Several years ago, psychiatrist Suzanne Garfinkle-Crowell began noticing a striking change among teenage girls and young women arriving for their first psychiatric sessions. Instead of waiting anxiously to hear whether a professional believed something was wrong with them, many arrived with diagnoses already in hand.
Attention deficit hyperactivity disorder. Obsessive-compulsive disorder. Anxiety. Depression.
They often announced these conditions before properly introducing themselves. Their evidence came from Instagram, TikTok quizzes, conversations with friends and the vast informal vocabulary of mental-health content circulating online.
The phenomenon crossed social and economic boundaries. They included film students and athletes, class presidents and girls who skipped school, young women from wealthy families and those who worked for their spending money. What united them was not a particular background or personality, but a new fluency in therapy-speak.
For Garfinkle-Crowell, the response produced an unusual tension. As a physician, she would immediately begin considering possible treatments, including D.B.T., C.B.T., E.M.D.R. and medication. As a parent and Xennial, she sometimes struggled to suppress an inner eye roll.
Parents, she suggests, may experience a similar divide. They may be frightened by what their daughters are describing or alienated by the unfamiliar vocabulary. Some may respond by insisting that everything is fine.
Neither response necessarily addresses what the young women are attempting to communicate.
The central argument of Garfinkle-Crowell’s forthcoming book, “Girlhood, Translated: Understanding Young Women in the Age of Therapy Speak and Self-Diagnosis,” is that diagnostic language does not always function as a literal medical claim. For some young women, she argues, words associated with psychiatric conditions can operate as a coping mechanism: a recognised narrative through which deeply personal distress can be expressed.
The distinction matters.
A diagnosis can be clinically precise, but it can also become shorthand for an experience that is difficult to articulate. One patient told Garfinkle-Crowell that she had diagnosed herself with depression because she believed the label would make the psychiatrist care about her. Another remained attached to an A.D.H.D. diagnosis because it connected her to an active online community and made her feel less alone.
Other patients insisted that they suffered from anxiety because attributing their distress to an inherent problem in their brains seemed less frightening than examining its underlying causes. In some cases, those causes involved anger towards loved ones and guilt about experiencing that anger.
Another young woman used several self-diagnoses as a container for everything she considered “too much” about herself. The labels allowed her to organise feelings that seemed incompatible with the expectation that a teenage girl should remain, as she understood it, “chill”.
The result is an uncomfortable question: are these labels providing young women with a language of recognition, or are they gradually becoming identities from which it is difficult to escape?
The answer, according to Garfinkle-Crowell, is neither straightforward nor uniform. Some self-diagnoses turn out to be accurate. Others appear to represent compromises between painful emotions and the desire for social acceptance.
The trend is not confined to young women. Some measures suggest that 50 percent of Gen Z-ers have labelled themselves with mental-health conditions, while illness identities have become increasingly visible both online and offline. But young women are described as the principal drivers of the phenomenon. They are particularly active in searching for health information online, discussing feelings and relationships, and looking for explanations for what they believe is wrong.
There is another contradiction at its centre. Young women are simultaneously the principal participants in this expanding vocabulary of psychological distress and a demographic with a particularly poor mental-health profile. Yet because young women have historically been dismissed as frivolous, their language about mental health can itself be dismissed as weakness or self-indulgence.
Garfinkle-Crowell argues that psychiatrists themselves may think about diagnoses differently from the way the public imagines. Psychiatric categories can be flexible, particularly when dealing with young people and young women. Classifications change, experiences differ from person to person, and understanding the individual must come before applying a rigid category.
That becomes particularly important when therapy-speak begins replacing descriptions of feelings.
A young person who says she has A.D.H.D. may or may not meet the clinical definition, but she may be trying to communicate that she feels scattered, overwhelmed or afraid that something is fundamentally wrong with her. Someone who says she has anxiety may be communicating that she is nervous, uncertain or frightened. Someone who describes herself as depressed may be attempting to express hopelessness, loneliness or despair.
The same principle applies to another increasingly common term: “toxic”. Rather than dismissing the word as a cliché, Garfinkle-Crowell suggests looking for the harm the speaker is attempting to describe.
The purpose is not to confirm or disprove every self-diagnosis. It is to listen beneath it.
That approach also offers a way through the competing dangers of parental overreaction and premature reassurance. Reacting too strongly can turn a young woman’s distress into an adult’s fear. Telling her too quickly that everything will be fine can leave her feeling unheard. Translation, in this sense, becomes a means of occupying the space between panic and dismissal.
It is also an argument about language itself. Words can clarify an experience while simultaneously narrowing it. A diagnostic label may provide relief by giving distress a recognised name, but it can also obscure the particular circumstances that produced that distress.
For therapists, parents and others trying to communicate with young women, the task may therefore be less about winning an argument over whether a diagnosis is correct than about understanding what the diagnosis is being used to say.
The broader challenge is to create an environment in which young women do not have to present themselves as clinically unwell simply to be taken seriously. Talking about trauma and psychological suffering can be preferable to a culture in which difference is mocked or ignored. But the vocabulary of distress also needs room for uncertainty, contradiction and ordinary human pain.
That is why Garfinkle-Crowell describes the process as translation. The goal is not to challenge the words but to understand what lies beneath them.
Whether the label is accurate, exaggerated or simply borrowed from an online conversation, something prompted the young woman to use it. The important question may therefore not be, “Do you really have this disorder?” but, “What are you trying to tell me?”
In an age when mental-health terminology has become part of everyday speech, that distinction may be increasingly important. Diagnosis can identify illness, but language can also be a plea for recognition.
And sometimes, before asking whether a young woman has named her problem correctly, the more urgent task is simply to hear what she is trying to say.
