allow their children to seek therapy, fearing societal backlash," stated Dr Rozario.

Alongside the social stigma still attached to mental health, another major reason for self-diagnosis is the lack of finances or access to proper mental health care.

Anika Akhtar, 24, works at a private company. She self-diagnosed herself with anxiety disorder, coupled with obsessive-compulsive disorder (OCD). "Therapy is very expensive, and it must be sustained long-term to be truly beneficial. For me, I cannot yet afford to go to a professional to get my diagnosis. So, until I can, I am experimenting with different medicines for my anxiety to see what helps."

For those who live outside of Dhaka, the situation is even more dire, as there is a lack of accessible mental health institutes with qualified therapists.

In addition, a major reason why people are reluctant to seek professional help is that many therapists turn out to be judgmental about their patients rather than helpful. 

Navila Rahman, 22, a private university student has been identifying herself as being on the autism spectrum for three years now. 

"I struggle to pick up basic social cues, and I am often confused about how to communicate with people without offending them. I always feel like there are social scripts that everyone other than me is aware of, and when I am not able to follow the script due to a lack of understanding, people get upset," she said. 

However, for Navila, getting a proper diagnosis is not a feasible option. 

She believes autism is an extremely misunderstood illness. She also pointed to another shortcoming. "There have been numerous studies that show that therapists often cannot accurately diagnose autism in women because most of the knowledge that they work with comes from observing men with autism, whereas women exhibit different symptoms."

Navila continued, "I did attempt to get a diagnosis once, but my experiences were dismissed by my therapist. Because I have been forced to mask my illness from society for so long, the psychiatrist did not think there was anything wrong with me, and he was condescending towards me when I explained my difficulties." 

Dr Rozario admits that this is a big problem in the industry. 

"There are some educational institutes that offer degrees in psychology or psychiatry but lack proper resources for teachers. Patients must do a proper background check on a therapist before selecting one. They must find out where they graduated from, whether they received clinical training etc in order to avoid bad experiences," she asserted.

Dangers of self-diagnosis

The main threat of self-diagnosis is the danger of self-treatment.

On one hand, social media has resulted in a global trend of young people becoming more aware of mental illness and on the other hand, this has also exposed them to potential misinformation or surface-level understanding of mental health, fueling inaccurate self-diagnosis.

"One of the problems with self-diagnosing is the chance of misdiagnosis. People who diagnose themselves through gaining social media knowledge have a sort of tunnel vision. They match their symptoms with ones associated with specific conditions, and they assume that must mean they have that condition. But, as trained professionals, we can see the bigger picture that they are missing," Dr Helal explained.

He further went on to say, "Exhibiting symptoms normally associated with a certain mental illness, such as ADHD, does not mean you have that condition. Symptoms can arise from a number of places. Lifestyle, diet, stress, family dynamics etc can all cause similar symptoms. This is why we have comprehensive tests, screenings and diagnostic tools for different conditions."

Dr Rozario concurred. "I have seen cases, especially with conditions like ADHD, where people not only diagnose themselves but take it one step further and start seeking medical treatments without consulting a specialist." 

In Bangladesh, ADHD medicine is available in drug stores without a prescription, so it is fairly easy to go from self-diagnosis to self-treatment for an individual, according to Dr Rozario. "This is extremely dangerous as an expert will consider many factors before deciding on medication as treatment." 

"They will look at your stress levels, whether your condition is actively hampering your life etc. Side effects of these drugs can be a problem, especially if people are taking them without proper knowledge or understanding," Dr Rosario added.

But is it all bad?

Social media has also increased the general level of awareness people have about mental health, leading to greater numbers of people seeking professional help. In Bangladesh, social media apps such as Facebook have also provided a platform for people who are suffering from mental health problems to come together in online groups and discuss their lives with each other, share positive and negative interactions with therapists, and offer each other support.

Furthermore, self-diagnosing often acts as the first step towards seeking a proper diagnosis, rather than being a side-step. 

For example, Aqib's journey to self-diagnosing his ADHD did not end there. After understanding that he has ADHD, he booked an appointment for an ADHD assessment at the Telepsychiatry Research and Innovation Network (TRIN). 

"The psychologist and psychiatrist who assessed me were very helpful, and they ended up diagnosing me with ADHD too. I am thankful to them, but I would never have thought to seek help if it were not for my self-diagnosis through the knowledge I gained on social media," Aqib said.

Dr Helal admitted that self-diagnosing can have positive outcomes. He also spoke of many cases where people self-diagnosed themselves accurately. "If this [self-diagnosis] can encourage them to then seek out a specialist for a proper diagnosis, then it can be a force for good," he said.