Psychology and Pseudonymity

Some courts have allowed a plaintiff or a defendant to proceed pseudonymously based on a finding that identifying the party would yield "mental harm," e.g.,

Plaintiff's primary therapist from 2010 to 2011 has declared under penalty of perjury that not allowing Plaintiff to litigate this action under a pseudonym "has the serious risk of causing Jennifer to relapse into her eating disorder behaviors."

and

[P]laintiff offers the opinion of … a psychiatric specialist in Dissociative Identity Disorder, from which the plaintiff suffers, that proceeding publicly would "cause her to decompensate [psychologically] to a point at which she could not … pursue the current legal process and would suffer severe risk to her safety and to her survival." … [T]he plaintiff has presented particularized and undisputed evidence that proceeding publicly would seriously threaten her mental health, requiring her to choose between dropping her action and placing her life in jeopardy. As a result of this newly provided evidence, the court finds that the plaintiff has provided evidence of an exceptional circumstance warranting authorization to proceed anonymously.

Do any of you know (whether based on your experience as psychologists, as lawyers, or otherwise) how reliable these sorts of evaluations might be?

My sense is that very many people who are faced with litigation that risks public disclosure of various things would be quite upset by that. If someone was accusing you of, say, sexual assault or embezzlement or malpractice—or if you were suing for libel or wrongful firing or wrongful expulsion that stemmed from such allegations—I expect you might be worried about the prospect that this information would become public. I would think you might feel anxiety; lose sleep; be tempted to turn to alcohol or drugs; or perhaps even contemplate suicide, especially if you feel that public exposure would yield professional ruin.

This makes me wonder whether courts can reliably sort "the foreseeable stress of being a named defendant in a lawsuit," especially one that involves serious allegations, from other kinds of more serious psychological risk. And that would be especially so when the pseudonymity determination is based (as these things generally are) not on a contested evidentiary hearing, but just on an affidavit from a psychologist or therapist chosen by the party who seeks anonymity, with no cross-examination. But perhaps I'm mistaken, and psychologists are reluctant to make such assertions absent real evidence that their clients are unusually vulnerable; or perhaps there are other tools to make sure of that. Do any of you either have personal experience along these lines, or can point me to articles that deal with the matter (or experts who might be able to give me some perspective)? Thanks!