My Kid Has Diagnosed Herself on TikTok. What Should I Do?

TRANSCRIPT | MY KID HAS DIAGNOSED HERSELF ON TIKTOK. WHAT SHOULD I DO?Ask Lisa Podcast, Ep. 157

The Ask Lisa Podcast does not constitute medical advice and is not a substitute for professional mental health advice, diagnosis or treatment. If you have concerns about your child’s well-being, consult a physician or mental health professional.

Reena Ninan: You know, I’ve just not a big fan of Valentine’s Day, are you?

Lisa Damour: Well, I feel like I feel like for people who are in relationships, it feels like laborious and I feel like people who aren’t in relationships, it just makes them feel bad. I am not sure there is a lot of upside.

Reena Ninan: You summed it up perfectly. My kids are so into Valentine’s Day. But I think all those years of being single and all alone have really weighed down my soul.

Lisa Damour: I will tell you there are wonderful thresholds to cross in parenting. And for me, one of them is when you no longer have to help your kid provide valentines to the entire class.

Reena Ninan: Oh, that is a game changer. I hadn’t thought of that. What do I know?

Lisa Damour: It’s very nice one. Yeah, that goes away.

Reena Ninan: I love it. I love that. Well, social media can also enhance our feel on that with people talking about love on social media. And so we’re going to talk about Tik Tok and I want to read you this letter that we got. Dear Dr. Lisa, my 13 year old spends a lot of time watching Tik Tok mental health videos. I’m sure that some of what she’s finding there is okay. But I don’t know what to do when she mentions her OCD. I really don’t think she has OCD. Or that she thinks she might have ADHD. I’m reaching out now because I got a call last week from the school after my daughter told the teacher that she quote, has anxiety that can make it hard for her to do schoolwork, or teachers are wondering if there’s something more they should know. Or do. How do I talk to my daughter about this? And what should I say to her teachers? Thank you for your help. Okay, what is the story here, Lisa?

Lisa Damour: Okay, this, okay, again, I love our letters, they take us right to the heart of what is happening. This is happening a lot. There is a ton of content, I would say on Tik Tok in particular, but other places, have all of these videos around. Do you have this symptom? Do you have that symptom, you might have this. And lots of kids are going down lots of rabbit holes, where they get very curious about what they’re and I’m going to use finger quotes here “symptoms” mean What diagnosis they may have what is described here, sort of the casual use of diagnostic terms like OCD or ADHD is very common. And it’s a problem. It’s a problem.

Reena Ninan: So I’m slightly embarrassed to admit this to you. But my daughter had this cough that wouldn’t go away. And I saw a video on social media that said to put chopped up onions in her sock and I was sent her sock in her sock for like 10 minutes. I know you’re laughing at me, but I was so desperate because like I’m up all night with this cough. And I was like okay, maybe this will work. But like, I’m ashamed to tell you even I have like fallen prey to some things like of course are surely onions in your sock must.

Lisa Damour: Okay, that’s bananas. I will just tell you that.

Reena Ninan: And it did not work for anybody wondering. I am even susceptible to this stuff. Like what is happening here?

Lisa Damour: Well, so this is a version of the way in which I mean, I’m gonna use a simpler and probably more generic example. And like, honestly, like Reena, don’t put onions and socks.

Reena Ninan: It’s embarrassing. I know, but I had to be honest with everyone.

Lisa Damour: I appreciate it. I appreciate it. But you know that way in which like WebMD is like, you know, really terrifying. You get a pimple you’re like that nearshore it’s a tumor, right? I mean it. This is a version of that. But what’s tricky Reena, and this is really tricky is it has different ramifications. It has individual ramifications in terms of identity development, and how one thinks about oneself. It has social ramifications in terms of, you know, saying I have this. I have OCD even, you know, it can annoy people, right like OCD -the diagnosis itself – I don’t use this term lightly is torture for people. If you have full blown OCD, your life is absolutely constrained, paralyzed, limited by the OCD for people who are suffering with that or people who are around people who are suffering like that the casual use of like, “Oh, that’s my OCD” bothers them a lot. And I get it. So there’s like, it’s one thing on WebMD to be like, Oh, this pimple might be a tumor, right? That’s anxiety provoking for the individual. But the self diagnosis stuff and using language casually around diagnosis, it takes on a whole new, whole new level of concern.

Reena Ninan: Have you seen this, kids trying to diagnose themselves this way? Can they really do this?

Lisa Damour: Okay, so, can they do it? I am not going to say that there is not a kid who hasn’t gotten it right, right, where they are being under diagnosed, somebody is missing the diagnosis. Maybe let’s focus on ADHD, which this kid sometimes wonders if she has. There can be kids who are struggling and it is getting overlooked. And they get onto Tik Tok, and maybe hopefully a wiser side of Tik Tok. And they line up a whole bunch of symptoms, and they’re like, this is really me. I’m not saying a kid can never be right about that. Here’s the challenge. Okay, so have you heard of “medical school syndrome”? So this is this is something that happens in medical school, is that as you start as a medical student, and I’m not a physician, but there’s an equivalent in psychology, you suddenly decide you have all the diseases being discussed, like everything being discussed, for sure you have it. And the reason is, you can have like, if you have the sniffles, and then you learn about like, you know, some horrible RSV you’re like, I have the sniffles. RSV has sniffles.  I must have RSV, right. There’s this easy jump from having one symptom or a very low grade version of a symptom to thinking you have the diagnosis. Why is that? Why do we do that? Because we’re terrified because we’re anxious, I don’t know. But like there’d be the equivalent is in college teaching, which I did for a long time. The class on our pathologies is called the abnormal psychology. I taught this for a long time, I co authored a textbook in this right like, this is my favorite part of the field. And so one of the things we warn students about in abnormal psychology is you do not have all of these diagnoses because they open up the chapter on, like personality disorders. And then there’s they read about narcissism, and they’re like, well, sometimes I can be a little bit low in empathy or a little bit grandiose, does that mean I have narcissistic personality disorder?  And what we say to the students in abnormal psychology is one symptom does not make a diagnosis. And symptoms occur on a continuum. Right? So if we look at like depression, and the diagnosis of depression, one of the symptoms of depression is low motivation or loss of focus. Okay, Reena, that’s me,

Reena Ninan: every day, we all feel that loss of focus of focus.

Lisa Damour: Exactly. And so there’s a real hazard. If you don’t appreciate that it’s got to be part of a continuum. If you don’t appreciate that we’re looking for whole clusters of symptoms, not a single symptom. It is very easy for 13 year olds on Tik Tok to suffer from medical students syndrome, or abnormal psychology undergraduate symptom syndrome, where they do resonate to one description of a symptom, or they do have a very low grade version of a symptom. And then they make the leap that I must have the diagnosis.

Reena Ninan: So what do you think is really the worst case scenario in this? Okay?

Lisa Damour: This is really the key question, because kids are doing this a lot. Okay, so I’m gonna give you a couple of versions of that. I’ll give you the not worst case scenario, but a not great scenario, and then I’ll give you what I consider to be a very worrisome scenario. So one thing that is interesting to me is teenagers aren’t dumb. There are a lot of teenagers who are like, you don’t have OCD, you don’t have ADHD like that. They themselves are aware that, you know, just because you have some things that line up with some parts of a diagnosis. And I have been fascinated when I’ve been meeting with groups of teenagers, by the gentle way, they will say to me, what do you do if you have a friend who’s telling you they’re depressed, you know, capital D depressed, but you don’t really think they’re depressed. And what they’re saying is like, these terms are getting thrown around too much. And people are, for lack of a better word abusing them. And we want to be kind and supportive friends, like we don’t want to say to them, you’re not depressed, get over it. But we also don’t want to collude in something that we think is inaccurate, at best, and then I’m going to say self dramatizing at worst, right? So, so one of the not great scenarios is it actually creates friction with friends. Because friends, other peers will be like, Nah, you know, and then they’ll feel stuck.

Reena Ninan: Are you saying that the teen friends start to lose trust in their friendship because they’re like, this person is cuckoo, because they’re creating something that isn’t there.

Lisa Damour: Yeah, I don’t know. That’s a cuckoo, but like definitely, like, they’re putting me in a jam, because I don’t want to seem unempathic, right. And there’s a lot of social awareness and decency among teens. Like, if I tell you I’m suffering, you know, your friends are going to be like, you know, friends, good friends are going to take your suffering seriously. So they want to take the kids seriously, but they also feel really torn, because they’re like, I don’t think you’ve got the diagnosis you say you have, right? Or I think that’s unlikely, or that kid over there, that kid has ADHD, you are having a hard time focusing today, right? And so it can put their peers in an awkward position. Okay, what happens next? Who knows, right? Some peers may confront it, some peers may let it go. Some peers may find distance, some, you know, like, it can go a lot of directions. But I just want to say that even among the 13 year olds, and certainly that among 14, 15,  16, this stuff doesn’t always fly that well. And, and we want to be mindful of that. Okay, so that’s one version of an upgrade scenario. Here’s a much more like, concerning version of things. You know, this, I know this being 13, 14,  15 you’re constructing an identity. Right? You’re getting a sense of who you are and what you’re about. Right? And don’t you have such vivid memories we now have? You remember the kids who were like, came back to school as a skater kid, when you’re like, do you remember that? Like you said goodbye in eighth grade and they were preppy?

Reena Ninan: Totally my my kids say like their emo kids. Like, that’s an which I didn’t even know what that was, but we call them maybe it’s goth. Is that the right? I don’t think goth was a precursor of Emo. But some people showed up after summer. Yeah, totally different. Totally different identity.

Lisa Damour: Yeah. And it’s got a lot of outward signaling, okay, that can be short lived, it can turn into something perfectly fine. It can be wildly creative, like emo on its own is not inherently problematic. But one of the things I have seen happen in my clinical career is where kids latch on to a diagnosis, say, eighth/ninth grade, right, which is right around where this kiddo is age wise. And they’re like, I have depression, right. And that that becomes an a sense of their organizing identity. And they call it like a habit like this is a factory setting. This is not, you know, this is just going to be something I have, you know I live with, and that they use that then to you know, like guide who they’re gonna hang out with other kids who, you know, understand this or that they feel understand this, they may not put themselves out to do things, they may feel limited in their capacities as a result of this. And it can really foreclose, I think is probably the best way to talk about it. Like if kids organize their identity around a diagnosis. Whether it’s accurate or not, almost sometimes, it can foreclose all sorts of developmental possibilities that we would love to stay on the table. So that would be for me more concerning. And you hear a tinge of that in this letter where the kid has said to the teacher, there’s stuff I can’t do, because I have anxiety. I have anxiety. And so this kid is already pulling herself out of things in the name of this diagnosis, which may not even be an accurate diagnosis.

Reena Ninan: I also want to ask you how the parents even began to approach this with the child who thinks they have a diagnosis that they might not. And then also what do you tell the teachers who are concerned that the parents might be hiding something? We are talking about a letter that a parent wrote into us talking about their 13 year old who self diagnosed themselves after watching Tik Tok videos for having OCD and potentially ADHD. These uh, what do you think? What would you say to this parent? What do you think the parent should say to the child at this point?

Lisa Damour: Well, okay, so let’s pull it back a little bit. And just think about like, the background information, I would want any adult in this situation to have. Part of what has emerged and this is in the letter is this, and we’re just talking about this like this, I have depression, or I have anxiety, that one of the misunderstandings that circulates among young people in particular, is that these are permanent states. And what I will say is, oh, no, no, no, like, we’re really good at treating a lot of these things. So even if it’s accurate, right, we’ll come back to the question of whether it’s accurate or not, but even if it’s accurate, I think that this is a point we want to all get clear on which is, we are very good at treating anxiety. There are many many options for treating anxiety. It’s probably the thing we treat best. So people it doesn’t mean you’ll never feel anxious again, anxious feelings are part of life, but For pathological levels of anxiety, we’re really good at helping get that under control. People can feel better, they don’t have to live with this. Depression honestly, if it’s if it’s full blown depression is more like diabetes, it has to be managed over time. But just like you can manage diabetes, you can manage depression, and people can live rich full lives. Where depression is not organizing things for them. There are some diagnoses that we don’t cure, right, that are part of a person’s life, right? They’re things like schizophrenia, they’re things like autism, right? Where they are much more grounded in the biology. And you know, we can’t, right now, make them go away all the way. You know, we manage those. But most of what kids show up with ADHD, OCD – when they do have it – depression, anxiety, we can treat it, it doesn’t have to become something that the kid feels is a forever thing. Yeah. Okay, so then to the question of what the parents should say. I think with that awareness in mind, I think that when the kid is throwing around terms, OCD, ADHD, my anxiety, teenagers love to learn about mental health, this is what I have found. And so, when kids do this, in my presence, which they do, I will say, talk to me about what makes you think you have OCD, or say more about the OCD. And then they’ll be like, I like to organize my desk, and I don’t like leaving my room till it’s organized. And I will say, okay, so you really like things organized, and you can feel anxious when things are not organized. Let me tell you a little bit more about OCD. And a parent could learn, look this up. Here’s what the diagnosis of OCD involves. And if you look up the full blown diagnoses, you will see how harrowing it is. So then you can say good news kid, you do not have OCD.

Reena Ninan: But won’t that sort of be, if the kid believes they have it? And you’re like, No, actually, you don’t like what you do, Mom, you’re not a doctor?

Lisa Damour: Well, that is a good point. Right? So one of the things you could do is you could do it together, right? You could say look, Tik Tok can be good for lots of things, I would never have you diagnosed off of Tiktok. Let’s go to the American Psychological Association’s website and learn about OCD together. Let’s learn about that. So you can give them full. And you know, I won’t rule out the possibility that the kid will say, actually, there’s a lot I haven’t told you. And actually, I have to count to 300 every night before I fall asleep. And if I don’t do it in the right way, I have to do it 10 more times, right. So right, leave the door open, maybe, maybe there’s more that you don’t know. But go to the real information, and engage teenagers and learning about it because they love it. And when teenagers say to me, our friend is saying they’re depressed, we don’t think they’re depressed. I will say, Okay, well, here’s what you need to know, here’s what depression is. And here’s what sadness is. And I walk them through here are the symptoms of depression. Here’s how we make the diagnosis. It’s a complex process, but we’re very clear on it. And here’s what sadness looks like. And they will often say, yeah, a friend is sad. And then I’ll say to them, okay, so you go back to them. You don’t have to tell them, they don’t have depression. But you can say you were feeling really sad. How can I be of help?

Reena Ninan: And does that work? Lisa, do you find that when they go back and say, actually look at sadness? That helps?

Lisa Damour: I don’t know. I mean, in some ways, I’m not there for the conversation. But it definitely seems to satisfy the kid I’m talking to, because they’re like, right, I want to validate what my friend is saying. But I don’t want to participate in calling it depression when I don’t think they’re depressed. But I think that other kid might be depressed, right? I mean, I think that there’s sort of a defense of the kids who really may be suffering with those particular disorders that also comes up.

Reena Ninan: What do you do about the teachers, right? Because if the student is telling the teacher, and if I’m that teacher, I’m concerned about, you know, teachers are really great students, and they’re concerned and like, I just want to help out, like, what do I need to know? And how do you explain: We don’t really think she has this?

Lisa Damour: I really love that this parent wrote to us, right? Because this is a bit of a jam, right? And again, the kids showed up and said, “hi, I have anxiety. And of course, a good teacher is gonna think, Alright, if you have a diagnosis I need to know about and that I need to accommodate, like, I’m here to help teacher did exactly the right thing to be like, “Hi, hey, I have this information.”

So I think the first thing I would do is I would sit with the child and say, Listen, I got a call from your teacher. You know, and your teacher said this, and I would find out more about the context in which this went down. And then again, and it’s why I love how he like think it all through together. If you could entertain the possibility that this kid has an anxiety disorder. So you say Okay, talk to me about why you feel you have anxiety, right and using the kids language. Let’s go look it up. And then you go look up and you we a lot of diagnosing Rena is ruling out, we rule out things. So you would want to rule out that the kid has a anxiety disorder, and here’s how you rule it out. If the kid is anxious when nothing’s wrong, they might have an anxiety disorder. If the kid is anxious way out of proportion to what’s wrong, right, that they were anxious about a test and they had a full blown panic attack, they may have an anxiety disorder. But if the kid is anxious because something’s amiss, the anxiety is, you know, corresponds to a problem in the world or, you know, worry inside. And the anxiety is proportional to it. That’s healthy anxiety. And a lot of kids don’t know about healthy anxiety. So there could be some really loving teaching like, Okay, so let’s rule out that you have an anxiety disorder. And if you can say, Okay, I think my hunch is that you have healthy anxiety that is there to help you get back on track, stay on track. And then I think you say to the kid, what do you don’t want to do with teachers, because the teachers need to know that it’s healthy anxiety, that is sometimes a barrier for you. And I can work with you on how to get past it. Your teachers can work with you on how to get past it.

Reena Ninan: I never thought about mentioning healthy anxiety, and how that could get them to rethink it. It’s a lot of rethinking is what it seems like like it’s been presented to them. But you’re like, if it’s depression, look at sadness, you know, it’s really interesting. Well,

Lisa Damour: and again, like this gets to the continuum piece, right? That everybody experiences anxiety. And then when there’s so much messaging around us that all negative emotions are pathological people, like I have anxiety, I must have an anxiety disorder, okay. Also, I will just say a psychologist, we completely blew this to call every day nerves anxiety and to also called the diagnosis of anxiety, like we have not helped the situation. So I will sometimes when I’m talking with good kids, they like it sounds like you’ve got some nerves about this as a way to actually create a linguistic distinction between anxiety disorders and you know, having a healthy, you know, kind of activated response when something’s not quite right. Make sense?

Reena Ninan: So, can you just give us your little quick guidebook on, if you find your, yourself in this situation, your child is self diagnosing something you really don’t believe they have it? What are like the three steps you think we should take?

Lisa Damour: I think step number one is asked the kid more about it. Right? You’re using that term, tell me where that’s coming from. Right? What makes you think that really get them laying it all out. And again, like, as we’re talking through, like, there may be more you don’t know, like, you don’t want to necessarily shoot this down. Just because it, you know, is sort of a trendy thing right now. Chances are though, as soon as you start to get more information, you’re gonna have more clarity. And I will tell you even Reena on this step number one, there’s stuff circulating on tick tock, like diagnostic names were like, I’m like, that’s not even a thing. Like, that’s not a thing. Like, that is a completely invented, like, no psychologist isn’t ever. I mean, so there’s some pretty out there stuff. So get the kid talking, see what you can find out? And then number two is, take seriously, whatever it was that got them thinking they had the concern. Right. So if they’re like, I don’t know, sometimes I feel like I can’t turn in my work, because it’s just not perfect. Right? That may be where the kid comes up with the idea that they have OCD. Well, then take that seriously. Okay, what do you want to do? You’re right, the work doesn’t have to be perfect, you know, how can I help. So as long as the kid’s concerns are being addressed, they’re often pretty ready to let go of whatever, you know, term they’ve come up with to describe the term that concerns even how ever ill fitting that term can be. And I think three, understand the teenagers love to learn about mental health, I really love about them. Well, they’re talking about it all the time. And they take it very seriously in themselves in their peers, far more than any generation before them. And they want to get it right, right work with the assumption that they want to get it right that they do not want to be in this parallel invented universe of diagnostics. We have an actual scientific universe of diagnostics. And so inviting them in going and looking at the American Psychological websites. So you know, American Psychological Associations website about disorders, helping them find good media information, right. And this is, this is a media literacy conversation, right? And you can actually say the same thing. And if you have a medical concern, please do not take it to Tech Talk. Right? And maybe take it to WebMD. We will take it to your pediatrician, right? I mean, making that argument like that, it’s like other things like if it’s serious, we do not go to tech talk to try to get information about it.

Reena Ninan: I can’t tell you how badly I wanted to believe those onions.

Lisa Damour: I love you, but come on.

But sometimes when you’re in a vulnerable state, you

try to even imagine the mechanism for how that will work. I mean, I’m not saying I haven’t looked on WebMD Lord knows I have

Reena Ninan: Don’t worry about the mechanism. Her room smelled of onions for for data.

I bet I bet that now you have a new problem. So maybe the coughing then becomes lesser of a thank you that order doesn’t bother you so much.

Reena Ninan: Well, thanks for walking us through this. Lisa, what do you have first parenting to go?

Lisa Damour: Teenagers make sense. That’s what I have for us for parenting to go that they will bring sometimes some of the lupia just stuff our way, right. I mean, there are teenagers who have used Tik Tok to decide that they have dissociative identity disorder, which is our new term for multiple personality disorder. It is highly unlikely that most of them have such a unusual and rare diagnosis. But there’s something behind it. When it kid comes to that conclusion. It happens for a reason. It’s something and what they read attached to something that they were thinking or feeling. And so our job as people who love teenagers is however they bring it to us, even if it is off putting or, you know, just totally outlandish in some ways. Do not dismiss them. Ask Tell me more. Tell me more. What made you think that Where did you see it? Talk to me about this, you will get to a conversation that you probably need to have. The big takeaway from me always with you is have conversations with your kids. You can never have enough and the good that it can do. Because they’re hard to have. They’re hard to have by Yeah. Yeah. Make can make a difference.

Reena Ninan: Absolutely. Thank you, Lisa. And next week, I’m really excited for our guest. We’re going to have Dr. Sue Varma, who’s going to talk about her new book, practical optimism. I’ll see you next week.

I’ll see you next week.