Out On The Couch

A Rise in Self-Diagnosis

Some DSM-trained clinicians may bristle when a patient identifies with a mental health diagnosis they have come to informally. In recent months, a common concern voiced in supervision and among mental health providers is the increase in patients and clients questioning if they embody characteristics of Autism.

Self-reflection is arguably a mainstay of being an aware human. While the rise in patients presenting with concerns of Autism may seem novel, the phenomenon is arguably not much different from a patient who seeks professional guidance after recognizing characteristics of any other mental health concern. In fact, many of our patients first consider therapy in part because they recognize their own experience parallels another person’s symptoms.

We may recognize symptoms of depression, anxiety or effects from trauma in ourselves after talking to a friend or consuming media and then reach out for professional help based on this speculation.  While self-reflection and exploration of identity is not new, we do spend more time online than ever before, with increased access to information. Many seek comfort, connection, validation and understanding in online spaces. Participation in online social forums increased during the early pandemic (Instagram vs Reality, 2021) while accessibility to mental health services continues to be difficult (Stringer, 2023). Autistic and LGBTQIA+ individuals are at risk of facing discrimination in medical settings (Doherty, Neilson, Sullivan , et al, 2022 and Mirza & Rooney, 2018), which may lead to avoidance of interactions with healthcare workers who may offer screening and referrals for diagnosis. 

The Trans and Non-Binary Connection

Recent research estimates that Autistic traits among those who experience gender dysphoria is 5% to 20% (Gratton & Cheaney 2020). Somewhere between 8% to 10% of children treated at gender clinics worldwide meet the criteria for Autism (Rudacille, 2016). The terms ‘autigender’ and ‘neuroqueer’ describe gender identities that are shaped by, and intrinsically linked to, neurodivergence (LGBTQIA+ Wiki, 2023 and Walker, 2021). A provider’s biased or incomplete understanding of Autism may lead to a dismissive attitude toward one’s Autistic experience in underrepresented communities including women, people of color and non-binary and trans people (Price, 2022). 

Affirmative Psychoeducation

While an Autism-informed approach to psychotherapy is valuable, psychotherapy does not specifically treat Autism. Autism is one of many forms of valid neurotypes, not something to be “fixed” through therapy. Affirmative psychoeducation about Autism and exploration of client’s experiences of learning about Autism online are both excellent interventions.

The internet can serve as a space of connection and affirmation, especially for marginalized populations who otherwise may not have access to those spaces. The internet is also a place of potential misinformation. Phillips (2022) reflects, “social media…tends to simplify the process [of diagnosis] and often reduces psychological theories and disorders into brief snippets of common stereotypes.” 

Further, “social media algorithms, which filter content based on people’s interactions, can also play a role in leading someone toward an incorrect self-diagnosis” (Phillips, 2022).  

Affirmative psychotherapists can invite our patients to share what they are learning and help to clarify or dispel myths and disinformation. We can answer questions and validate perspectives that might differ from our own. We can also make recommendations to online spaces and creators well regarded by the Autistic community and also learn from those resources ourselves. 

When is a referral for formal assessment warranted?

In our role as psychotherapists, it is important not only to offer compassionate and accurate psychoeducation about Autism and other potential diagnoses, but also to clarify what the process of assessment and diagnosis may signify to the patient.  Are they looking for a better understanding of self?  Affirmation of belonging to a community? Documentation for accommodations or disability benefits?

It may be useful to discuss the potential pros and cons of formal assessment and diagnosis with the patient. A formal diagnosis may facilitate accommodations in school and work environments and is a prerequisite for disability benefits. 

Professionals are not without their own biases and misunderstandings, so it’s important to consider what it may mean for the patient if testing indicates that a patient who identifies as Autistic does not meet the clinical threshold for official diagnosis.  As Dr. Devon Price reflects, “some people are also subclinically Autistic, meaning they might not qualify for an official diagnosis, in the eyes of psychiatrists, but share enough struggles and experiences… that they belong in the community” (Price, 2022). 

Additionally, those seeking validation from doubtful family members or wider society may be advised to anticipate a lack of affirmation; after all, those who do not extend compassionate understanding prior to formal diagnosis may not shift their misunderstandings and biases even with “proof” in the form of diagnosis.  

The Final Word

The therapeutic relationship is a collaborative partnership, an expert team built by both patient and clinician. We can provide informed psychoeducation without gatekeeping, and hear our patients when they share their experiences and insight. Let us believe what our patients are telling us and compassionately work toward improved collaboration with our neurodiverse patients.

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 References

American Psychological Association. (2023, April 1). Providers predict longer wait times for mental health services. here’s who it impacts most. Monitor on Psychology. https://www.apa.org/monitor/2023/04/mental-health-services-wait-times 

Doherty M, Neilson S, O'Sullivan J, et al Barriers to healthcare and self-reported adverse outcomes for autistic adults: a cross-sectional study. BMJ Open 2022;12:e056904. doi: 10.1136/bmjopen-2021-056904

Gratton, F. V., & Cheaney, H. (2020). Supporting transgender autistic youth and adults: A guide for professionals and families. Jessica Kingsley Publishers. 

Instagram vs. reality: The pandemic’s impact on social media and mental health.

Penn Medicine. (2021, April 29). https://www.pennmedicine.org/news/news-blog/2021/april/instagram-vs-reality-the-pandemics-impact-on-social-media-and-mental-health 

LGBTQIA+ Wiki. (2023, February 7). Autigender. LGBTQIA+ Wiki. https://www.lgbtqia.wiki/wiki/Autigender 

Mirza, S. A., & Rooney, C. (2018, January 18). Discrimination Prevents LGBTQ

People From Accessing Health Care. https://www.americanprogress.org/article/discrimination-prevents-lgbtq-people-accessing-health-care/

Phillips, L. (2022, March 28). Self-diagnosis in a Digital World. Counseling Today. https://ct.counseling.org/2022/03/self-diagnosis-in-a-digital-world/ 

Price, D. (2022). Unmasking autism: Discovering the new faces of Neurodiversity. Harmony. 

Rudacille, D. (2016, April 16). Living between genders. Spectrum. https://www.spectrumnews.org/features/deep-dive/living-between-genders/ 

Walker, N. (2021, Summer). An introduction • NEUROQUEER. NEUROQUEER. https://neuroqueer.com/neuroqueer-an-introduction/