Increasing self- and desired psychiatric diagnoses among emerging adults: Mixed-methods insights from clinical psychologists

Anecdotal observations suggest that self-diagnoses and desired psychiatric diagnoses may be increasing among emerging adults, yet systematic evidence from clinical practice is scarce. This mixed-methods study surveyed 93 Austrian clinical psychologists (CPs) regarding their experiences with these phenomena in the context of conducting psychological assessments. CPs rated the frequency of both self-diagnoses and desired diagnoses as significantly higher than the neutral scale midpoint ("no change"), with large effect sizes (both <i>p</i> < .001). ADHD and ASD were most frequently identified as self-diagnosed or desired. Patients presenting with such expectations were commonly described as female, highly educated, and strongly engaged in online activities. CPs, many of whom indicated that they actively inquire about patients' motives when suspecting a desired diagnosis, explained such pursuits mainly in terms of relief from guilt, identity affirmation, and social recognition, while treatment access was cited less often. Qualitative analyses highlighted three recurring themes: (1) the impact of self- and desired diagnoses on the course of the assessment itself, including diagnosis-driven responding and limited openness to collaborative exploration; (2) strong reactions to diagnostic discrepancies, such as emotional distress, rejection of outcomes, criticism of clinicians, or "diagnosis shopping"; and (3) increased demands on clinical practice, particularly extended assessment time and the challenges of feedback sessions where unexpected outcomes must be communicated with clarity and empathy. These dynamics are discussed in relation to online mental health cultures and the symbolic appeal of neurodivergence, underscoring how digital environments shape both the spread of self-diagnosis and the pursuit of professional confirmation.