By Evgeny Legedin
In an era where mental health awareness campaigns proliferate across social media and educational platforms, a recent study has cast light on the potential pitfalls of such efforts, particularly concerning attention-deficit/hyperactivity disorder (ADHD).1 As members of the Critical Psychiatry Network, we must scrutinise these findings with a keen eye, balancing the benefits of destigmatisation against the risks of over-medicalisation and self-misattribution.
This article examines a double-blind randomised controlled trial that explores how ADHD awareness might inadvertently foster false self-diagnosis among healthy young adults, and how a simple intervention – education on the nocebo effect – can mitigate this issue. While the study targets young adults, its implications resonate with our work in child and adolescent mental health services (CAMHS), where early perceptions of symptoms can shape lifelong trajectories.
Who Arranged and Conducted This Research?
The study, titled “Inform and do no harm: Nocebo education reduces false self-diagnosis caused by mental health awareness,” was led by Dasha A. Sandra and colleagues from the University of Toronto Scarborough.1 It was published in Psychological Medicine on 10 November 2025. The research team included experts from the Department of Psychology at the University of Toronto, as well as collaborators from Ontario Tech University and Toronto Metropolitan University.2
Participants were recruited from the University of Toronto Scarborough campus, comprising 215 healthy young adults (predominantly university students, 77% women, aged 18–25) with no prior diagnoses of ADHD or other mental health conditions. The trial was conducted in-person, adhering to rigorous ethical standards, and was funded through academic grants without apparent pharmaceutical industry involvement – a point worth noting in our critical appraisal.
What Were the Researchers Trying to Find?
The investigators aimed to test whether standard ADHD awareness interventions could inadvertently increase rates of false self-diagnosis among individuals without the disorder, and whether incorporating education on the nocebo effect (where negative expectations lead to symptom misattribution and perceived worsening) could counteract this.3 This builds on growing concerns about the “awareness paradox” in mental health, where efforts to reduce stigma might amplify self-labelling and unnecessary medicalisation.
Participants were randomised into three groups: one receiving ADHD awareness alone, another combining ADHD awareness with nocebo education, and a control group focusing on sleep hygiene.
Outcomes were assessed via self-reported ADHD symptoms and self-diagnosis likelihood at baseline, immediately post-intervention, and at a one-week follow-up. The study sought to quantify the persistence of any induced effects and evaluate the scalability of nocebo education as a protective measure.
Interventions Delivered in Each Group
The workshops were structured as two-part sessions, lasting approximately 30 minutes, delivered in group settings to mimic real-world awareness campaigns. The content was carefully designed to test the hypotheses, with the first part varying by condition and the second part providing condition-specific materials. All groups concluded with a writing activity to reinforce the presented information.
ADHD Awareness Group: The first part consisted of generic information on sleep hygiene, serving as a neutral lead-in. The second part focused on ADHD awareness, drawing from popular advocacy organisations and demographic studies. It included statistics on ADHD prevalence in adults (emphasising underdiagnosis in certain groups like women), detailed symptom descriptions (e.g., inattention, hyperactivity, impulsivity), and “hidden signs” of the disorder. To incorporate social learning, a brief video featured a well-known ADHD advocate sharing her personal diagnosis story. The writing activity prompted participants to reflect on their acceptance of a potential ADHD diagnosis, whether they related to the symptoms, if these indicated undiagnosed ADHD, and strategies for managing such symptoms.
ADHD Awareness + Nocebo Education Group: This began with a 10-minute session on the nocebo effect, explaining how negative expectations can cause symptom misattribution and worsening (e.g., reinterpreting normal fluctuations like occasional distractions as pathological). It included relatable examples, such as mistaking transient headaches for medication side effects or post-concussion symptoms after a minor head bump that later proves unfounded. This was followed by the identical ADHD awareness content as the ADHD-only group. The writing activity was modified: participants answered similar questions about relating to symptoms and management but also explored alternative explanations (e.g., stress, poor sleep, or external distractions) and strategies informed by nocebo principles to prevent expectation-driven symptom escalation.
Control Group (Sleep Hygiene): The first part provided information on sleep hygiene, matching the neutral introduction in the ADHD group. The second part covered unusual sleep experiences, including nightmares, sleep paralysis, and lucid dreaming, along with mechanisms of dreaming and explanatory theories (e.g., threat simulation or memory consolidation). No mental health or ADHD content was included. The writing activity involved reflecting on the sleep experiences learned and evaluating the dreaming theories presented.
The nocebo education component, detailed in Table 1 of the study, was multi-faceted: delivered by a trusted authority (a clinical psychology PhD student), it educated on nocebo mechanisms, provided social learning examples, normalised experiences, and encouraged a mindset shift through reflection.
What Did They Find?
The results were striking and underscore the double-edged nature of awareness campaigns. The group exposed solely to ADHD awareness exhibited a significant increase in false self-diagnosis immediately after the workshop (standardised β=0.80, p<0.001) and persisting at the one-week follow-up (β=0.50, p<0.001) compared to controls, despite no actual change in symptoms.1
In contrast, the group receiving nocebo education alongside ADHD awareness saw this effect halved immediately (β=0.45, p<0.001) and effectively eliminated at follow-up (β=0.16, p=0.08), rendering their outcomes indistinguishable from the control group.5 The authors concluded that while ADHD awareness can reliably induce persistent false self-diagnosis in healthy young adults, a brief nocebo education intervention—lasting just a few minutes—mitigates this harm without diminishing the core awareness message. This finding has been echoed in media reports, highlighting its relevance amid rising social media influences on self-perception.6
Limitations and Critical Perspective
While methodologically robust as a randomised controlled trial, the study has notable limitations. The sample was predominantly female university students from a single Canadian institution, limiting generalisability to broader populations, including children, adolescents, or diverse socioeconomic groups.3 The one-week follow-up is relatively short; longer-term effects remain unexplored. Moreover, self-reported measures, though common in such research, are susceptible to bias, and the in-person workshop format may not translate directly to online or school-based campaigns.
From a critical viewpoint, these findings invite deeper scepticism towards the unchecked expansion of ADHD as a diagnostic category. The ease with which awareness can provoke self-diagnosis aligns with concerns about overdiagnosis fuelled by pharmaceutical interests and social media platforms like TikTok, where misleading content proliferates.87
Studies on TikTok’s ADHD-related videos reveal a preponderance of non-professional, sensationalised portrayals that may encourage self-identification without clinical rigour.7
This risks pathologising normal variations in attention and behaviour, particularly in young people navigating academic pressures. Critically, we must question whether such awareness serves public health or perpetuates a biomedical model that overlooks social, environmental, and cultural factors in distress. The nocebo intervention, while promising, should not distract from advocating for systemic changes, such as reduced reliance on diagnostic labels and enhanced support for non-pharmacological approaches.
How This Might Change Our Practice?
These insights could profoundly influence psychiatric practice, especially in CAMHS where ADHD referrals are surging amid heightened awareness. Integrating nocebo education into awareness programmes – whether in schools, online resources, or clinical consultations—offers a practical safeguard against iatrogenic harm.4
For instance, when educating adolescents about ADHD, we might explicitly discuss how expectations can amplify everyday lapses in focus into perceived pathology, fostering resilience against self-misdiagnosis. This could extend to training for educators and parents, emphasising balanced information that avoids alarmism.
In our critical network, it reinforces the need for advocacy: pushing for awareness campaigns that prioritise evidence over hype, and exploring alternatives like mindfulness or environmental adjustments before diagnostic pathways. Ultimately, this study reminds us to “inform and do no harm,” ensuring our efforts empower rather than ensnare young minds in unnecessary labels.1
References
- Sandra, D. A., et al. (2025). Inform and do no harm: Nocebo education reduces false self-diagnosis caused by mental health awareness. Psychological Medicine.
- University of Toronto. (2025). ADHD awareness may increase false self-diagnosis among young adults: Study.
- CHADD. (2025). Study shows that ADHD awareness may lead to increase in false self-diagnosis, but intervention can help.
- PsyPost. (2025). Learning about the “nocebo effect” prevents false ADHD self-diagnosis, study shows.
- Medical Xpress. (2025). ADHD awareness may lead to increase in false self-diagnosis, but intervention can help.
- Yeung, A., et al. (2024). A double-edged hashtag: Evaluation of #ADHD-related TikTok videos. PLOS ONE.
- Yeung, A., et al. (2022). TikTok and Attention-Deficit/Hyperactivity Disorder. NIH.
- Mad in America. (2025). ADHD Awareness Campaigns Lead to Huge Jump in False Self-Diagnoses.
Original source
Sandra, D. A., et al. (2025). “Inform and do no harm: Nocebo education reduces false self-diagnosis caused by mental health awareness.” Psychological Medicine.
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About the author
Dr. Evgeny Legedin is a trainee psychiatrist originally from Russia, now working in the NHS in Scotland. Known for his critical perspective on the medical model of mental health, he is a member of the Critical Psychiatry Network and advocates for evidence-based and human rights-oriented approaches in psychiatry.
