Should we allow answers to make potential diagnoses?

Question

I have a lot of experience - several years professionally - with mental illness and drug addiction. Twice (that I can recall), I have made potential diagnoses in my answers regarding people the OP is having problems with.

I was asked about the wisdom of doing this by a moderator, so I stopped, even though I have pretty fair confidence in my ability to diagnose given enough information (and I would not diagnose if that information was not presented in the question, either deliberately or unintentionally.)

One thing I would not do, however, is to try to diagnose the OP. For one thing, it's unprofessional. Would you want a bunch of people on the site to read that you were probably a narcissist? Even though it's only an SE [gr]avatar? Probably not. Secondly, it's tricky. It's easier to diagnose someone that a person is talking about (when they have no reason to misrepresent facts) than it is to diagnose the person who's talking (who is probably presenting themselves in a selected light).

Yet on several occasions, I've seen this done, and have flagged a moderator about it, but nothing was done, most recently, on this question: How to deal with anxiety/control issues in relationship.

In this answer, the user suggests that the OP may have Borderline Personality Disorder (I doubt he means Bipolar disorder.)

My flag was deemed helpful, but the answer remains, unchanged. (The underlying cause of BPD is an intense fear of abandonment, but there's a lot more to it. Lots of people have abandonment issues but don't have BPD.)

What do we as a community want? Do we diagnose or not? (N.B. When I diagnose, I cite references. This should be the minimum requirement.) I'm ok with not diagnosing, but not with the inconsistency.

Edited to add: I would have edited it, but, in case no one has noticed, I also answered that question, which would make it entirely inappropriate for me to edit. So the diagnosis has remained (as has the double standard.)

Answer 1

As a rule, I would lean towards not. While you may be a medical professional, and have all the surrounding education and experience, most users probably don't.

Unfortunately there's nothing stopping users from claiming professional status, training, etc. when they don't actually have it, and we don't really have a great way to verify someone's claims. (If I remember correctly, you may have already commented on one question because the OP had claimed a professional status that seemed to contradict their current question...)

It's one thing to mention that something sounds like X, for Y and Z reasons, but I would try to discourage actual diagnosis. It's not really what we're here for and there's a pretty big risk for abuse.

Answer 2

Do we diagnose or not?

There is a third possible option and this may actually be a rather safe and useful one for a user with expert knowledge like you, anongoodnurse. This is the case, when not enough information is provided by the OP and/or the OP has a suspicion:

Use your expertise to not diagnose.

What I'm referring to is How to constructively engage a female friend with possible body image problems?, where the OP saw a friend after a long time again, and noticed that she became thinner with every day. His concern was, that she may have an eating disorder.

The OP gave some information (in the question and in comments):

• I did notice she left more than a few strands on the pillows.
• She complained of being tired quite frequently during her visit.
• She also has noticeably sunken cheeks, and her ribs were visible through a thin tight fitting shirt she was wearing.
• The weekend she spent with me she ate what I considered to be a smaller than normal portion (ie for dinner she ate ~6 chicken wings and a handful of berries and yogurt for dessert after having a small salad for lunch) but she didn't seem to be avoiding food or uncomfortable at meal time.
• I don't think she has any friends/support system in her new city and has minimal close friends in this country at all. Her family is also still in her home country;
• She had her advisor tell her that "you can't always rely on looking so hot to get ahead" She was quite upset by that episode since it embarrassed her in front of her cohort, but that was something else I didn't know how to broach.

I am not a medical professional, but I only have personal experience with one type of eating disorder. Since this is quite a sensitive issue for me, I hesitated to answer at all and only did so after a while, when answers came from people who explicitly had no experience with eating disorders (and one of them included the advise "Tell her you do not want to be around her when she engages in this behavior because it is to hard to watch her self destruct."), just with once having been quite thin.

Your expertise may not only come in handy in enabling you to tell what it is (or not) with greater accuracy, but also to show that an array of symptomes can have different causes. E. g. I may panick and write "Bob has fever. He must suffer from flesh-eating bacteria!" and then an expert comes along and says, that it could also be something else and give helpful advise.

Or in this example, an expert may be able to use the background information (social isolation in a foreign country, stress at work) together with the physical symptoms (hair loss, tiredness, weight loss) and conclude that it may be an eating disorder, but could also have a physiological cause, be mainly related to stress or whatever.

Basically, to use your knowledge not to narrow it down to one diagnosis, but to widen it to more possible diagnoses.

Answer 3

It is fundamentally difficult and not recommended to make a definitive diagnosis based on information supplied in a written account online, especially for mental health disorders, and even an expert health care professional (whether physical or mental health) needs to make a thorough face-to-face personal evaluation before pronouncing a verdict.

Moreover we probably do not derive any practical benefit by making a 'looks like BPD' 'looks like OCD' diagnosis since the management of the condition then requires offline professional help anyway.

So it is not appropriate for a user to 'diagnose' OP or another person in their answer. In such cases it would be much better to comment that OP or someone else described in the question needs a thorough psychological evaluation by a qualified mental health professional.

If a user thinks the question as presented needs expert help and cannot be given an interpersonal solution, then the user can also vote to close it as 'off-topic because it needs professional help which is beyond the scope of this website.'

Related meta questions:

• Should we get a custom close reason for 'needs professional help'?

• How to handle ips questions by people with "mental disorder"?

• Have we decided to adopt 'requires professional help' as a new, custom close reason, and how should the close message be worded?

• Where do we draw a line for 'needs professional help'?

We are not in a position to make a diagnosis based on a written account submitted online by or about an unknown person who is not available for detailed direct assessment. Nor is Interpersonal Skills a website intended to pronounce professional opinions or diagnoses when people ask their questions here. If users see a diagnosis in an answer they should flag it for moderator attention. When moderators review such a post I sincerely recommend that they should edit the 'diagnosis' part out of the answer and inform the author not to roll back the edit.