The Impact of Mental Health Misdiagnosis

By Gaan Akers, LPC, NCC | October 18, 2019

When someone sees a medical or clinical professional for treatment, one often assumes the professional’s judgment of their condition is correct. However, the problem of misdiagnosis — where the diagnosis is incorrect or the professional can’t come up with a diagnosis at all — is more common than you may think.

It isn’t always easy or straightforward to produce a correct diagnosis, and a misdiagnosis may prevent the actual condition from getting better. In many cases, it can lead to the root issue getting worse. Understanding this common issue can help you determine whether the treatment a child is receiving could be more effective.

In This Article

How Common Is Misdiagnosis?

Misdiagnosis can happen with any condition. However, the following three disorders have among the highest mental health misdiagnosis statistics in children and adolescents.

1. ADHD

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common diagnoses for children to receive. Just over 6% of all kids in the U.S. are currently taking medication for ADHD. However, the symptoms of ADHD can also be seen in other conditions. Kids usually receive a diagnosis of ADHD after reporting disrupted sleep, an inability to sit still and making careless mistakes in school — and these criteria could be indications of other concerns.

For example, a child may be diagnosed with ADHD when the real root of their problems is a sensory processing disorder (SPD) that creates a heightened sensitivity to sight, sound, touch or other sensory inputs. Alternatively, the fidgeting and difficulty with focus can indicate that a child has anxiety rather than ADHD. In a good number of cases, a child may not have a diagnosable condition at all. Every child matures at a different rate, and some of them may take longer to learn the self-discipline it takes to be considered successful in a typical school environment.

If a doctor or mental health professional doesn’t take the time to examine the less obvious causes of ADHD-like symptoms, a child may end up medicated for ADHD when they don’t have it. It’s also essential to consider the possibility of co-occurring disorders. For example, ADHD is estimated to co-occur with autism spectrum disorder (ASD) anywhere from 37% to 78% of the time.

2. Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is another condition that is often misdiagnosed in children. This disorder is characterized by disruptive behavior. When they don’t get their way, children will become irritable and lose their temper. These behaviors can happen in various settings, ranging from home to school and disrupting their daily routine.

Children with ODD will repeatedly have tantrums and display hostile behavior. They are defiant toward authority, such as their parents, and repeatedly break rules. Most will not show any signs of remorse for their actions. To be diagnosed with ODD, children must be displaying these kinds of disruptive behaviors for at least six months.

While ODD is often diagnosed whenever a child is frequently arguing and defying adults, other conditions can have the same symptoms. Instead of ODD, a child could instead be struggling with a learning disorder, anxiety or even obsessive compulsive disorder (OCD).

3. Bipolar Disorder

Bipolar disorder, sometimes called manic-depressive disorder, can be significantly more disruptive when misdiagnosed. It causes unmanageable and dramatic changes in energy, mood and activity levels, which impairs the ability to function in everyday life. 

While most cases of bipolar peak during late adolescence or early adulthood, it’s possible for children to be diagnosed with pediatric bipolar disorder (PBD), especially when they display manic symptoms. 

These periods of ups and downs, though, can also mimic the symptoms of ADHD, post-traumatic stress disorder (PTSD) and major depressive disorder (MDD), which contribute to misdiagnosis rates. 

The Effects of Misdiagnosis

A mental health diagnosis is the first step on the path to treatment. If that first foray is a misstep and someone receives an incorrect diagnosis, a few consequences can be devastating, depending on the root issue at hand.

1. Confusion

A misdiagnosed mental illness can confuse the patient. Very few people know enough about mental illness to spot incongruence between their symptoms and their diagnosis, and fewer still would question the judgment of their clinician.

A misdiagnosis will result in the patient becoming confused and potentially distraught when the course of treatment recommended isn’t working. They may feel it’s a personal failing, and even develop feelings of guilt or shame when they don’t make progress under the diagnosis. It can result in a breakdown in communication between the patient and provider, and is even more damaging in children who cannot communicate their symptoms effectively in the first place.

2. Incorrect Medication

Being prescribed a medication for a condition you don’t have can be dangerous. If, for example, a child who has simple anxiety gets diagnosed with ADHD, they will likely receive a prescription for a medication like Adderall® or Concerta®. In people without ADHD, these prescription stimulant medications can cause impairments in working memory performance and other areas of cognition.

Receiving the wrong medication can also lead to a person experiencing all the side effects of the medication without any of the benefits, causing undue distress and anxiety while leaving the root problem untouched.

3. Worsening Condition

If a mental health condition gets misdiagnosed or never diagnosed at all, the patient is likely to keep getting worse. Many medications prescribed for mental illness, like selective serotonin reuptake inhibitors for depression, take several months to reach therapeutic levels in the patient’s system. Therefore, even people with a correct diagnosis often have to wait a while before seeing the benefits of their treatment.

But when the diagnosis is incorrect to begin with, a doctor or therapist may tell a patient to “wait and see” while they are getting worse all the while.

4. Distrust of Medical Professionals

Unsurprisingly, receiving a false mental health misdiagnosis can cause a distrust of medical professionals. Sometimes, a misdiagnosis can result from physicians who don’t have enough information about the patient’s condition to make an accurate diagnosis or tend to diagnose the conditions they feel more comfortable treating. Either way, this can cause individuals to not get the treatments they need to manage their symptoms.

Here at Hillside®, we have a team of experts committed to understanding your specific needs to ensure the best outcomes, such as increased distress tolerance and improved moods and behaviors. We follow each patient’s progress and track indicators of treatment progress and success. Our methodology allows us to determine which approaches and therapies work best for our patients.

Why Does Misdiagnosis Happen?

A lack of competency can certainly lead to a high incidence of misdiagnoses but other factors can complicate the situation as well.

1. Patient History

In medical diagnosis, countless tests can determine an illness or medical condition without a shadow of a doubt. Mental health clinicians, on the other hand, must rely exclusively on reported symptoms and patient history. Patient history is essential, as it includes observations from past providers, as well as any relevant medical information. Clinicians are more likely to come to incorrect conclusions without sufficient information.

Patients are not always willing to talk about subjects such as substance abuse or childhood trauma, and may not understand how crucial they are to the formation of a correct diagnosis. Alternatively, they may not feel some of their experiences and emotional states are worth speaking up about.

For example, someone with bipolar disorder might not bring up their manic or high-energy periods because those episodes feel good to them while they’re occurring. Compared to their depressive periods, these manic periods may make someone feel like they’re in a more stable state because they are able to accomplish tasks and responsibilities. Because they can get more things done each day while needing less sleep, they may not feel their manic state is anything they should mention to their clinician. 

2. Masking Symptoms

Many people assume mental health diagnosis is a matter of checking off symptoms nicely arranged in lists. However, there is a significant crossover between conditions in terms of symptoms. For example, one common misdiagnosis is labeling post-traumatic stress disorder as generalized anxiety disorder.

A good clinician does not look at a patient’s list of symptoms and pick a diagnosis that fits most of the parameters. To avoid a misdiagnosis, clinicians will consider all possible factors, and won’t shy away from considering some of the more complex conditions, rather than attempting to put a Band-Aid on symptoms with a hasty and incomplete diagnosis.

Parsing symptoms from one another and performing a comprehensive investigation into their origins is the only way for a clinician to provide a confident, accurate diagnosis for any patient.

3. Multiple Diagnoses

It is quite common for misdiagnosis to occur when the client has more than one condition to diagnose. The second condition can be medical or psychological. For instance, someone with undiagnosed borderline personality disorder may receive an incorrect diagnosis of bipolar disorder due to the severe and intense emotions. Someone with an undiagnosed hypothyroidism may be incorrectly diagnosed with depression due to the lack of energy and lethargy.

It is also quite common for substance abuse disorders and mental health disorders to occur in a patient simultaneously. The misuse of substance can mask the underlying mood or anxiety disorder. Skilled and caring clinicians understand how common dual diagnosis occurs and go to great lengths to ensure that the treatment will be appropriate for each individual.

4. Lack of Culturally Competent Care

Another reason that misdiagnosis of mental disorders occurs is due to the lack of culturally competent care. Because both the diagnosis and treatment of mental health conditions are heavily influenced by a clinician’s discretion, implicit bias can impact the level of patient-centered care when working with marginalized groups and diverse populations.

African Americans, for example, frequently face stigma, provider bias, inequality of care and socioeconomic disparity when seeking mental health services. This group is less likely to be diagnosed with a mood disorder even if they have the same symptoms as other groups. Instead, Black Americans often face a high level of misdiagnosed mental illnesses, specifically receiving more misdiagnoses of schizophrenia.

Similarly, due to the stereotype that Asian Americans don’t suffer as much from mental health conditions, it can be more difficult for some providers to ask the right diagnostic questions or recognize symptoms of mental illness in this population. Facing a lack of culturally competent care can prevent individuals from seeking care or receiving the treatments they need to live healthier lives.

How to Prevent Misdiagnosis

There’s no definitive way to guarantee a clinician will not provide a misdiagnosis of mental illness. However, if you suspect there may be an issue or condition a clinician is missing, here are three ways you can engage to help improve diagnostic accuracy.

1. Be Open and Honest

Many people are embarrassed about aspects of their personal history or symptoms. They may feel ashamed to disclose certain details and omit important information that the clinician needs for accurate diagnosis. Clinicians try to draw out as much information from the patient as possible, to put together a complete picture of a patient’s condition, and they need the client’s cooperation and willingness to disclose honest information. If the clinician misses key information in a patient’s history, the likelihood of coming to an incorrect conclusion and misdiagnose the individual increases.

2. Create a Record

Useful records don’t have to be official. If you can keep a daily or weekly journal of symptoms and behaviors, a clinician can get a much more realistic view of how those symptoms and behaviors are affecting the patient. Putting pen to paper helps clarify how symptoms affect a person’s life, making it easier to spot red flags and signs you may not have even thought of before. You can also use one of the many apps available to track mental health if it works better for you.

Depending on the frequency and magnitude of symptoms, it may feel overwhelming to start tracking them all at once. In this case, it helps to pick a few of the most severe symptoms and start by paying attention to those. Multiple styles of record-keeping may be equally helpful. If you’re a journaling type, there’s nothing wrong with recapping the day “Dear diary” style, as long as you highlight the crucial parts for the clinician.

You can also go the other direction and write down bullet points explaining what the symptom was and approximately what time it occurred. As long as the information is accurate and legible, it doesn’t matter what format you present it in.

3. See a Specialist

Not every clinician has the same experience. Especially when dealing with children and adolescents, expertise matters. A clinician who specializes in treating kids and teens will take a different approach that works for those age ranges and will be better equipped to address the challenges of diagnosis.

If you believe there is a specific condition at play, finding a specialist will help shorten the diagnostic process. A specialist will likely be able to identify the condition more quickly than a general practitioner, which can result in prompter treatment appropriate for the condition.

Differential Diagnosis: What Is It and How Can It Help? 

When a child continues experiencing symptoms even though they’re receiving treatment for a mental health condition, it may be time to try differential diagnosis. A differential diagnosis is a process that allows clinicians to differentiate between two or more mental health conditions. Many mental health conditions can cause similar symptoms like fatigue, mood swings or physical pain. Through this process, medical professionals can take a closer look at a patient’s symptoms before making a diagnosis. 

To obtain a differential diagnosis, clinicians will often consider a patient’s medical history and then perform a physical exam and diagnostic testing. These tests can vary depending on symptoms but often include blood or urine samples. 

The process is similar to getting a second opinion from another doctor or specialist when evaluating a medical condition. This is why it’s so beneficial to consider a differential diagnosis whenever a mental health disorder is suspected. You’ll undergo a more thorough diagnostic process, which allows clinicians to rule out similar conditions and determine whether more testing would be beneficial.

Don’t be afraid to ask a child’s current mental health care provider to refer you to another clinician or a specialist.

Experience Healing at Hillside

Being diagnosed with a mental health condition is a big deal for kids as well as parents and other authority figures. A diagnosis gives everyone involved an idea of what to expect, and if that idea is wrong, the patient may suffer. At Hillside, we specialize in diagnosing and treating children with a range of treatment needs. We have the clinical expertise to help children heal and develop necessary skills for a healthy life.

Hillside recognizes kids who have behavioral issues need individual attention and a toolkit of strategies to manage their emotions and change their behavior. We understand that kids fit into a family unit, and work to give families the skills they need to support and nurture their children.

Learning to live successfully with a diagnosed mental health condition requires an open and honest relationship with the provider. The better a clinician knows your child, the better they can help the child. Hillside is one of the most trusted names in providing mental health treatment for children and adolescents. We are ready to help and we invite you to contact us to find out more about our services. Call Hillside at 404-875-4551, or fill out our contact form to get in touch and take the first steps toward a correct diagnosis.

Author

  • Gaan Akers, LPC, NCC

    Director of Clinical Education & Outreach - Gaan has been working with children, adolescents, and families for over 10 years in various settings. In her current role, she provides education and training for mental health professionals, parents, and the community. She lives in Atlanta with her husband. In her free time, she enjoys reading, hiking, climbing, and cooking. She is a donut aficionado and a national park enthusiast!

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Current Version
May 9, 2024
Written By: Angie Hoke
Edited By: Angie Hoke
October 18, 2019
Medically Reviewed By: Angie Hoke