Today’s modern search engines have opened the world to anyone who has internet access. Today, unlike any other time in history, we have almost instant access to whatever information that we type into our favorite internet search engine. However, this can be both good and bad. Good in the sense that there is no reason for anyone not to be able to develop a basic knowledge or understanding about any subject within their mental capacity to grasp. Bad in the sense that there are often foundational principles that govern various disciplines from electricity to neurosurgery. Principles that are often unknowingly overlooked by these seekers of information trying to diagnose a problem.
Each year millions of Americans use their internet access to seek information about medical conditions either physical or behavioral. In fact, in the 2020 article, Assessment of the Frequency of Online Searches for Symptoms Before Diagnosis: Analysis of Archival Data, published in the Journal of Medical Internet Research authors Irit Hochberg, Raviv Allon, and Elad Yom-Tov concluded that as many as 15 % conducted internet searches of their symptoms before receiving their first diagnosis. For more serious physical medical conditions this can certainly be a good thing for both the doctor and the patient. The more educated a person is about symptoms they are experiencing the better their chances of effectively communicating with their providers and receiving an accurate diagnosis.
But what about those behavioral health conditions that, while not life-threatening, cause people serious daily emotional problems that can cloud their minds? Researchers have found that internet searches on mental health related concerns are no different in volume and, interestingly enough, show signs of seasonal patterns of keyword search. Having worked now in the field for a decade my experience has shifted regarding patient self-reported diagnosis. It has gone from a primarily historically diagnosis as the primary complaint to more and more of an internet driven self-diagnosis. I am finding more and more that these self-given diagnoses are then being reinforced through podcasts and YouTube videos searched out based on their conclusions about themselves or their loved ones.
Why this is bad.
In the field of human behavior, we have long been aware of the phenomenon of confirmation bias. Confirmation bias is the tendency to process information by looking for, or interpreting, information that is consistent with one’s existing beliefs. In the field of behavioral health once a person has reached a conclusion it often makes my work more difficult, particularly in the initial stages of work as I rely heavily on self-assessments and self-reports to understand what is happening and then begin to treat a presenting concern like every other behavioral health practitioner. Only then to realizing through observation that a person is struggling with something entirely different, after which I often then spend a good deal of time working to overcome their initial bias created through self-diagnosis.
So how to help.
First, understand that diagnosis of mental health conditions, or any medical condition, can and often is a complex process. Considerations of age of first onset, development and course, population prevalence, risk factors, gender-related issues, and differential diagnosis are some of the many considerations that go into accurate diagnosis of mental health related disorders. I have spent perhaps half of my career in behavioral health involved in case reviews as part of my primary responsibilities. I have found that for a variety of reasons even those trained in diagnosis often get it wrong or reach conclusions that directly conflict with other professionals’ diagnosis. I have also found that this primarily results in acute care settings where they are reliant heavily on the patient, or close relation to the patient, self-report of symptoms. This is where confirmation bias created by internet search has perhaps it greatest negative impact on accurate diagnosis leading to proper treatment.
Secondly, and perhaps most important. Become an accurate historian. An example that may help you understand. One of the more common diagnoses I find when review cases of older children and younger teens is disruptive mood dysregulation disorder. Often on the surface it seems plausible given the historic information. However, because of my role, I get the opportunity to interview persons other than the parents who are often in as much crisis as a child when these diagnoses are given. I more often than not discover that the core feature of DMDD is missing. Chronic, severe, persistent irritability across environments. Because I am able to talk to other persons who interact with these children outside of their home I find they often have a completely different perception of a child due to the environmental change. Rather than Johnny being described as “always angry or upset” he is described as a sweet or helpful kid most of the time that can have his moments.
So, if you step back and ask yourself a couple of easy questions, it will go a long way to getting you or your loved one the help needed.
How is this situation affecting me emotionally and how is that skewing how I am seeing what is going on?
Then take time to really observe and record by writing down what is going on over a period of time. The good and the bad. This will provide not only a professional a better understanding of your concerns but you as well. It will also help to reduce or eliminate faulty conclusions that can not only become severely clouded by the phenomenon of confirmation bias. But also result in improper care and poor outcomes.
Comments