Tuesday, October 17, 2023

Don’t Shut Down Conversations When Youth Present With ‘Trending’ Disorders, Psychiatrist Says

Youth increasingly rely on social media to diagnose themselves with a variety of psychiatric illnesses—a trend that has been met with more than a few raised eyebrows.

In a short article in the Journal of the American Academy of Child & Adolescent Psychiatry, child and adolescent psychiatrist David C. Rettew, M.D., described how he works with youth with so-called “trending presentations” and cautions against the dangers of oversimplifying such cases. 

  • Ask patients direct questions about whether they have a specific diagnosis in mind, as well as the research that led them to this conclusion: “[I]t is common for my new patients to get a little sheepish when disclosing the source of their investigations, as most commonly the ideas come from social media platforms such as YouTube or TikTok rather than the medical textbooks that used to make medical students wonder about being stricken with lots of exotic ailments,” he described.
  • Reject the tendency to dismiss or deny the patient’s narrative “because it does not fit our current scientific or political perspective”: “Science has shown us repeatedly that virtually everything when it comes to mental functioning—from common personality traits to psychopathology to gender typical behavior—comes from a complicated mash-up of mutually interacting genetic and environmental factors. These environmental contributors include things such as peers and media influences, and their presence in the mix should not immediately disqualify someone’s history as undeserving.”
  • The more complicated a clinical situation appears, the more important it is to stick to the basics: Establish good rapport with the patient, be thorough, validate while maintaining some skepticism, and give yourself time to conceptualize, he said. “[I]n so doing, we may find that those supposed trending presentations are an accurate description of symptoms that have been long experienced and suppressed by the individual until they are living in an environment supportive enough for their expression. … Or maybe we find out that, indeed, someone really has been heavily influenced by what they have heard from a peer or seen on a social media video as part of developmentally appropriate needs to feel connected socially and developmentally appropriate introspection at this age about their identity,” he wrote.

Rettew concluded, “Rigid and oversimplistic thinking often fails us and our patients by closing conversations before they ever truly open. The pathways through which our patients find their way to our office are incredibly rich and diverse. We lump them into convenient boxes at our peril, virtually begging our patients to reveal to us the deficiencies of our mental shortcuts.”

Rettew works for Lane County Behavioral Health in Eugene, Ore.

For more on this topic, see the Psychiatric News article “‘Outbreak’ of Sudden Tics Among Teen Girls Has Surprising Global Similarity.”

(Image: iStock/monkeybusinessimages)

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