The Misdiagnosis of Severe Mental Health Disorders
It would be ideal to visit a mental health provider and receive an accurate diagnosis of your illness. That is, hopefully, most often the case. However, several studies have shown that a wide variety of psychiatric conditions may be initially misdiagnosed.
The peer-reviewed journal "Psychiatry" published a research paper in 2006 that cited a study that found "As per the survey taken by the National Depressive and Manic-Depressive Association (DMDA), 69 percent of patients with bipolar disorder are misdiagnosed initially and more than one-third remained misdiagnosed for 10 years or more."
A 2011 study in "The Primary Care Companion for CNS Disorders" found that primary physician "misdiagnosis rates reached 65.9% for major depressive disorder, 92.7% for bipolar disorder, 85.8% for panic disorder, 71.0% for generalized anxiety disorder, and 97.8% for social anxiety disorder."
Borderline personality disorder is difficult to diagnose, as another example, and is often mistaken for bipolar disorder or even unipolar depression, or not considered a mental illness at all.
Other studies have shown appreciably lower rates of misdiagnosis, but clearly individuals with a mental health disorder are more likely to be misdiagnosed than someone who has pneumonia, for instance.
An article by Michael G. Pipich in a 2021 edition of "Psychology Today" warns:
Some [of my patients with bipolar disorder who have been misdiagnosed] have reported to me that while their pre-existing depressive episodes may improve with antidepressants, they often experience manic episodes that are more agitating and consequential than ever before.
Schizophrenia is not infrequently misunderstood as a diagnosis. The National Alliance on Mental Illness flatly states on their website: "Diagnosing schizophrenia is not easy." The Johns Hopkins Early Psychosis Intervention Clinic reported in 2019 that "researchers report that about half the people referred to the clinic with a schizophrenia diagnosis didn't actually have schizophrenia." That is a stunning statistic, but representative of the fact that whether people with mental health issues are underdiagnosed or overdiagnosed, the result is the same. They are likely to be receiving medications and treatment that do not address their complete underlying condition.
In 2021, "The Huffington Post" ran an article entitled, "5 Mental Health Conditions That Are Way Underdiagnosed."
Some conditions tend to be particularly underdiagnosed (meaning more people have them than get a diagnosis) or misdiagnosed (meaning they’re told they have something else). That means too many people continue to struggle on their own rather than connecting with the treatment they need and deserve.
"Consumers" may be perplexed as to why providers using the Diagnostic and Statistical Manual of Mental Disorders (DSM-Edition 5) sometimes can't match the criteria listed with distinct mental disorders. There are many reasons for that, far too many to list here.
However, a key factor may be the limited time period that most people with mental health problems have with providers. Most complicated mental diagnostic categories require long-term interaction with the client and the ability to pick up on nuances in behavior and recollections.
Unfortunately, many clients don't know the specific language to use that reflects the medical criteria in the DSM, and so medical symptoms are sometimes not communicated clearly. Furthermore, many symptoms of mental health conditions overlap.
Also many beleaguered providers likely want to quickly establish a diagnosis because of time constraints or due to a lack of knowledge in the case of primary physician "screeners." It can be speculated that hospitalized psychiatric patients may receive more accurate diagnoses because of the intensity of time spent observing, testing and talking with them and the long-term experience of psychiatric unit staff. However, misdiagnoses can happen even in these cases.
If you think that you are being misdiagnosed, you should strongly consider getting at least one second opinion as an option.
Mark Karlin is retired, after a long career in advocating against gun violence, as a hospital executive and founder of a progressive website. He graduated from Yale University with an honors degree in English.