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Mental health conditions are misdiagnosed more often than one might think. Anxiety and depression often go undiagnosed, or are misdiagnosed in place of medical diagnoses, like medical conditions that cause chest pain, lethargy or shortness of breath. More severe mental health disorders like schizophrenia and bipolar disorders are often misdiagnosed and confused with each other. In a study done on Canadian primary care clinics, it was found that 65% of major depressive disorder, 85% of panic disorder, 71% of generalized anxiety disorder, and 97% of social anxiety disorder were misdiagnosed (Vermani, 2011). In another study on clinics in Ethiopia, the misdiagnosis rate of severe psychiatric disorders was almost 40%, with the most commonly misdiagnosed disorder being schizoaffective disorder (Ayano, 2020). These numbers are alarming, as misdiagnosis of a mental health disorder can lead to inappropriate treatment or medication options, leading to worsening of the condition. Therefore, it is crucial that the correct diagnosis be made so that the proper course of treatment can be recommended by the doctor.
Why do misdiagnoses happen? One major reason for the misdiagnosis of mental health disorders is that many disorders have overlapping symptoms, which makes it challenging to make the appropriate diagnosis. Unlike many medical disorders, mental health disorders do not have signs or symptoms that are specific to that particular disorder. For instance, the most common symptom of schizophrenia, hallucination/delusion, can also occur in patients with bipolar disorder or major depressive disorder. Also, a patient may simultaneously have multiple mental health conditions, making the proper diagnosis even more difficult. For example, 60% of schizophrenic patients had comorbid depression (Ayano, 2020). Bipolar disorder and depression were the two disorders that were most confused with each other due to depression being one of the defining symptoms of bipolar disorder. Similarly, in many cases, physical or developmental symptoms are misinterpreted as a mental health condition. ADHD is a commonly misdiagnosed disorder in children. Symptoms of ADHD include sleep irregularities, fidgeting, difficulty focusing and inability to sit still. However, a child with sensory processing disorder (SPD), which makes you overly sensitive to your senses, can have similar symptoms to ADHD (Akers, 2019). In many cases, children with autism are misdiagnosed with ADHD or other mental health disorders (Au-Yeung, 2018). Difficulty focusing and inability to sit still may simply be due to delayed development of self-discipline, rather than a symptom of ADHD (Akers, 2019). Similarly, a medical condition, like hypothyroidism, which causes lack of energy and lethargy, can be misinterpreted as an underlying symptom of depression. Another barrier contributing to the misdiagnosis of mental health conditions is that patients may not report their symptoms in an appropriate manner. In a medical diagnosis, numerous tests can be done to find the exact underlying cause of physical symptoms. However, in a mental health diagnosis, clinicians rely solely on the patient’s self-reporting of their symptoms. Patients may feel less inclined to disclose matters about more sensitive topics, like drug abuse or trauma. Patients may also not understand the importance of disclosing certain symptoms. For example, a patient with bipolar disorder may not consider the manic period as problematic, especially when compared to the depressive period. The patient may see the manic period as the “stable” phase, as they are able to be productive without any of the depressive symptoms, and therefore when discussing with a clinician, not report the manic phase as a symptom (Akers, 2019). Misdiagnosis of mental health conditions can have grave consequences. One such effect is the inappropriate recommendation by the clinician for the course of treatment. Inappropriate medication can have a worsening effect on the symptoms and make proper treatment that much more difficult. For example, Adderall, a common medication for ADHD patients, can cause impairments in working memory and cognitive decline in individuals that don’t have ADHD. Also, when the recommended treatment is not working, the patient may feel shame or guilt, thinking that it is their own fault, potentially leading to symptoms of anxiety or depression. Or, the patient may fault the clinician and develop a distrust of healthcare professionals, preventing future visits to the clinic (Akers, 2019). It is clear that the appropriate diagnosis of mental health disorders is crucial to treatment, but how do we reduce misdiagnoses? Most importantly, a patient must give honest, clear reports of their symptoms. It is crucial that patients don’t feel shame in disclosing their symptoms or life history, while healthcare professionals have the responsibility to provide a safe space where the patient feels comfortable disclosing information about themselves. Patients must also be well-informed about different mental health conditions, so that they understand the importance of reporting certain symptoms. It is also important for clinicians to carefully evaluate each patient on a case-by-case basis to make the appropriate diagnosis based on the patient’s symptoms, background, and patient history. Creating an accurate criteria for diagnosing different mental illnesses is no easy task; however, understanding why misdiagnoses happen and how we can prevent them is a step in the right direction. References:
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