Late diagnosis, overthinking, and the two most dangerous words in the English language

From relationship breakdowns to career regrets, experts say the human brain has a dangerous habit of replaying alternate versions of life. According to GP Dr Kasim Usmani, the spiral often starts with two deceptively simple words: What If?

“What if I’d known sooner?” “What if I’d made different choices?” “What if my life had turned out differently?” According to doctors and therapists, these repetitive thought patterns can quietly worsen anxiety, depression and emotional burnout. Mental health expert Dr Kasim Usmani explains why the brain becomes trapped in hindsight thinking — and how to stop regret, guilt and overthinking from taking over your life.

The mental-health trap of “What If?”

There are few things the human brain loves more than rewriting the past. A failed relationship becomes a different life that could have happened. A missed diagnosis becomes years supposedly “lost”. A career setback transforms into endless imagined versions of success.

For many people, the spiral starts innocently enough. But according to Dr Kasim Usmani, hindsight can quickly become psychologically corrosive.

“That’s the ultimate question, isn’t it?” he says. “What if I knew 20 years ago that I had this? And then the mind goes into a spiral of multiple possibilities — what could have happened, what may have happened, what may happen now.”

Usmani sees this frequently among patients receiving later-life diagnoses of ADHD, autism, dyslexia or other long-misunderstood mental health conditions.

For some, finally having an explanation is life-changing. “The power of a diagnosis does carry relief,” he explains. “It improves someone’s ability to equip themselves with the necessary support and understanding.” But clarity can also arrive alongside anger.

“Why did nobody notice?”

Many patients, he says, begin mentally revisiting their entire life after a diagnosis. “They think about the jobs they lost, the support they never had in school, the opportunities they may have missed because nobody picked this up earlier.”

For someone who spent decades being labelled “difficult”, “lazy”, “too emotional” or “socially awkward”, the emotional fallout can be enormous.

“Late diagnosis can lend itself to resentment and frustration,” Usmani says. “Some patients say: ‘I came to doctors so many times. Why did nobody realise?’”

And that resentment is not always directed outward. “Often there’s introspection too,” he says. “People wonder: Should I have pushed harder? Should I have recognised it sooner myself?”

The result is a thought process that constantly loops backwards — replaying alternative timelines that no longer exist.

“You’re thinking about every possible permutation of your life,” he says. “And in some ways you can drive yourself insane doing that.”

Why the brain gets stuck in overthinking

Part of the problem is that the brain struggles to distinguish between imagined emotional realities and actual ones.

A hypothetical life can feel painfully real. And modern life only intensifies the problem. Endless online information, self-diagnosis culture and social comparison give people more material than ever to catastrophise over.

“Younger generations have access to huge amounts of information,” Usmani says. “But they can’t always disentangle what’s medically accurate from what isn’t.”

That constant exposure can heighten fear and uncertainty, particularly for younger people who feel their future has suddenly become defined by a diagnosis or label.

At the same time, older adults often carry a different kind of grief — decades spent masking difficulties or surviving without support.

“There’s a degree of reflection older patients tend to have,” he says. “They look back over their entire life.”

That reflection can become dangerous when it shifts from understanding into self-punishment.

“We incarcerate ourselves in mental prisons”

One of the most striking things Usmani says is that people often become trapped not by circumstances themselves, but by repetitive thinking around those circumstances.

“We mustn’t confine ourselves to our own mental prison,” he says. “It’s not going to make us feel any better.”

That does not mean pretending painful emotions do not exist. In fact, he believes many people worsen their mental health by judging themselves for struggling in the first place.

“There’s this belief that because someone else has it worse, your feelings somehow don’t count,” he says. “But your emotions are still valid relative to your own experience.”

So how do you stop the spiral of overthinking?

Usmani does not believe it is possible to eliminate “what if” thoughts entirely. “I’m not sure there’s a way to completely stop asking those questions,” he says. “That’s part of being human.”

But he believes people can learn to stop living inside those thoughts. “The best thing we can do is work with what’s tangible now.”

That often starts with speaking openly to somebody else before anxious thinking becomes isolated and distorted.

“Quite often we are blinded by our emotions,” he explains. “Speaking to somebody can help contextualise and rationalise the issue.”

Sometimes that support comes from therapy or CBT. Sometimes it comes from trusted friends. Sometimes, he says, it needs to come from someone entirely outside your personal life. “A neutral third party can help you see the woods from the trees.”

He is also keen to remind people that thoughts themselves are temporary — even when they feel permanent. “What you were thinking last year is not what you’re thinking now,” he says. “And what you think in a year’s time will likely be completely different again.”

Words: Sally Saunders, Images: Shutterstock