DMEJ
Duke Medical Ethics Journal
From WebMD to Well-being: The Implications of Self-Diagnosis of Mental Health
By Nam Ho
A mother is concerned by her son’s worsening behavior over the past few weeks. He has been acting impulsive and lashing out, not to mention that he got into a physical fight with two of his classmates and was recently caught shoplifting from a convenience store. Suspecting that something might be wrong with her son, she decides to look up his symptoms and behaviors on WebMD, a website she has used multiple times to diagnose minor illnesses in her family. The results that come back indicate that her son is a sociopath or at least shows signs of sociopathy [1]. Trusting WebMD’s results, she decides to take her son to be professionally diagnosed. Multiple visits with different psychiatrists suggest that a problem at school might be the root cause of his behavior, and the mother is surprised to learn that her son is not a sociopath.
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While this story is entirely fabricated, many people find themselves in situations similar to these. Health information services websites such as WebMD are popular sources of medical and psychological information used by approximately 70% of American adults to learn more about their illnesses, symptoms, and health concerns [2]. As of 2020, nearly a third of the U.S. population identified health problems within themselves, otherwise known as the process of self-diagnosis, based on online health data without any professional input or opinions [2]. More specifically, nearly 44% of the U.S. population has either self-diagnosed or diagnosed others with some type of mental health condition [3]. These health websites, health apps, and even social media sites can significantly influence a significant amount of individuals, leading to an overwhelming amount of cases of self-diagnosis based on the available information, especially relating to mental health or illness. When people make decisions regarding their mental health, the difficulty in making correct diagnoses and the possible consequences of an incorrect self-diagnosis should turn people away from the trap of self-diagnosing based on online resources.
“Self-diagnosing mental illnesses can lead to long-term consequences that could potentially be life-threatening”
Several key factors can contribute to the high percentages of self-diagnosis. One such factor is an effect known as confirmation bias, which is the tendency to lend more weight to evidence supporting their initial diagnosis while avoiding opposing evidence [4]. Individuals who look up their symptoms online might have some pre-existing, subconscious belief that they might have some disease, causing them to favor information that claims that they have some condition simply because some of the symptoms match those found online. Individuals also will tend to ignore or deny any symptoms that do not match because they do not fit in with their preliminary belief, making them much more likely to self-diagnose based on the initial search results instead of researching more carefully into whether the potential condition or illness wholly matches their own symptoms [5]. Confirmation bias can therefore lead to very inaccurate self-diagnoses, which may be detrimental for individuals that might have serious health or mental issues.
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Barriers to healthcare can also lead people to lean more into self-diagnoses of mental illnesses. A lack of education on mental health and illness in communities can cause individuals to be more susceptible to misinformation and online influences, potentially leading to more false self-diagnoses based on limited knowledge [3]. Issues such as lack of health insurance, limited access to transportation, and limited health resources in communities with lower socioeconomic statuses can lead individuals to delay or avoid seeking out care, or even prevent people from receiving necessary care even if they want it [6]. Over 100 million Americans, which constitutes nearly a third of the U.S. population, do not have a primary care provider, and 10% of that population also lacks adequate health insurance [7]. Overall, two-thirds of the global population does not receive professional treatment despite suffering from some form of mental illness, meaning that many people have limited options when it comes to medical information [8]. The fact that individuals are not able to receive professional mental health diagnoses from healthcare professionals or specialists leads to more reliance on online resources such as WebMD or social media as solutions for any present issues.
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Social media is one of the leading sources of mental health misinformation and contributes greatly to the self-diagnosis crisis. Many individuals on social media apps such as TikTok and Instagram brand themselves as “educational” influencers, and these influencers generally spread posts, videos, and other content regarding mental health topics. Many social media educators claim to have professional experience or certification, and their content is spread without any adequate verification or fact-checking [9]. Examples of some of these videos and posts might include titles such as “How to know if you have ADHD” or “Signs that you are depressed.” Although this type of content can help to decrease the stigma behind mental illness and increase mental health awareness, data suggests that 52% of social media videos regarding mental health are medically misleading, 27% of them only deal with personal or anecdotal experiences, and only 21% of the content are sufficiently accurate according to scientific and diagnostic criteria [9, 10]. Additionally, recent studies show that 83.7% of mental health advice on TikTok contains misleading claims, while the rest of the videos could even be damaging to the audience [10]. This is particularly distressing as most users of these apps, especially TikTok, are teens, adolescents, and young adults, meaning that these misleading and false videos make their way unchecked through a population of impressionable and potentially undereducated people. Due to the popularity and prominence of this type of mental health content, younger audiences are more likely to self-diagnose their mental health based on misleading claims, which can actually lead to a greater likelihood of developing mental illness and mental health anxiety [10]. If this misinformation is left unmoderated, the audience of these social media apps will only continue to self-diagnose, which could have lasting harmful effects on all users, especially the younger generations.
Diagnoses and facts from online resources or social media should be treated as helpful information but not as definitive and professional diagnoses. As discussed, much of the information found online could be misleading and should not be fully trusted. Additionally, some self-diagnoses may be based on personal experience or anecdotal evidence, which might not reflect the proper criteria for a certain mental illness [3]. For example, a person might believe that they are on the autism spectrum because they exhibit some behaviors similar to a person with autism that they know. There could be various explanations for the individual’s behaviors that would not place them on the autism spectrum. Misleading and anecdotal evidence are therefore incredibly unreliable in producing an accurate assessment of an individual’s mental state and health.
Infodemic. (2020). WHO. Retrieved from https://www.who.int/images/default-source/health-topics/coronavirus/feature-stories/who-infodemic---main-graphic-digital---no-text.jpg?sfvrsn=79f2b1bd_2.
Even if all the information and claims are correct and verified, people still should not depend solely on Internet sources for their mental health diagnoses. Mental illness are incredibly diverse with over 200 different official forms of mental illness, yet many mental illnesses and disorders have overlapping or similar symptoms [11]. Therefore, choosing to self-diagnose based on a list of symptoms or signs from a website can lead to faulty conclusions, as one condition could have very similar symptoms to another condition. Due to confirmation bias, an individual might fail to look more closely to see if there are other conditions or illnesses that better reflect the actual symptoms present in the person. Forming a diagnosis can be a difficult process even for professional psychiatrists and professional healthcare providers, as the Diagnostic and Statistical Manual of Mental Disorders, the guiding manual for professional mental health diagnosis, often contains variable criteria for different mental disorders that are often changed and revised [5]. Therefore, it is impossible to accurately produce a self-diagnosis based on general information from sites like WebMD or TikTok, even if the information is correct.
Self-diagnosing mental illnesses can lead to long-term consequences that could potentially be life-threatening. Making a self-diagnosis regarding a potential mental illness could lead to incorrect medical intervention and treatment if improperly diagnosed. People who self-diagnose mental issues may fail to recognize a medical condition in their bodies that may be causing their psychological symptoms [11]. For example, a tumor in the brain can cause both anxiety and changes in an individual’s personality. If an individual with a brain tumor improperly self-diagnosed themselves with some type of anxiety disorder without consulting a doctor, then they would run the risk of having the tumor go unnoticed and untreated for a long time to the point that it becomes unmanageable [11]. Self-diagnosing one mental disorder can cause people to look over more serious or life-threatening conditions, and due to the lack of professional training and knowledge, individuals might not realize the severity of their issue if they were to self-diagnose. Additionally, individuals may subconsciously act in a certain way or change their behavior to reflect their incorrectly self-diagnosed condition, which might lead to an incorrect professional diagnosis and improper treatment and care as a result [5]. Self-diagnosis of certain conditions might also lead to drastic changes in a person’s life as they try to adjust to their perceived condition, which could result in actions that affect their finances, life insurance, personal relationships, potential long-term plans, or more.
Online sources should not be trusted to provide accurate self-diagnoses of mental health and illnesses. While websites like WebMD and Mayo Clinic’s Symptom Checker are useful tools for better understanding both mental and physical illnesses and getting a general clue of what might be ailing a person, a correct and proper diagnosis must only be completed by professional healthcare providers. Doctors, psychiatrists, and other healthcare professionals have received years of training and education regarding all sorts of different health concerns, and these experienced professionals should be the ones to make diagnoses for all health-related issues, whether mental or physical. A quick trip to the doctor or psychiatrist would yield much better and more accurate results than a scroll through Google or TikTok. However, many people do not have easy access to health care or mental health resources, meaning that a trip to a psychiatrist is simply not feasible. Therefore, to prevent the rise of self-diagnosis, accessible and affordable healthcare for all people must be the number one priority. Social media can also be used to destigmatize mental health issues and resources as long as the information has been checked for accuracy. With the ability to receive easier and cheaper care without worrying about negative perceptions of mental illnesses, people would be more likely to go to a psychiatrist or healthcare professional to receive a formal diagnosis rather than relying on themselves and online information. Internet health websites and social media may not be sufficient for diagnosing mental disorders, but they can serve as platforms for improving mental health literacy and promoting better mental health care for everyone.
Review Editor: Jerry Liu
Design Editor: Angelina Huang
References
[1] WebMD Editorial Contributors. (2022). Signs of a sociopath: What to look for. WebMD.
https://www.webmd.com/mental-health/signs-sociopath.
[2] Hochberg, I., Allon, R., & Yom-Tov, E. (2020). Assessment of the Frequency of Online
Searches for Symptoms Before Diagnosis: Analysis of Archival Data. Journal of Medical Internet Research, 22 (3), e15065. https://doi.org/10.2196/15065
[3] Crosby, J. (2022). Thriveworks research indicates Americans commonly
diagnose themselves and others with mental health conditions. Thriveworks.
https://thriveworks.com/help-with/research/thriveworks-research-americans-diagnose-sel
ves-others/#:~:text=In%20a%20study%20commissioned%20by,%2C%20and%20sibling
[4] Elston, D. (2019). Confirmation bias in medical decision-making. Journal of the American
Academy of Dermatology. https://www.jaad.org/article/S0190-9622(19)32285-6/pdf
[5] Jaramillo, J. (2023). Down The Rabbit Hole of Self-Diagnosis in Mental Health. University of
Colorado Denver | Anschutz Medical Campus. https://www.ucdenver.edu/student/stories/library/healthy-happy-life/down-the-rabbit-hole-of-self-diagnosis-in-mental-health
[6] OASH Editors. (2020). Access to health services. Healthy People 2030.
https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-sum
[7] NACHC Editors. (2023). Closing the primary care gap: How community health
centers can address the nation’s Primary Care Crisis. National Association of Community Health Centers. https://www.nachc.org/resource/closing-the-primary-care-gap-how-community-health-centers-can-address-the-nations-primary-care-crisis/
[8] Shim, Y. R., Eaker, R., & Park, J. (2022). Mental Health Education, awareness and stigma
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[9] Pretorius, C., McCashin, D., & Coyle, D. (2022). Mental health
professionals as influencers on TikTok and Instagram: What role do they play in Mental
Health Literacy and help-seeking?. Science Direct.
https://www.sciencedirect.com/science/article/pii/S2214782922000987
[10] Martin, J. (2023). The big issue: Mental health and the TikTok effect therapy today. British
Association for Counselling and Psychotherapy. https://www.bacp.co.uk/bacp-journals/therapy-today/2023/april-2023/the-big-issue/
[11] Thatcher, T. (2022, July 26). Dangers of self diagnoses. Highland Springs.
https://highlandspringsclinic.org/dangers-of-self-diagnoses/