The Dangers of Mental Health Misdiagnosis: Why Accuracy Matters

Magda is hardly alone in her experience of mental health misdiagnosis. A 2012 study by Bipolar UK, the Royal College of Physicians, and Bipolar Scotland found that “people with bipolar disorder wait for an average of 13.2 years before they are diagnosed, and often spend years receiving treatment for other conditions.” Of 706 people surveyed, only 15% received a prompt diagnosis, while 85% experienced diagnostic delay. “Most of those were wrongly told they had depression,” writes Denis Campbell for The Guardian. “Among the 85% whose diagnosis was delayed, 71% said that their symptoms had become worse as a result of receiving inappropriate treatment, such as antidepressants or sleeping pills.” As Suzanne Hudson, chief executive of Bipolar UK, says, “A delay of this length has a significant impact for individuals and families, with sometimes devastating consequences, as bipolar has the highest rate of suicide of any psychiatric illness.”

Of course, people with bipolar disorder are not the only ones vulnerable to misdiagnosis. “Misdiagnosis can happen with any mental health disorder,” says Gabrielle Moss, a writer for Bustle. “[For example], a 2009 meta-analysis of 50,000 patients published in the Lancet found that general practitioners only correctly identified depression in patients in 47.3% of cases.” Meanwhile, a 2008 study by researchers at the Brown University School of Medicine found that 57% of adults diagnosed with bipolar disorder did not meet diagnostic criteria upon more comprehensive diagnostic review. Aside from bipolar disorder and depression, some of the most frequently misdiagnosed mental health disorders include borderline personality disorder, ADHD, PTSD, and anxiety.

So what causes these high rates of misdiagnosis? The answers are multiple and complex. “We believe that clinicians are inclined to diagnose disorders that they feel more comfortable treating,” says Dr. Mark Zimmerman, associate professor at Brown University and director of outpatient psychiatry at Rhode Island Hospital.

The increased availability of medications that have been approved for the treatment of bipolar disorder may be influencing clinicians who are unsure of whether or not a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication-responsive.

This may be particularly true of doctors who do not have specialized training in psychiatry, such as GPs. But personal expertise and treatment availability (or lack thereof) are not the only factors influencing inaccurate diagnosis. As Hudson explains, patients may also play a role:

It could be psychiatrists that fail to diagnose when they can. But a lot of the time it’s patients themselves not telling the doctor their full symptoms. If we’re in a hypomanic state, coming out of a stable phase and starting to get high, we rarely present to a [doctor] then, which makes it more difficult.

Indeed, many people may fail to recognize emotions as behaviors as symptomatic of mental illness and thus fail to report them, particularly if they are not explicitly asked. They may also fail to report due to shame or embarrassment. As one client now in treatment for bipolar disorder says, “I hid my symptoms from my GP. I never revealed the true extent of my illness, albeit I did not know what I was doing was necessarily part of being ill.”

Research also reveals that cultural and ethnic factors can play a significant role in mental health misdiagnosis. “African-Americans, for example, are more likely to receive misdiagnoses of schizophrenia and less likely to receive accurate diagnoses of depression or other mood disorders [according to a U.S. surgeon general’s report],” writes Erica Goode in The New York Times, “And while rates of mental illness in Asian-Americans do not differ significantly from those found in other groups, mental health professionals may hold the stereotype that they are ‘mentally healthier,’ a bias that contributes to inadequate treatment and prevention.”

The immediate effect of mental health misdiagnosis is obvious: it keeps people from receiving treatment for their affliction, allowing distress to grow unchecked as hope diminishes. This can lead to increasingly dangerous psychological conditions that threaten both your emotional and behavioral function. But misdiagnosis and inaccurate treatment can also increase dysfunction by exposing you to pharmacological therapies that augment existing symptomatology or cause the emergence of new symptoms. For example, people whose bipolar disorder is treated with antidepressants are at heightened risk of mania, increased frequency of mood switching, and more severe depressive episodes than if they received no treatment at all. This is dangerous both in the immediate and long-term, as each mood episode can cause neurological changes that complicate treatment and compromise treatment outcomes.

The effects of inaccurate diagnosis can also go beyond the individual and have widespread deleterious effects on entire communities. As the National Alliance on Mental Illness points out:

Historically, African Americans have been and continue to be negatively affected by prejudice and discrimination in the health care system. Misdiagnoses, inadequate treatment and lack of cultural competence cause distrust and prevent many African Americans from seeking or staying in treatment.

Similarly, misdiagnosis amongst Asian-Americans can perpetuate the stereotype that this group does not struggle with mental illness, particularly severe mental illness, at the rate of the general population. In turn, this may contribute to the maintenance of damaging stigmas that keep people from identifying their own distress and seeking care.