As psychologists, our mission often treads a tightrope of diagnostic precision and ethical consideration. The emergence of artificial intelligence (AI), particularly language models like ChatGPT, introduces an exciting yet complex layer to this balancing act. Such innovations have been lauded for their diagnostic acumen but also raise questions about legal implications and ethical stewardship. For this reason, I think it is important to explore the current state of AI applications in behavioral health, focusing on ChatGPT's diagnostic capabilities as an aid to rendering a clinical diagnosis. In doing so, I hope to engage you in a thoughtful discourse about the ethical and legal dimensions of embracing AI in psychological practice.
A foundational study led by Mass General Brigham revealed that ChatGPT displayed a diagnostic accuracy of 72% across multiple medical specialties, even likening its performance to that of recent medical school graduates. Similarly, researchers at Queen Mary Hospital's Division of Geriatrics investigated the efficacy of Generative Pre-trained Transformer 4 (GPT-4) in diagnosing older patients, citing an accuracy of 66.7% for primary diagnoses. These findings signify the AI’s prowess but also underscore the necessity for additional benchmarking and regulatory oversight.
In the context of behavioral health, Hilty and colleagues employed natural language processing to quantify linguistic features associated with mental and neurocognitive disorders. They advocated for using large datasets to enhance diagnostic objectivity, a mission that aligns well with the capabilities of ChatGPT. Salih Tutun and their colleagues discussed ethical frameworks that must be established to guide AI’s role in mental health, emphasizing the need for innovative yet ethically responsible diagnostic tools developed in line with guidelines for integrating ethical approaches to designing AI.
Prompt #1: What are possible DSM diagnoses for someone who is easily wounded, drinks alcohol to the point of being unable to show up for work, gets angry quickly, has poor boundaries, is marginally employed, is in debt, and is unsuccessful in romantic relationships?
The 1st ChatGPT Response
The following response (in italics) was obtained verbatim. As you read the response, consider whether it would be helpful, legal, and ethical for you to be able to enter a behavioral prompt (question posed to ChatGPT) to get this type of response:
It appears that the individual in question may be exhibiting several symptoms that could potentially align with various Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses. It’s important to note that making an accurate diagnosis requires a comprehensive assessment by a qualified mental health professional. However, based on the information provided, several potential DSM diagnoses could be considered:
Intermittent Explosive Disorder (IED). Intermittent Explosive Disorder involves recurrent outbursts of anger that are disproportionate to the situation and often result in aggressive behavior or destruction of property. Individuals with IED struggle to control their anger impulses, and this may negatively impact their relationships and work life.
Borderline Personality Disorder (BPD). BPD is characterized by emotional dysregulation, unstable relationships, poor self-image, and impulsive behaviors. Individuals with BPD may experience intense anger and have difficulty managing their emotions. Poor boundaries and struggles in romantic relationships align with BPD features.
Alcohol Use Disorder (AUD). Excessive alcohol consumption, to the point of impairing daily functioning and causing absence from work, could indicate an Alcohol Use Disorder. This diagnosis would be based on criteria such as loss of control over drinking, unsuccessful attempts to cut down, and continued use despite negative consequences.
Depressive Disorder. The individual’s difficulty in managing anger, poor boundaries, and struggles in relationships could be associated with a Depressive Disorder. Depression can manifest as irritability and impaired social functioning, impacting both work and personal life.
Generalized Anxiety Disorder (GAD). Poor boundaries, being easily wounded, and difficulties in relationships might also be indicative of Generalized Anxiety Disorder. Chronic worry, heightened sensitivity to criticism, and interpersonal difficulties can be features of GAD.
Unspecified Personality Disorder. The individual’s challenges in maintaining boundaries, unstable relationships, and difficulties in employment could suggest the presence of a personality disorder that does not neatly fit within one specific category.
It’s crucial to emphasize that these are preliminary considerations and not a substitute for professional evaluation. A comprehensive assessment by a licensed mental health practitioner is essential for accurate diagnosis and appropriate treatment. The provided descriptions should not replace personalized clinical advice, and any diagnostic conclusions should be made by a qualified professional after a thorough evaluation.
Prompt #2: Which characteristics would need to be evaluated to make a differential diagnosis between the above possible diagnoses?
The 2nd ChatGPT Response
To differentiate between the potential diagnoses mentioned earlier (Intermittent Explosive Disorder, Borderline Personality Disorder, Alcohol Use Disorder, Depressive Disorder, Generalized Anxiety Disorder, and Unspecified Personality Disorder), a thorough assessment of various characteristics and factors is essential. It’s important to consider a combination of clinical interviews, self-report assessments, collateral information from family or close contacts, and possibly psychological testing. Here are some key characteristics that need to be evaluated to make a more accurate differential diagnosis:
Frequency and Intensity of Anger Episodes. For Intermittent Explosive Disorder, the frequency, intensity, and context of anger outbursts need to be evaluated. Determining whether the anger reactions are disproportionate and recurrent is crucial.
Emotional Instability and Impulsivity. Borderline Personality Disorder is characterized by emotional instability, impulsive behaviors, and unstable relationships. Assessing the pattern of emotional shifts, impulsive actions, and unstable sense of self is important. Alcohol Consumption Patterns. For Alcohol Use Disorder, an assessment of the individual’s alcohol consumption patterns, including frequency, quantity, and impact on functioning, is necessary. Evaluation of withdrawal symptoms, unsuccessful attempts to quit, and continued use despite negative consequences is important.
Presence of Depressive Symptoms. Depressive Disorder involves a range of symptoms beyond irritability, such as low mood, changes in appetite, sleep disturbances, and feelings of worthlessness. A thorough assessment of depressive symptoms is needed to consider this diagnosis.
Excessive Worry and Anxiety. In Generalized Anxiety Disorder, persistent and excessive worry about a variety of topics is a hallmark. Evaluating the extent of worry, physical symptoms of anxiety, and impact on daily life is crucial.
Impaired Interpersonal Functioning and Boundaries. Assessing the individual’s ability to establish and maintain healthy boundaries, as well as the quality of their relationships, can help differentiate between various disorders. An examination of interpersonal dynamics is particularly relevant for personality disorders.
Duration and Chronicity. Evaluating the duration and chronicity of symptoms is important. Some disorders, like personality disorders, involve longstanding patterns of behavior, while others might have more episodic presentations.
Family and Developmental History. Gathering information about the individual’s developmental history, family dynamics, early life experiences, and any history of trauma or adverse events can provide insights into potential underlying factors.
Response to Treatment. Observing how the individual responds to interventions, therapy, or medication can help in refining the diagnosis over time. Different disorders may respond differently to specific treatments.
Rule Out Medical and Substance-Related Factors. It’s important to acknowledge that medical and physical factors can indeed contribute to or mimic psychological symptoms. When evaluating an individual with behavioral and emotional concerns, considering potential medical conditions is a crucial aspect of a comprehensive assessment.
Need for Medical Evaluation. Given the individual’s symptoms, it’s advisable to conduct a thorough medical evaluation to rule out any underlying medical conditions that could be contributing to the symptoms. Medical conditions such as hormonal imbalances, thyroid issues, neurological disorders, or even medication side effects can impact mood and behavior.
In a comprehensive assessment, both psychological and medical factors should be taken into account. If an individual is experiencing significant psychological distress, it’s recommended to consult both a mental health professional and a medical doctor to ensure a comprehensive understanding of the situation and to consider all potential contributing factors. Remember that an accurate diagnosis often requires a multidimensional approach, and it’s not uncommon for individuals to have overlapping symptoms or co-occurring disorders. A licensed mental health professional with experience in assessment and diagnosis should guide the process, integrating various sources of information to arrive at the most appropriate diagnosis.
Despite its promise, ChatGPT is not without challenges. The AI model can inadvertently exhibit social prejudice and toxicity, thereby warranting rigorous oversight from clinicians. Furthermore, the legal ambiguities surrounding liability remain unresolved, especially when ChatGPT diagnoses are used as standalone evaluations. Multicultural and diversity issues, and protected health information were intentionally excluded from this demonstration.
ChatGPT and similar AI models serve best as adjuncts rather than replacements for human expertise. The current state of these tools does not support their verbatim use in clinical settings. If you're contemplating the incorporation of ChatGPT into your practice, seek advice from your malpractice carrier’s attorney, your state or national psychological association’s legal office, or the APA Division 5, the Division of Psychometrics and Quantitative Psychology. If these groups don’t offer anything yet, get involved and start something as part of their group. Depending on your circumstance, independent legal counsel may also be advisable.
Telehealth.org also offers Continuing Medical Education (CME) and Continuing Education (CE) courses to guide you in this evolving terrain. Ensuring responsible utilization of ChatGPT in psychological diagnostics requires a confluence of caution, human judgment, and robust regulatory frameworks. As we step into the future of AI-augmented healthcare, let us tread with both anticipation and due diligence.
Disclaimer: This article is written for educational purposes only and should not be construed as legal or clinical advice. The information contained in this article was sourced from a telehealth.org blogpost titled, ChatGPT Diagnosis: Walking the Tightrope of Legality and Ethics found here and is re-printed with the author’s permission.
File under: Musings and Reflections, Therapy & Technology
Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.
Recent Literature on ChatGPT and Diagnostic Accuracy
A foundational study led by Mass General Brigham revealed that ChatGPT displayed a diagnostic accuracy of 72% across multiple medical specialties, even likening its performance to that of recent medical school graduates. Similarly, researchers at Queen Mary Hospital's Division of Geriatrics investigated the efficacy of Generative Pre-trained Transformer 4 (GPT-4) in diagnosing older patients, citing an accuracy of 66.7% for primary diagnoses. These findings signify the AI’s prowess but also underscore the necessity for additional benchmarking and regulatory oversight.
In the context of behavioral health, Hilty and colleagues employed natural language processing to quantify linguistic features associated with mental and neurocognitive disorders. They advocated for using large datasets to enhance diagnostic objectivity, a mission that aligns well with the capabilities of ChatGPT. Salih Tutun and their colleagues discussed ethical frameworks that must be established to guide AI’s role in mental health, emphasizing the need for innovative yet ethically responsible diagnostic tools developed in line with guidelines for integrating ethical approaches to designing AI.
A Foray into ChatGPT’s Diagnostic Utility in Behavioral Health
To demonstrate AI’s capacity to enrich clinical thinking, I asked ChatGPT-4 to generate potential Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnoses based on a specific behavior pattern. The result is offered below.Prompt #1: What are possible DSM diagnoses for someone who is easily wounded, drinks alcohol to the point of being unable to show up for work, gets angry quickly, has poor boundaries, is marginally employed, is in debt, and is unsuccessful in romantic relationships?
The 1st ChatGPT Response
The following response (in italics) was obtained verbatim. As you read the response, consider whether it would be helpful, legal, and ethical for you to be able to enter a behavioral prompt (question posed to ChatGPT) to get this type of response:
It appears that the individual in question may be exhibiting several symptoms that could potentially align with various Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses. It’s important to note that making an accurate diagnosis requires a comprehensive assessment by a qualified mental health professional. However, based on the information provided, several potential DSM diagnoses could be considered:
Intermittent Explosive Disorder (IED). Intermittent Explosive Disorder involves recurrent outbursts of anger that are disproportionate to the situation and often result in aggressive behavior or destruction of property. Individuals with IED struggle to control their anger impulses, and this may negatively impact their relationships and work life.
Borderline Personality Disorder (BPD). BPD is characterized by emotional dysregulation, unstable relationships, poor self-image, and impulsive behaviors. Individuals with BPD may experience intense anger and have difficulty managing their emotions. Poor boundaries and struggles in romantic relationships align with BPD features.
Alcohol Use Disorder (AUD). Excessive alcohol consumption, to the point of impairing daily functioning and causing absence from work, could indicate an Alcohol Use Disorder. This diagnosis would be based on criteria such as loss of control over drinking, unsuccessful attempts to cut down, and continued use despite negative consequences.
Depressive Disorder. The individual’s difficulty in managing anger, poor boundaries, and struggles in relationships could be associated with a Depressive Disorder. Depression can manifest as irritability and impaired social functioning, impacting both work and personal life.
Generalized Anxiety Disorder (GAD). Poor boundaries, being easily wounded, and difficulties in relationships might also be indicative of Generalized Anxiety Disorder. Chronic worry, heightened sensitivity to criticism, and interpersonal difficulties can be features of GAD.
Unspecified Personality Disorder. The individual’s challenges in maintaining boundaries, unstable relationships, and difficulties in employment could suggest the presence of a personality disorder that does not neatly fit within one specific category.
It’s crucial to emphasize that these are preliminary considerations and not a substitute for professional evaluation. A comprehensive assessment by a licensed mental health practitioner is essential for accurate diagnosis and appropriate treatment. The provided descriptions should not replace personalized clinical advice, and any diagnostic conclusions should be made by a qualified professional after a thorough evaluation.
Prompt #2: Which characteristics would need to be evaluated to make a differential diagnosis between the above possible diagnoses?
The 2nd ChatGPT Response
To differentiate between the potential diagnoses mentioned earlier (Intermittent Explosive Disorder, Borderline Personality Disorder, Alcohol Use Disorder, Depressive Disorder, Generalized Anxiety Disorder, and Unspecified Personality Disorder), a thorough assessment of various characteristics and factors is essential. It’s important to consider a combination of clinical interviews, self-report assessments, collateral information from family or close contacts, and possibly psychological testing. Here are some key characteristics that need to be evaluated to make a more accurate differential diagnosis:
Frequency and Intensity of Anger Episodes. For Intermittent Explosive Disorder, the frequency, intensity, and context of anger outbursts need to be evaluated. Determining whether the anger reactions are disproportionate and recurrent is crucial.
Emotional Instability and Impulsivity. Borderline Personality Disorder is characterized by emotional instability, impulsive behaviors, and unstable relationships. Assessing the pattern of emotional shifts, impulsive actions, and unstable sense of self is important. Alcohol Consumption Patterns. For Alcohol Use Disorder, an assessment of the individual’s alcohol consumption patterns, including frequency, quantity, and impact on functioning, is necessary. Evaluation of withdrawal symptoms, unsuccessful attempts to quit, and continued use despite negative consequences is important.
Presence of Depressive Symptoms. Depressive Disorder involves a range of symptoms beyond irritability, such as low mood, changes in appetite, sleep disturbances, and feelings of worthlessness. A thorough assessment of depressive symptoms is needed to consider this diagnosis.
Excessive Worry and Anxiety. In Generalized Anxiety Disorder, persistent and excessive worry about a variety of topics is a hallmark. Evaluating the extent of worry, physical symptoms of anxiety, and impact on daily life is crucial.
Impaired Interpersonal Functioning and Boundaries. Assessing the individual’s ability to establish and maintain healthy boundaries, as well as the quality of their relationships, can help differentiate between various disorders. An examination of interpersonal dynamics is particularly relevant for personality disorders.
Duration and Chronicity. Evaluating the duration and chronicity of symptoms is important. Some disorders, like personality disorders, involve longstanding patterns of behavior, while others might have more episodic presentations.
Family and Developmental History. Gathering information about the individual’s developmental history, family dynamics, early life experiences, and any history of trauma or adverse events can provide insights into potential underlying factors.
Response to Treatment. Observing how the individual responds to interventions, therapy, or medication can help in refining the diagnosis over time. Different disorders may respond differently to specific treatments.
Rule Out Medical and Substance-Related Factors. It’s important to acknowledge that medical and physical factors can indeed contribute to or mimic psychological symptoms. When evaluating an individual with behavioral and emotional concerns, considering potential medical conditions is a crucial aspect of a comprehensive assessment.
Need for Medical Evaluation. Given the individual’s symptoms, it’s advisable to conduct a thorough medical evaluation to rule out any underlying medical conditions that could be contributing to the symptoms. Medical conditions such as hormonal imbalances, thyroid issues, neurological disorders, or even medication side effects can impact mood and behavior.
In a comprehensive assessment, both psychological and medical factors should be taken into account. If an individual is experiencing significant psychological distress, it’s recommended to consult both a mental health professional and a medical doctor to ensure a comprehensive understanding of the situation and to consider all potential contributing factors. Remember that an accurate diagnosis often requires a multidimensional approach, and it’s not uncommon for individuals to have overlapping symptoms or co-occurring disorders. A licensed mental health professional with experience in assessment and diagnosis should guide the process, integrating various sources of information to arrive at the most appropriate diagnosis.
Ethical and Legal Caveats in Using ChatGPT
This demonstration is but one of many examples where ChatGPT can be used to broaden the clinician’s thinking about possible diagnoses to consider, as well as different avenues to explore to gather additional relevant information.Despite its promise, ChatGPT is not without challenges. The AI model can inadvertently exhibit social prejudice and toxicity, thereby warranting rigorous oversight from clinicians. Furthermore, the legal ambiguities surrounding liability remain unresolved, especially when ChatGPT diagnoses are used as standalone evaluations. Multicultural and diversity issues, and protected health information were intentionally excluded from this demonstration.
ChatGPT and similar AI models serve best as adjuncts rather than replacements for human expertise. The current state of these tools does not support their verbatim use in clinical settings. If you're contemplating the incorporation of ChatGPT into your practice, seek advice from your malpractice carrier’s attorney, your state or national psychological association’s legal office, or the APA Division 5, the Division of Psychometrics and Quantitative Psychology. If these groups don’t offer anything yet, get involved and start something as part of their group. Depending on your circumstance, independent legal counsel may also be advisable.
Telehealth.org also offers Continuing Medical Education (CME) and Continuing Education (CE) courses to guide you in this evolving terrain. Ensuring responsible utilization of ChatGPT in psychological diagnostics requires a confluence of caution, human judgment, and robust regulatory frameworks. As we step into the future of AI-augmented healthcare, let us tread with both anticipation and due diligence.
Disclaimer: This article is written for educational purposes only and should not be construed as legal or clinical advice. The information contained in this article was sourced from a telehealth.org blogpost titled, ChatGPT Diagnosis: Walking the Tightrope of Legality and Ethics found here and is re-printed with the author’s permission.
File under: Musings and Reflections, Therapy & Technology