according to a study by Ahuvia et al 2024 [Ahuvia, I., Eberle, J. W., Schleider, J. L., & Teachman, B. (2024, March 21). Anxiety Identity Centrality Is Associated With Avoidant Coping in Anxious Adults. https://doi.org/10.31234/osf.io/5wgnc (Link)]. To assess centrality, members of the public scoring highly on a measure of trait anxiety were asked to consider 2 circles, one labelled ‘me’ and the other labelled ‘anxiety’. Then to consider the extent of overlap between the two circles, on a 1-5 point scale, were a one would mean no overlap at all (minimal centrality), to a 5 which would denote total overlap (maximal centrality) and that anxiety was central to their identity. Their findings applied whether the focus was on situational anxiety or on emotional avoidance. The results stood up when differences in the severity of initial anxiety was taken into account.
People commonly bestow a mental health label before they first see a mental health professional e.g ‘I have always been a worrier’, without any evidence they are worse in this regard, than anyone else. Or ‘my father developed dementia, my concentration has become poor, I will probably follow in his footsteps’. On the one hand the label confers a sense of identity but on the other as Ahuvia et al 2024 have suggested, it may result in avoidance of anxiety evoking situations e.g a busy shop, or emotional avoidance e.g non-attendance at a funeral, ‘don’t want to get upset’. The anxiety is thereby perpetuated.
In principle a psychological therapist could help reduce the overlap of the 2 circles. But centrality has not been a focus in CBT, except in my works on trauma [ I have addressed the Centrality issue with regards to trauma extensively in the clinician handbook ‘ Personalising Trauma Treatment : Reframing and Reimagining’ Routledge (2022) and in the 2nd edition of the self-help book ‘Moving On After Trauma’ to be published in June, by Routledge]. The Centrality framework is also clearly pertinent beyond trauma.
NHS Talking Therapies the main provider of UK primary care mental health services, staff do not make diagnoses. GPs mental health diagnoses are usually vague e.g ‘mixed anxiety and depressive disorder’, but can be more specific, though no more reliable, in the wake of an extreme trauma when PTSD may be opined. It seems likely that most people use largely publicly available information on disorders to explain their difficulties.
In the anti-psychiatry movement psychiatrists are often branded as the villains of the piece for making diagnoses. But their domain is largely restricted to those with moderate-severe impairments, who are at the top of a pyramid of prevalence with the great majority of sufferers being at the base of the pyramid. It is arguably the insidious effects of self-diagnosis that is the bigger problem numerically than those effected by severe mental illness. Most people with a recognised psychiatric disorder are likely to be mildly affected with comparatively few at the moderate-severe end. Judgements at the mild end/difficulties are likely to be the most unsound and it is in this area that self-diagnosis is likely to be most in evidence. In the real-world, self-diagnosis is likely to be far more prevalent than diagnoses made by usually psychiatrists on those with moderate to severe disorder.
A mental health professional can be alert to the sabotaging behavioural and emotional avoidance consequences, highlighted by Ahuvia et al (2024] that can arise from over-identification with a diagnostic label, ‘this is who I am’ and strive to separate difficulties to be addressed from the person. A process akin to stopping a person with a physical disability defining themselves in terms of it. But the lay person who has self-diagnosed is likely less equipped to address the centrality issue.
Dr Mike Scott