Psychiatrists Reveal How They Handle Difficult Patients Who've Already Diagnosed Themselves

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Why do you even need me then?

Getting one's health in order is a very daunting necessity of life. But getting health, mental and physical, in order is brave. That's why one should never assume or self-diagnose. Google is not your MD!

Redditor u/krisdmc wanted therapists to speak up about some patients that don't seem to understand therapy by asking.... Psychiatrists of Reddit, how did you handle "I know everything, I already diagnosed myself" types of patients?


It was Me!

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I was this patient. I had already been diagnosed with generalized anxiety disorder and it got worse as time went on and I eventually convinced myself that I had paranoid personality disorder and when I told my therapist this she took out her DSM-V and went through all the symptoms with me and explained how some of them I do have but it's because it stemmed from the current anxiety disorder I already have. She did a really good job explaining it and was so sweet and professional. grown-issh

Open-ended.

I'm a therapist and do tons of intake assessments for my agency. I've had numerous people come in like this, and I just ask them what symptoms they notice and how they came to that diagnosis. I keep everything open-ended, and I don't ask leading questions or yes/no questions about symptoms.

I gather information about other situations in their life to get a full picture, and then I make my own diagnosis based on what they say. Rarely do I agree with people, but sometimes, they seem pretty close.

At the end of the assessment, I don't typically share my diagnosis, I just tell them my recommendations for treatment and see if they agree and go from there. rrirwin

The Roasting....

I used to be that type of patient.

I was CONVINCED that I had a panic/anxiety disorder and wouldn't accept anything else for an answer. 3 hours of "roasting" me later, he diagnosed me with BPD.

He was CRUEL but I'm not mad at him. I can't type three hours of arguments in a single comment, but it pretty much went "I did not study psychiatry for you to come into my consult and act like you have the right to diagnose yourself.

I've been here for 15 years and even I make wrong diagnoses every now and then. You do NOT get to pull stunts on me. If you want to pull them, find another therapist."

Left his office in tears but glad that my little bubble of headfoolery was gone.

TLDR: the key is not sugar coating anything. A lie repeated a thousand times does NOT become the truth. Don't let your patient act all nonchalant and simply smack them with the good old truth. BTSAREUSELESSCUNTS

The Master....

I'm a Master's level therapist. A lot of doctors get into pissing matches with clients trying to convince them of their diagnosis. The thing is, I don't bother unless it prevents me from doing the treatment. If I'm effectively treating the same symptoms it doesn't matter.

I do a lot of psycho-education with people with psychosis around the idea that it doesn't matter if I believe your delusions; if the FBI really is following you I can't do anything about it. If it is delusions, the medication is going to help.

TLDR: don't bother getting into a pissing match about it. Build the rapport and work them to the reality later. SvodolaDarkfury

Too Many Pills.

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I wasn't this kind of patient. I was the opposite. Two years after meeting my psychiatrist I was on a bevy of unnecessary drugs. It took me several years to wean off and feel normal again. I needed therapy and help learning coping mechanisms, not medication to fit a diagnosis he gave me after 15 minutes of conversation.

I am a lawyer so I totally understand the whole google diagnosis thing, I see it all the time in my field. But a lot of people have suffered experiences in their lives that have taught them that they need to be their own advocate. And I'll be honest, I'd rather annoy the heck out of a psychiatrist than ever go down the path I was on again. Just because you have an advanced degree doesn't mean you don't have to earn my trust the good old fashioned way, by being respectful and hearing me out.

So this is my recommendation, you hear the person out and build a trusting relationship. Chances are the people coming in all hot and ready with a diagnosis have had a lot of invalidating experiences involving medical professionals. They don't trust you. That's not your fault. But you have to earn the trust to deal. I give this advice from my perspective as my own advocate, and dealing with similar stuff in my field. malapropagandist

Don't Assume. Find Out. 

Not a psychiatrist but I am clinically diagnosed with depression and anxiety. my ex-friend is one of those bound to be Karen people, she has this 'i looked up the symptoms so I can diagnose it.' vibe to her. one day we were talking about mental disorders (i was stressed and at the moment I needed to talk to someone about it.) and as I was talking about my depression she gave me this look, it was a look of hatred and anger.

She said "you shouldn't act like you have those things, you don't." she started ranting at me that I shouldn't try to special and say I have depression and anxiety because "you don't because you came up and talked to me about it, depressed people are introverts." I stared at her because she thought this, seriously?

I asked her where she learned this and she said: "well, depressed people are sad all the time and so they don't go out or talk to people." I am no longer friends with this person. woah_im_gay_

Be Honest. 

I am a doctor, and I was that patient!

Diagnosed myself with depression in medical school, demanded antidepressants from my GP, then carried on miserably with medication that was only half-working.

When I could afford it as an intern, I got a psychiatrist and told her the same thing. But because I knew what depression was SUPPOSED to look like, I gave the "correct" history. So she accepted my diagnosis and we carried on trying to find the right drugs.

She always had a feeling it was actually BPMD, but whenever she asked about symptoms of hypomania, I denied them.

I don't know how much of it was denial (BPMD has much more stigma than depression) or how much of it was me wanting to follow the textbook.

But eventually we reached that point where I let go of the power and let her do the diagnosing. Once we started treatment for BPMD, things got SO much better.

BPMD, not BPD. sunrisechimera

The Reverse. 

I am the reverse. I've known I have had some sort of mental health issues since I was a teenager, but didn't think I had much more than depression. So, under the urging of my ex girlfriend, I saw a psychiatrist.

And I was diagnosed with Bi Polar disorder.... and then Generalized Anxiety Disorder.... and then Post Traumatic Stress Disorder.... and then ADHD, over the course of the last three years. This has been over multiple psychiatrists.

I accept that this is probably right. But some part of me to this day questions if I have any of it. lil_Big_G

No to Google! 

My longtime psychiatrist recently put a mug that says "Please Do Not Confuse your Google Search with my Medical Degree" on her desk.

I laughed and complimented her on it and she said "PEOPLE ACTUALLY DO THIS! They diagnose themselves with something they read online, like i went to medical school, and they argue with me about it."

She told me she gets a good first impression of new patients based on how they react to the mug. Ones she ends up working well with always laugh at it. Whereas the patients who are offended by it usually end up butting heads with her.

My doctor is damn smart, haha. On_Too_Much_Adderall

Don't Wait.

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I've been putting off seeing a psychiatrist because I'm afraid I'm that patient. My wife tried to kill herself back in April (she's doing much better now) and it helped me realize I probably need some help as well. My wife's psychiatrist (who happens to be a friend of ours) told her he'd really love to treat me.

He thinks I have some form of adult ADD among other things, I also had to explain to my wife that a psychiatrist saying he love to treat you isn't exactly a compliment or good news...

I personally think I suffer from situational depression and some form of narcissistic personality disorder. Which is funny because I have a low opinion of my physical self, but I'm very high on my intelligence.

Damn, I should just call and make the appointment. outoftouch49

If you or someone you know is struggling, you can contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

To find help outside the United States, the International Association for Suicide Prevention has resources available at https://www.iasp.info/resources/Crisis_Centres/

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