When a diagnosis feels both validating and like an undeserved free pass for your “flaws.”

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Imposter Syndrome About My Mental Illness
Credit: Emily Lundin

"That seemed too easy," I thought to myself as I left my second appointment with a new psychiatrist. After years of suspecting that ADHD was the real reason I lived in a cloud of constant chaos, surrounded by literal and figurative mess, I finally decided to see a professional. When I got the diagnosis, my first feeling was validation. The second was doubt. Don't these symptoms kind of describe everyone? Did I exaggerate to get the answer I wanted? Was this just one of those doctors who diagnoses everyone who comes into his office?

I went back to work and spent the rest of the day clicking anxiously between my email and Twitter, wondering if maybe my generalized anxiety disorder (GAD) was just an affectation, too. Like a white lady Instagram influencer who has to apologize for a gaffe and immediately brings up "anxiety."

When I tell people I have an anxiety disorder and ADHD, I still often wonder if they believe me. While society as a whole has taken some important first steps toward destigmatizing mental health disorders, a greater willingness to speak openly about neurodivergence has also opened the door for critics who speculate that these disorders are over-diagnosed or that some people are self-diagnosing as a way to pathologize normal feelings of insecurity, angst, or lack of focus. And some have been accused of falsely claiming anxiety or some other mood or behavioral disorder as an identity or for attention, minimizing the reality of the condition felt by those who really have it. 

So when someone online or in your community complains about people "pretending" to have anxiety, when they have been having regular panic attacks since childhood, or are unable to leave their homes, or their hair is falling out, it can even make you doubt yourself — am I one of those pretenders?

In a word, it's gatekeeping, which sometimes results in a game of one-upmanship to "prove" your right to claim your diagnosis. And if you fail — perhaps you've been too successful in your career, you can't list enough physical manifestations of your anxiety, you've never experienced suicidal ideation — if you're made to feel like your neurodivergence has not been sufficiently devastating, you can feel invalidated, or even guilty.

When you've been successful in your career, for example, you may question whether your ADHD diagnosis is legit, "because other people discount it or they don't see it," IngerShaye Colzie, MSW, LCSW, a coach and counselor focused on ADHD, says. "They don't know all the stuff you're doing behind the scenes in your head, running around or working twice as hard."

She continues, "There's so much misinformation about ADHD that most of the time people don't know what it is. And so even if they get diagnosed, sometimes you question it because you are able to do things some of the time." So one day you may be able to function perfectly and the next you can't get out of bed, which, Colzie says, can make you feel off-kilter. 

Without a trained, professional understanding of mood or mental health disorders — as in, one that follows the diagnostic model — criteria for these disorders can seem pretty nebulous and vague, and are therefore subject to a lot of self-doubt. So while you may feel all the symptoms of anxiety, and while these may be impacting your daily life, you can still second-guess your own assessment, or even a professional assessment, of how serious they really are. 

David Susman, PhD, clinical psychologist and advocate, names "limited awareness" as one reason people do not seek treatment at all. "A person may acknowledge some mental health concerns, but can lack full awareness of their significance," or fail to "understand they have an actual illness," Susman writes on his mental health awareness website. "They may dismiss or minimize their issues and say 'everyone gets stressed out' or 'my problems aren't that bad' or 'you're making more out of this than you need to.'" 

On the r/Anxiety subreddit board, for example, it's not uncommon to see posters describe their symptoms of anxiety and ask the community for perspective on whether it's worth it to seek help or if they're just being "dramatic" or "faking."

One poster wrote, "Feel like I've been living in denial of my anxiety/depression for years now, but at the same time I feel that I'm being dramatic and actually fine." Another asked, "I have searched up the symptoms for anxiety and I feel like I have it but then immediately think I don't. I really don't know if I do have it and I'm afraid that I'm just faking it." And another, "In the community I grew up [in], mental illness is looked at as a weakness. So every time I talk to my parents about the things I feel, they keep on saying I am just overreacting, that I don't have anxiety."  

As Colzie notes, popular misconceptions and invalidation often leads people to internalize the mental health condition as a character flaw, creating a lot of shame and anxiety — which certainly rings true for me. 

Adam Mandel, PhD, clinical psychologist at NYU Langone Health, notes that without an accurate diagnosis, caregivers of children with ADHD who are failing to meet their full potential are "left to write their own stories as to why the child appears so inconsistent. These stories are not always kind." He explains, "Children may begin to form what we psychologists describe as 'maladaptive core beliefs' about themselves and the world.  For example, children may come to believe that they are lazy or unreliable … Without intervention, these core beliefs may persist into adulthood and contribute to the higher rates of anxiety and depressive disorders observed in adults who meet criteria for ADHD."

Growing up, the symptoms of my anxiety and ADHD were treated simply as personality quirks or family jokes ("Katie always does her homework, she just leaves it in the bottom of her locker somewhere," or "Well, of course you're crying, Kate, you've always been a bit weepy"). I grew up believing that I, fundamentally, was a lazy and often histrionic person. The idea that any of the mess in my life could be in any way not my fault was utterly foreign and, to be honest, felt like a cheat.

Chronic invalidation and stigma does not affect people equally across gender, racial, or class lines, of course. Research suggests that the adult Black community in the United States is 20% more likely to experience major mental health problems. At the same time, powerful cultural stigma about mental health means that people in these communities are likewise less likely to seek mental healthcare — in addition to other barriers to access to care including cost and racism within the healthcare system. 

But while disorders are likely underdiagnosed in Black and brown people, there are real concerns that as a whole, certain mental health disorders are being overdiagnosed, and that we are in a "diagnosis epidemic," a term coined by Allen Frances, MD, psychiatrist and professor at Duke University. Joel Paris, a professor of psychology at McGill University, argues in his book Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes, that the boundaries between what we'd call normal and what we'd call a pathology are becoming fuzzier, and doctors, erring on the side of caution, are actually overdiagnosing and overprescribing. 

Taking all of this together, it's not irrational to wonder if a diagnosis of GAD, ADHD, major depression, or bipolar disorder — all named as examples of overdiagnosis — is just a reflection of your own privilege or a failure to take responsibility for your own faults, thus restarting the cycle of internalized shame and inadequacy that led you to seek treatment in the first place. Ironically, a hyperfixation on whether or not you're anxious enough to have anxiety could, in itself, be a sign of anxiety. 

And this self-doubt is often reflected on social media, within friend groups, or in pop culture, sometimes with legitimate reason and sometimes less so. Take Cazzie David, daughter of Larry David, who described her severe anxiety in an interview with LA Times promoting her new book of essays — and her irritation with those who falsely claim the disorder. 

"I give people this anxiety test as a joke, because anxiety has become such a trend, and it deeply annoys me. I ask them if they had anxiety when Clinton or Obama was president. Have you taken a nap in the last two years? Do you like roller coasters? Do you like scary movies? There's a difference between having stress and having an anxiety disorder, and that's never feeling safe or comfortable or like the rug is gonna be pulled out from under you at any second."

But while no professional recommends self-diagnosis in a clinical way, most individuals are very good at describing and assessing their own feelings, according to experts. Meaning that while you may not be able to correctly identify which specific disorder, syndrome, or condition you have, if your instinct is that something is not right in your brain and it is impacting your life, you're probably correct.

For instance, while I fail Cazzie David's test (I love naps, roller coasters, and scary movies), and though this passage does continue to haunt me, I also know that my own panic attacks and neuroses and physical symptoms are both real and disruptive to my life. 

"I don't have too many biological assessments when people come into my office," says Mandel. "I don't put them in an fMRI study. I don't put electrodes on their head. I ask them how they're thinking and how they're feeling, and we figure it out together. So, if someone feels like something's wrong, they're usually going to be the expert in it."

The process, Mandel explains, is collaborative. The patient describes what they're feeling and experiencing, and if it feels necessary, together the provider and patient figure out a diagnosis and find a professional practitioner to speak to regularly.

Whether or not you feel your disorder rises to the level that certain of your peers or community would deem adequately disruptive, the most important point, experts agree, is that you are the authority on what does and does not impact your life.

I don't talk about my GAD and ADHD for clout, and if you accused me of trying to make them my whole personality, well, in a lot of ways they are. I could list all of my symptoms, describe my daily internal pandemonium, and show you a lifetime of destruction left in their wake. But that would be boring and I don't have anything to prove. I really don't care if you call it a disorder, a syndrome, a condition, or just a normal variation in the human experience. At the end of the day, a diagnosis is just a way to describe how my brain works — and how to help it work in the world.