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  • Writer's pictureColorado Coherence Collective

Pros/Cons of Formal Diagnosis and How Internalized Ableism impacts Self-Compassion

Many people struggle to extend nonjudgmental compassion to themselves and others without a reason they perceive to be acceptable or valid .

  • Keep reading to learn more about how to manage this form of internalized ableism and how to explore this overcontrolled perspective.

  • To learn more about neuronorms, read our other blog post about The Neurodiversity Paradigm.


Humans often feel resistance to unexpected outcomes, or lived experiences that deviate from our conscious/unconscious expectations. This resistance may manifest as frustration, judgment, resentment, bitterness, grief, shame, or other distressing emotions. This resistance may not subside until we find an acceptable reason for the discrepancy between the reality of our lived experience and our conscious/unconscious expectations.

  • For example, if a student is late to class or an employee is late to a meeting, we may judge them and express frustration. 

  • However, when we learn that their tardiness is due to a family medical emergency or a minor car accident, our frustration and judgment dissipates because we perceive the reason for their tardiness to be acceptable and valid. 

  • Alternatively, if we learn that their tardiness is due to them stopping to eat breakfast at a cafe or window shop at the mall, our frustration and judgment may increase because we perceive the reason for their tardiness to be unacceptable and invalid.


Similarly, some people struggle to extend self-compassion without a formal DSM-V diagnosis to describe their symptoms and experiences. This is often due to the unconscious overcontrolled expectation that they need an acceptable reason for their lived experience to deviate from neuronormative expectations.

  • For example, if an individual’s somatic, emotional, cognitive, sociocultural, and behavioral lived experiences deviate from societal neuronormative expectations, they may experience internalized ableism in the form of self-judgment and low self-esteem. 

  • However, if their lived experiences match DSM-V diagnostic criteria and they receive a formal medical diagnosis of a DSM-V “disorder”, their self-judgment may dissipate because they perceive the reason for the discrepancy between their lived experiences and societal neuronormative expectations to be acceptable and valid. 

  • Alternatively, if their lived experiences do not match DSM-V diagnostic criteria and they do not receive a formal medical diagnosis of a DSM-V “disorder", their self-judgment may increase because they perceive it as a lack of a valid or acceptable reason for the discrepancy between their lived experiences and neuronormative social expectations. 

  • Both examples listed above are examples of internalized ableism, or the internalization of neuronormative societal bias against individuals with disabilities. Internalized ableism is often accompanied by low self-esteem, a lack of nonjudgmental self-compassion, feelings of being unworthy or undeserving of acceptance and accommodation, and hopelessness that sometimes leads to learned helplessness and extreme demand avoidance.

Diagnostic privilege occurs when an individual’s Stress Response System patterns align with DSM-V diagnostic criteria, resulting in formal medical diagnosis. 


Diagnostic privilege:

  • Allows access to opportunities, accommodations, support.

  • Provides validation of lived experience and struggle.

  • Often leads to enhanced empowerment and self-compassion.


If you experience diagnostic privilege and feel empowered

  • We encourage you to continue using your diagnostic label to describe your lived experiences and symptoms.


If you experience diagnostic privilege and feel disempowered, or if you do not experience diagnostic privilege and feel lost:

  • We invite you to explore the Neurodiversity Paradigm. 

  • Consider alternatives to the pathological Medical Model. 

  • Find non-pathologizing ways to describe your lived experiences.


However, the pathological Medical Model is only one model; there are many others to explore that don’t require you to label yourself as “disordered”, “deficient”, defective, abnormal, or maladaptive in any way. Examples include the Neurodiversity Model, Salutogenic Health Model, Liberation Health Model, Feminist Model, Humanist Model, Disability Justice Model, and many others, none of which are predicated by the assumption that unique manifestations of sociocultural and neurodiversity can be pathologized as disordered or deficient in any way. 


The Neurodiversity Paradigm invites us to transcend the pathological Medical Model of psychiatry, adopting a nonjudgmental and compassionate perspective of openness, inclusion, and respect for all forms of diversity so we may feel deserving of accommodation and support. Without feeling worthy of acceptance and accommodation, we cannot effectively and assertively self-advocate, or speak up for our wants and needs, in order to access meaningful inclusion.


Below are a list of pros/cons of formal medical diagnosis:

Without a formal medical diagnosis, you won’t be able to:

  • Apply for formal accommodations at school or work

    • You can still have a human-to-human discussion with your direct supervisor to request informal support that will help you (they may will say no).

  • Use health insurance to pay for mental health care

    • You can still access mental health care by paying out-of-pocket or using HSA/FSA funds, many providers are willing to extend reduced rates (it may still be prohibitively expensive).


With a formal medical diagnosis, you might not be able to:

  • Apply to certain jobs in the future.

    • Some jobs - such as pilots, military personnel, and those with special security clearances - are inaccessible to prospective applicants with certain medical or psychiatric diagnoses. 

  • Visit certain countries in the future.

    • Some countries still discriminate against prospective visitors or immigrants based on medical diagnoses (ex: VISA and immigration paperwork)


Below is a list of lifestyle changes you can make, with or without a formal medical diagnosis, to achieve health-ease, mental wellness, and a values-aligned lifestyle:

Accept and accommodate your authentic self

  • Your strengths and weaknesses are worthy of support.

  • All of your quirks and flaws deserve prioritization & compassion.


Unlearn and replace disempowering belief systems

  • Such as internalized ableism, productivity and urgency culture, and other neuronormative and capitalist values. 


Map your triggers and learn how to emotionally regulate

  • Emotional regulation includes: situational selection, situational modification, attentional deployment, cognitive restructuring, and response modulation (Gross, 1998).


Adopt new paradigms and build new skills 

  • Explore new perspectives to generate openness and curiosity

  • Learn skills: executive functioning, regulation, motivation, etc.


Request informal accommodations and support 

  • Access available support to minimize scarcity & unpredictability while maximizing abundance & predictability. 


Change your lifestyle, environment, and social context 

  • Build sustainable self-care routines, prioritize your needs.

  • Access supports to minimize scarcity and unpredictability


Below is a list of skills you can build, with or without a formal medical diagnosis, to achieve health-ease, mental wellness, and a values-aligned lifestyle: 

Somatic - body-based self-soothing strategies 

  • Understand sensory sensitivities, nervous system patterns

  • Build interoceptive attunement, practice co-regulation 


Emotional - awareness, self-regulation, and maturity 

  • Emotional regulation: situational selection and modification, attentional deployment, cognitive restructuring, response modulation (Gross, 1998). 


Cognitive - flexibility and openness to new perspectives

  • Practice cognitive reappraisal to generate openness to alternatives

  • Build executive functioning, decision-making, and motivational skills


Social - Authentic connection and communication

  • Find authentic connection and belonging in your social context

  • Practice assertive and values-aligned expressive communication 

  • Explore receptive social communication patterns to identify inauthentic miscommunication (masking, camouflaging, fawning, etc.) 


Behavior - self-care routines and social supports 

  • Access health-ease through sustainable self-care routines

  • Set boundaries with yourself and others to achieve balance

  • Maximize abundance & predictability by accessing support


Below is a list of Self-Enquiry questions to reflect on to explore your experience with internalized ableism and identify the ways in which formal diagnosis might harm and help you. 

Friendly reminder: the goal of Self-Enquiry is to generate curiosity and openness about your experiences, not to find answers. 


What does a self-identification of neurodivergence help me access, obtain, achieve, or allow for myself? 

  • You may believe self-ID is required to extend self-compassion 


What does a self-identification of neurodivergence prevent me from accessing, obtaining, achieving, or allowing? 

  • It may prevent you from accessing formal and informal support.

  • You may feel resistant to utilizing an alternative model to describe your experiences (especially true for those with diagnostic privilege, or symptoms that align with DSM-V diagnostic criteria and result in formal diagnosis). 


What does a formal diagnosis of a DSM-V disorder help me access, obtain, achieve, or allow for myself? 

  • You may desire formal workplace or school accommodations


What does a formal diagnosis of a DSM-V disorder prevent me from accessing, obtaining, achieving, or allowing? 

  • You may internalize an ableist and pathologizing perspective

  • You may begin to view yourself as disordered, deficient, maladaptive, abnormal, undeserving, or inferior to others


Contact us today for a free initial consultation to explore your experiences with internalized ableism or overcontrolled coping.



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