TikTok vs. Psychiatry: Who’s Really Getting Neurodivergence Right?

Is TikTok actually helping people understand neurodivergence, or is it just fueling a wave of self-diagnoses? In this no-BS, unfiltered first episode of Brain Trash, we’re tackling the big debate about social media and self-diagnosis.

We’re Maria Ingalla and Tabitha Arey, psychiatric nurse practitioners who are super tired of the outdated approach to mental health. We’re here to dive into:

•  The real reason so many people are turning to TikTok for answers
•  How the system is screwing over neurodivergent people (especially women & queer folks)
• Why psych screenings can get it so wrong
• The dangers of blindly throwing meds at symptoms instead of getting to the root cause
• What clinicians AND patients need to know in navigating this mess

If you’re a clinician tired of outdated psych takes, a med-nerd who loves dark humor, or just someone who’s been told “you can’t possibly have ADHD/autism”, you’re in the right place.

Subscribe and send us your questions—we’re just getting started.

#Psychiatry #MentalHealthPodcast #Neurodivergence #ADHD #Autism #TikTokDiagnosis #BrainTrashPodcast #Mentalhealth #PMHNP #Nursing #Nursingstudent #AUDHD #Latediagnosedautistic #latediagnosedADHD #womenwithADHD #autisticwomen #neuroqueer

Transcript

Brain Trash: From DSM to Dumpster Fire – Episode 1

Maria: Welcome to Brain Trash: From DSM to Dumpster Fire, the podcast where we talk about raw, unfiltered, and messy realities of psychiatry.

I'm Maria Ingalla.

Tabitha: I'm Tabitha Arey.

Maria: And we are psychiatric nurse practitioners.

If you're tired of sugar-coated, textbook, psychiatry bullshit... this is the right place. You have entered it.

We’re talking about real mental health—meds that work, meds that don’t work, the side effects, clinical nightmares, and all of the shady things that no one else wants to talk about.

This is for the psych nerds, the sleep-deprived clinicians, med-geeks, and anyone who's ever had a patient say,
"I diagnosed myself on TikTok."

If you're here for evidence-based tea, the dark humor, or an excuse to procrastinate your charting, you're in the right place.

Let's talk.

Self-Diagnosis on TikTok & Autism Debates

Maria: First thing I wanna talk about, most important thing, is the fact that a lot of people are diagnosing themselves on TikTok with autism.

There is a huge movement in the psych NP community in which people are frustrated with this, and they're saying, "Why do all these people want to be autistic?"

Maria: Tabitha, what are you seeing from the front lines over here?

Tabitha: Well, I think it's something that we, like, see a lot of, and it's easy to complain about because it can feel like there's this influx of people who feel this way, and so it can't be real.

But also, like, everything in the DSM is based on crusty old straight white dudes and how they present.

And I think, really, what, like, the advent of technology and all of this has done is it's given people who don't look like that a voice of what it looks like for them.

And so, yes, there's a lot of people that are showing up, saying these things, that are connecting with others through social media.

But I also think it's important to, like, listen to them and believe them and ask questions for context and, like, think, "Oh, well, they saw a video that was like, 'If you have this one symptom, you've got autism,' right?"

Just like, I mean, we saw that with ADHD as well.

"Oh, well, I get distracted sometimes, so I have ADHD."

That's not what people who are diagnosing themselves on TikTok are doing.

But it's easy to have scrolled past one video and see that and be like,
 "Oh, this is what people are watching that's making them think they have something."

And that's not typically the case that I'm seeing in, like, actual practice.

People are doing a shitload of research. They're listening to a lot of people, and they're finding something that, like, finally explains to them all of the struggles that they've had across their entire lifespan, which is, like, pretty huge.

Misdiagnosis & The Problem with Mental Health Screeners

Maria: And that's kind of, like, one of the things I think is...

A lot of people are showing up and being diagnosed with:

• Anxiety disorder
• Social anxiety
• Depression
• Bipolar disorder
• Borderline personality disorder

And, like, those aren't even explanations, right?

Like, a lot of it comes back down to, like, these are people having sensory meltdowns, and sensory issues were never explored.

Or these are people who just, like, don't do well socially, and they don't know what to say in social situations.

So, of course, they're gonna have anxiety, right?

Tabitha: Well, yeah. And I think we use a lot of, like, evidence-based screeners, right?

But what happens on the back end of this is:

• These patients are sent out a screener.
• They do it by themselves at home.
• They maybe are not reading the context or misread a question.
• They're marking off the answers to these things.
• If a clinician doesn't have enough time to ask for context, they just look at these screeners and say, "Oh, well, this person meets the criteria for bipolar or major depressive disorder," right?

And that is problematic because these things are not necessarily going to give the person insight into why their brain works the way that it does.

And it's likely going to, especially in psychiatry, like, cause a clinician to give them medications that are not going to treat the root cause.

Or they may help slightly, but they also might worsen other things.

The ADHD, SSRI, & Dopamine Crash Problem

Tabitha: And so it can start this really big snowball of, like, "Meds blow, they're not helping me. I've always had a terrible time in psychiatry."

And, like, kind of that traumatic process for a lot of people of being put on medications that make them feel much worse, that give them terrible side effects, that don’t really help treat the root cause, right?

Because, like, for example, with ADHD, where, yes, there's anxiety, social anxiety, depression, these things...

But if we just keep jacking up someone's SSRI and decreasing their anxiety, really, what we're doing is we're taking away their ability to mask, right?

So now, ADHD gets much worse because they're like,

"I don't have this voice in my brain anymore going, 'Hey, did you remember to do that thing?'"

"Make sure that they think that you're listening to them even though you don't give a shit what they're saying."

Right? Like, your brain isn't doing that anymore.

Which is helpful because it doesn’t feel as distressing.

But also, like, I’m not getting shit done because nobody’s berating me in my mind, telling me what to do.

Maria: and that, you know, and the SSRIs are also decreasing the dopamine downstream, right? So, after you've been on it for a period of time, it starts decreasing your dopamine, which then worsens your ability to focus or function or anything so that you have less anxiety. You're not doing things, you also have worse dopamine. Then you add in things like having a period, which can also mess with your neurotransmitters and all of those other problems.

And then people are coming back saying, "Well, I feel flat or I don't feel good," and we have clinicians who are like, "Well, you must be bipolar."

Tabitha: Yeah.

Maria: Which is not. And then, you had mentioned screeners, so one of the other things that's happening on the back end is, we have a lot of people who are autistic and reading those screeners very literally, and they're answering yes to questions because they don't have enough context.

People who are autistic are often reading questions, saying like, "I don't know how to answer this cause there's not enough information." Or they're just doing their best to kind of guess at what it means.

So, if we don't have NPs and clinicians verifying that they understood the question and asking those questions in different ways, now we have people who are just completely going to be misdiagnosed, right?

Tabitha: Oh yeah.

And I think that there's a lot of places, and I've read through a lot of commentary from providers who maybe are, you know, in agencies where they don't have time to get that context and ask those questions, and they're just—every single time—their clients are filling out like a PHQ9 and a GAD7, and they're basing medication decisions on that.

And if somebody's coming to them saying, "Well, my, you know, my SSRI doesn't work anymore," for example, and they're just jacking up the dose cause it historically was helpful, now we're making all these things worse based on something that nobody asked context about.

And so, if we're taking things literally, especially in autism, right?—which side note, and I don't even know if this is funny or not, but like I saw a video the other day, this guy was like, "It's so strange, they say in autism, people are like taking things literally, but like I've never stolen anything."

I'm just like—and I was like—this is hilarious because we do say that all the time. They do think so literally. It's like, no, they're not actually literally—

Maria: Nobody's literally taking anything. I love it.

Tabitha: Anyways, um, I don't know what I was even saying. Do you remember what I was saying?

Maria: Um, no.

I think this is ADHD problems of two people.

Oh, medications.

Yep. And psych NPs and—

Tabitha: Oh, screeners—and taking the questions very literally, right? Like I'm trying to think of a really good example, but like, you know, even on the rapid mood screener, right? You've got like, "Have you had at least six periods of time where you have felt deeply depressed?" There's so many aspects of that question that are like, "But six? I mean, let me think."

And what counts as a period of time, right?

Maria: Right.

Tabitha: What does that look like?

Cause if I'm like on and off depressed for a whole year, are each of those times a depression, or is it like
 
 Maria: each day?

Tabitha: Was it deep, right?

Is it depression? What does that mean?

Right.

Maria: Like, have I had bad days? Like, absolutely. I've been depressed for moments. Like, there are so many different ways you could interpret that question.

Tabitha: And it depends on how you feel that day too.

Like, how literal are we taking things today?

What is my—what is my overall emotional regulation and overstimulation and sensory stuff doing today as to how quickly I fill out these questions and think about them?

And so, that can totally change how I answer those things. And then again, if nobody takes the time—

Maria: even in office, if you're filling that out in a new environment where you're already anxious and you're expected in, like, you know, there's people yelling or like moving around, and you have a hard time reading, right?

And interpreting information.

It's gonna be even harder in that situation when you're anxious,
 
Tabitha: And it's like the psychiatry version of white coat syndrome, right? Like, people being diagnosed with hypertension, but they're just like freaking the fuck out in the doctor's office, and that's why their blood pressure is high.

Maria: That's so accurate.

Everybody just gets the anxiety and the depression diagnosis instead, and it's like, "But I came here for ADHD and autism," and they're like, "Why are you diagnosis seeking? What are you trying to get?"

And it's like, people are literally like not trying to get money, they're not trying to get disability, they're not trying to get anything. They're trying to get validation on why their life has been so fucked up.

Tabitha: Well, I think this also doesn't even necessarily have to culminate in prescribing a medication for it, right? We can always just say like, "Oh, I hear what you're saying and this does sound like, you know, it's got some merit."

And maybe you are a clinician that's like, "I'm not gonna give you meds on the first visit for this," which I've seen a lot of people say. They have, like, very strict rules about this and, you know, to each their own.

And also though, like, this is a good time to start building those non-pharmacological interventions that are actually going to make an impact instead of saying, "Oh, go to therapy for your depression and anxiety."

It's like, how do we structure your world to fit the way that your brain thinks instead of trying to jam your fucking brain into 9-5 capitalism land and think, "I do everything wrong. Why can't I do it like other people?"

Maria: Really.

Yeah, and this is where we get a lot of, like, NPs who will give referrals for adults to go to therapy but not ever recommend occupational therapy, when occupational therapy for adults is an amazing resource for people who have struggles with, uh, life skills, executive functioning, um, sensory issues—all of the things—but it's just not being recommended.

Tabitha: Yeah, there's so many settings where doing things differently, uh, in an occupational sense or just whatever—organizational sense, all of it—like, it seems wrong or unprofessional or whatever, right? Like, I'm in an appointment sitting cross-legged, so, you know, in my jeans, my T-shirt, and I'm kind of like, if people don't think this is professional, it might not be the place for them, and that's okay. You know, but, like, I have to be able to support myself sitting through a day's long appointments, a day's worth of, you know, all kinds of stuff without just feeling dysregulated myself. And so, like, it's important to look at these aspects.

But I think that so many people are just like, "Oh, you have these symptoms, which means this med—unless it's ADHD—and then you don't get that med because you might abuse it."

Yep, and actually, studies show that, like, medicating ADHD actually decreases the chance of substance abuse disorders, which could probably be its own episode.

Maria: Decreases risk of death and all of the other things. And here we have the DEA, who are forcing regulations down our throats, saying like, "Well, we shouldn't be prescribing that via telehealth cause people could be abusing it."

It's like, no, that's not what's happening. People are getting access, women are getting access, and doing better in life, and all of a sudden, let's shut that down.

Tabitha: Right, and that's the thing—like, are there people who probably abuse the system? Yes. Is that a vast majority? Absolutely not, right? And having, like, worked in substance use in the past, like, being able to say, like, this kind of shit—if it is going down, it always comes out, right? It's not sustainable. And so, the people who are misusing it—like, we will know that eventually. It's not something where, like, you know, every single client I have that's on a medication that can be abused is probably just abusing it. It's like, not really, cause their lives are improving, right? They're, like, maintaining gainful employment. They're building happiness and community and doing the things that they've always wanted to do with their lives, and, like, how is that something that we hold back from people just because all of a sudden now, people who are not these cishet white men are finally getting treatment, you know?

Maria: Yeah.

That's exactly it, and there's so many women now, or, like, queer people who are trying to get help and they just can't. Um, and it's like, well, you got straight A's in school, or you've always done well. And it's like, yes, I also had a 4.0 and graduated in the top of my class, and, you know, I got a doctorate and I wasn't medicated or diagnosed at that time. But, like, it doesn't mean I don't struggle every day, and I'm not losing my keys and crying because my keys are missing for the millionth time, and using, you know, "Find My iPhone" every 10 minutes and just being a hot mess, like, breaking down all of the time. Doesn't mean that, you know, people just don't ask those kinds of things. They're like, "But you did good in school."

Tabitha: And I think also, when we look at the course of how it presents differently, a lot of times with women—and this is something that I've read quite a few studies on as well—like, ADHD does not become actually distressing until after you have your first baby because of this huge hormone shift. Right? Or, um, not necessarily right after you have your first baby—that is one of the most, like, prevalent times—but anytime that there is that big hormonal shift. So, going through puberty, which is why so many teenage girls are diagnosed with mood disorders at this time who are actually neurodivergent, cause all of a sudden moods start shifting, which is actually, like, "Hey, I'm, like, super overstimulated, my brain has no dopamine because my estrogen is all over the place, and our brains need estrogen to create and produce dopamine or to create and utilize dopamine."

So, like, there's that—puberty, and then pregnancy and childbirth, and then going through menopause, where people will say, like, "Oh, well, you just have menopause brain or mommy brain or whatever," but there's really no scientific evidence that that's a thing. There's a low level of, like, brain fog in these types of things that can be common without the neurodivergence aspect, but there's a level of it that becomes distressing during these times. And this is why adult women are getting diagnosed later in life—because it wasn't distressing necessarily externally before. And we start to realize how much it's been internally distressing our entire lives, but we've been able to cover it up.

Maria: And, like, you can handle it when it's just you living in an apartment or, like, you and a partner living in an apartment and, like, handling taking out the trash and, like, just kind of doing things and doing school. But then, like, when you're doing work and having a baby who requires 24-hour, like, uh—I don't know—love and touching, when you could get overstimulated by that and need multitasking. Like, being a mom is freaking hard, dude. Like, and then on top of the hormonal shift, I feel like a mess all the time. I've never, like, struggled more in my life than I have as a mom, period.

Tabitha: Yeah, yeah.

I'm just like, my brain has never worked the same.

Maria: But don't worry, that's normal because it must be—no, it has to be "mom brain," right? Like, that's just normal. This is where we get a lot of the invalidation I think that happens for people that just never come back to psychiatry after.

Tabitha: Well, I'm—I'm like, I could just, like, dive into more shit that can probably be its own episode. But, like, when we look at other things like autoimmune disorders, a lot of times when we are masking, we're holding a lot of things in, right? Girls and women are more likely to have autoimmune disorders because of this—internalizing stress, increasing cortisol levels, causing that inflammatory response in our bodies that leads to all these vague fucking things that are happening, right?

So you've got, like, all the connective tissue disorders. Um, PCOS, right? You can go on and on with all these things. But these are also really commonly co-morbid with neurodivergence. But there's, you know, some vague research that talks about it, but at the same time, it makes sense to me—at least in my brain—that masking and internalizing is so stressful that this is what causes a lot of that inflammatory response, autoimmune response, the development of these things.

Where then you show up to a doctor and you say, "I have all these symptoms," and they say, "You should probably lose a few pounds and stop being so anxious."

Maria: Yeah, did you need an SSRI? Have you heard of that?

Yeah, maybe we should think about that for your, um, EDS that you have and all the other problems—that might fix it, right?

Maria: It's so accurate.

Tabitha: We talked about all the problems, but, like, what do we do about it, right?

I think that there is an absolute need for us to come up with solutions to some of these more fucked up problems that are pretty systemic. And so, looking at what we can do as providers, but then also, like, what people can do for themselves to advocate.

I think especially for providers, the biggest thing is just making sure that we are taking the time to listen, believe our clients, ask for that context, right? Actually stay curious instead of the first time somebody says, like, "Hey, I think I have this thing," does your brain shut off? Is it like, "Oh great, here we go"?

That might mean that we need to indicate or start to do a deep dive on where our bias stands, right? Like, what is it that's making me feel so averse to somebody saying something about themselves that feels really meaningful to them? And why don't I want to listen, or why don't I want to validate that? Because that validation could make all the difference in that person's life.

And I think educating ourselves on what different things look like that are not exactly as the DSM describes them, right? Like, what does it look like when neurodivergence is masked and people who are, you know, women, non-binary, adults versus children—all kinds of different presentations exist and are real and matter. And so, teaching ourselves about these things so that we can identify them and so that we don't misidentify something that could actually be harmful to somebody or do them a disservice or send them down a path that is going to either waste their time or be very invalidating.

I think those are the main things that I can think of. What would you say about, like, any of that or things that clients can do for themselves?

Maria: Yeah, I would add on for, like, professionals to, like, uh, educate themselves a little bit more about the things that we necessarily didn't learn in school—things that can show up in autism as far as, like, the variations that you mentioned, like sensory processing disorder.

A lot of us don't know how to assess sensory processing disorder and don't realize that, like, this is something that's relevant outside of childhood and that people are still dealing with sensory issues. And it's not normal for people to be crippled by these, right? Like, that's not just something that's a human experience.

Like, sure, people who are kids will cover their ears at loud sounds, but what do adults do? Adults can get really irritable and have an outburst, and then you might diagnose them with bipolar because they're frequently irritable.

Um, so, kind of understanding context behind things and asking questions about the environment. Like, are you getting frustrated because you're working from home, and you can hear your partner, like, cooking, and that's irritating you? That they're moving near you, and, like, you're seeing them move, and you're getting overstimulated by that?

Like, starting to think through those components is really important for context. Understanding that there are different screeners and kind of looking at flaws within a lot of the screeners that we have, like the, you know, mood disorder questionnaire or Rapid Mood Screener.

A lot of people answer those very literally. Um, looking at variations, like, the DSM lists abnormal eye contact. It doesn't list no eye contact. It lists abnormal eye contact. Abnormal could also mean that somebody is focusing extremely, uh, intensely on, like, looking at your eyes, right?

So again, this is like, as you said, just, like, stopping to check for bias and understanding instead of just saying, like, "What I understand—this is the clinical presentation of autism." You probably don't understand the full thing, right?

And then I think for people, I don't wanna be like, you know, "Just, like, fuck it, like, diagnose yourself and, like, that's cool, like, find community." But also, like, diagnose yourself and find community and fuck it. Like, yes, it's gonna help you, like, understand yourself better, and you're gonna meet people who are going through similar things and having similar experiences.

And there's so many, like, online tests that you could take, you know, like the Autism Quotient test, and that can give you, like, some validation. You could see an occupational therapist and get a sensory profile done, and that could be helpful for life skills. And also, just to kind of validate that, like, yes, you do have sensory issues because an occupational therapist is gonna know a lot more than your actual therapist most likely. Some people, exceptions, and your psych NP almost definitely.

And then, like, I think just, like, trust your experience, and, like, know that, like, your provider might just not be educated. And that's, like, really sad cause we expect our providers to know things and to not be biased and to give us, like, support.

But, like, sometimes they just don't, and sometimes that means we have to, like, look for a new provider who's, you know, neuroaffirming, and that's just, like, what we have to look for.

And that sucks. It's hard—the part of the dumpster fire of the DSM.

Tabitha: Yeah.

Maria: And psychiatry.

Tabitha: Well, I think, too, just, like, not contributing to the stigma. Like, if we are making videos on social media of our experience, making sure to talk about, like, "Hey, just because you have this one thing doesn't mean that you are autistic, but it might be something to look at."

What is this doing for me? How is it affecting my life? Is it causing me distress? In what ways does this show up for me?

And then communicating that to our community so that this doesn't keep perpetuating the, "Oh, if you have one thing, then that means you have this diagnosis."

Maria: People get so mad on my stimming video. I have, like, 10 million views, and people are so angry in the comments being like, "You're not autistic," and I'm like, I literally did not mention autism once in this video. Like, not once.

People are like, "I'm not autistic," and I'm like, "Who said that? Like me? Me?" I don't even understand. People get so defensive about the, "You know, I might be autistic if I'm stimming."

No. Stimming is a human behavior. And yes, social scientists do put names on everything, cause we just do. You're just learning that it has a name.

I can't.

Tabitha: I think there's a lot of things that are okay to just, like, not name as long as we understand them about ourselves, right? Cause at the end of the day, like, no matter how much our experiences are the same or different than our patients, like, we will never know what it's like to live inside of their brain, right?

And so, the best thing that we can do for them is help them to understand how their brain functions and what's important and what matters and what's distressing and what's not. So that their experience is better in life, and so that when they put their head on the pillow at night, their brain doesn't feel like such a fucking dumpster fire, you know?

Maria: That's, like, the healing part, I think, of psychiatry that we miss out on a lot because our appointments can be so rushed. But that's, like, so valid. Okay, so today we got to unpack why the DSM sucks and a lot of the stigma behind diagnosing yourself on TikTok and finding community within our own profession and for other people.

So the big takeaway here is—check your bias. If you're a provider, educate yourself on all of the things, and start listening to autistic voices. Read some books written by autistic people. Like, you need to understand autism and ADHD and all of the things from their experience, not from the male professional, "I wrote the DSM."

It's not the Bible. Please, let's stop talking about it like it's the Bible.

So even if you are just curious, and you're checking this out cause you're a neurodivergent person, cool.

If you found this episode to be helpful, make sure to hit the follow button and subscribe, leave a review, leave a comment. We'll talk through some of your comments, and we'll work on that for future episodes.

And we want to reach more people and talk about all of the bad things that are happening in psychiatry and all the cool things that are happening and all the ways you can advocate for yourself. So send up your questions and hit subscribe, and we'll see you on our next episode.

Thanks for listening to Brain Trash.