As a licensed clinical psychologist, specializing in forensic psychology, I have worked in a multitude of settings. Those include maximum security prisons, state forensic and psychiatric hospitals, rehabs, outpatient facilities and private practices to name a few. As I continue along my career, I am consistently alarmed at the rate of misdiagnosis in mental health patients.
Misdiagnosis in medical patients is frustrating, costly, and can even lead to death. What about in mental health patients? What are the ramifications and why are we as practitioners and consumers not more concerned with mental health misdiagnosis?
Some say that when it comes to mental health, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5, 2013), is but one way to conceptualize symptomatology. We also have the International Classification of Diseases, 11th edition (ICD-11, 2019), which is used internationally. Some practitioners, researchers, and clinicians don’t subscribe to either, citing the argument that these diagnostic tools perpetuate stigma, and “label,” or “judge” patients. While that may be the case to some degree, the utility of mental health diagnosis far outweighs the concept of not using diagnoses at all. In addition, stigma and judging is not a diagnostic problem, it’s a miseducation problem.
I propose this analogy: when a medical physician diagnoses cancer in a patient, it facilitates the understanding of the symptoms, it assists other treatment providers in understanding the nature and etiology of the patient’s disease, and it clarifies the symptomatology and prognosis for the patient. So why would mental health practitioners not utilize the same model? The “cancer diagnosis” doesn’t define the patient or compromise their identity. It simply facilitates proper care and assists all providers in communicating effectively and in delivering optimal care.
Let us look at some of the implications of misdiagnosis in mental health patients:
-Treatment may be lengthy without results
-Inadequate or inappropriate clinical interventions
-More money spent in the long-term
-Clients don’t feel better and distress may increase
-Medical implications (potentially dangerous pharmacotherapy interactions)
-Treatment fatigue (frustration, burnout, low motivation, client may feel misunderstood)
-And yes, even death (i.e. lithium toxicity in a patient who isn’t even bipolar)
What do I propose?
Well, call me biased since I’m a clinical psychologist and love conducting assessments, but that is the solution. Empirically derived, researched, standardized, psychological assessments are LARGELY underutilized. It is much easier to prescribe Prozac (and more likely to be covered by insurance), than to say: “let’s invest in figuring out exactly where this symptomatology stems from, and what is going on with you." It is easy for a patient to go see a psychiatrist or therapist and say, “I’m depressed, I have anxiety, I hear voices.” But we have a duty as providers to find out exactly why. What are the underlying causes? The etiology? The diagnosis(es)? Because ultimately, accurate diagnoses lead to more effective interventions and successful outcomes. So, the next time a patient comes to you and says, “I am bipolar,” or “I have ADHD,” recommend a psychodiagnostic evaluation. It may turn out the mood lability actually stems from borderline personality disorder and not mania, and the inattention is actually due to depression not ADHD. The patient will ultimately benefit, and after all isn’t that our goal?