What happens when social media makes certain mental illnesses go viral?
Back when I was an attending psychiatrist on the Trauma and Dissociative Unit at McLean Hospital, we worked with individuals with complex PTSD, some of whom had dissociative experiences. A handful of these extremely traumatized individuals fit the diagnostic criteria for Dissociative Identity Disorder (DID), which used to be called “multiple personality disorder.” None of them remotely resembled how DID has been portrayed as essentially a one-person costume party in shows like the United States of Tara and books like Sybil (which is based on someone who later revealed they were making up most of their story) . It’s also worth emphasizing none of the people I have encountered in my professional life as a psychiatrist wanted to have DID.
When I heard from our IT Director, RJ Smith, that DID was trending on TikTok I scratched my head and began a deep dive into subreddits like r/FakeDisorderCringe to try and get to the bottom of this phenomenon. A recent article also helped me understand just how deep this rabbit hole goes. I quickly learned that not only was DID frequently trending on TikTok and Instagram, but other mental disorders that can be portrayed visually like Tourette’s, ADHD and Autism were taking up TikTok front page real estate the same way videos tagged with the much more innocuous #TimeWarpScan, #blindinglights or #MedievalTikTok hashtags got millions- sometimes billions- of views. On our Creator First show on Clubhouse, The Frontier Psychiatrists, we decided to host a conversation about why so many mental health influencers were essentially faking mental illnesses like DID.
Our panel included a number of mental health influencers who, contrary to the individuals spreading mental health misinformation, have found ways to share accurate information about mental illness and reduce stigma in the process:
-Jeremy Fox, a trauma specialist who practices EMDR therapy and has a very educational TikTok account
-Carly Krzanstek, a young woman on a mission to provide education and raise awareness about Tourette Syndrome through her YouTube Channel, Ticcing Together.
-Jessica Mayer, whose YouTube Channel devoted to Dissociative Identity Disorder, Multiplicity and Me, has over 200k subscribers and is a great source of nuanced information about dissociation, often complete with citations to academic papers.
-Gina Pellicci, LMSW, a Chronic Pain Warrior and the head of our Sex Positive Team at our practice, Brooklyn Minds
-Robert Tolppi, who has 1.1 Million followers on TikTok for videos that comment on pop culture and whose astute YouTube video on “TikTok’s Garbage Psychiatric Advice” really caught my eye.
Three Categories of Online Behavior
In many instances, we simply do not know the motivations behind the individuals posting these videos but they tend to fall into three broad categories:
-Factitious Disorder, also known unofficially as Munchausen-by-Internet when it involves online behavior: The motivation here is that the sick role itself is serving the psychological needs of the individual. “Just doing it for attention” could fall into this category but the key thing to keep in mind is that the motivations are often unconscious and people are not fully aware of what is motivating them to engage in feigning illness or exaggerating an actual illness (“gilding the lily”). Many of these individuals may have other underlying psychiatric disorders, especially personality disorders.
-Malingering: This is not an illness but rather a behavior where a person is intentionally feigning or exaggerating illness for a non-psychological reason such as wanting to make money or get out of another responsibility. A child who puts the thermometer under a lamp to miss school because they would rather play video games would be malingering. On TikTok or YouTube, someone who fakes Tourette’s disorder to capitalize on monetized views/subscribers and score brand partnership deals would be malingering. People faking cancer on the internet to scam others out of money would be malingering but if the person also is enjoying the attention of people believing they are sick could also be showing signs of factitious disorder so these distinctions are not always clear cut.
-Trolling: This is a scenario where people intentionally feign illness in order to cause drama online and rile people up, not because they enjoy the sick role or because they have another secondary motive but because they find the act of trolling thrilling and satisfying in its own right. There are definitely some videos on TikTok where it is unclear if the person is trolling, being satirical or is being sincere.
To Self-Diagnosis or Not to Self-Diagnosis
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