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Causes of Misdiagnosis in Mental Health
- Dr Titilayo Akinsola
- Oct 9
- 4 min read
Misdiagnosis in mental health is more common than many people realize. Getting the wrong diagnosis—or a partial diagnosis—can delay appropriate treatment, increase suffering, cause side effects, and erode trust in help. At Favor Mental Health, we believe understanding why misdiagnoses happen is essential both for clinicians and for clients, so we can build safer diagnostic processes and deliver more precise, compassionate care.
Below are the key causes, illustrated with examples, plus what patients and clinicians can do to reduce the risk.
Key Factors That Lead to Misdiagnosis
Symptom Overlap Between DisordersMany mental health conditions share symptoms. For example:
Low mood, sleep problems, fatigue show up in depression, generalized anxiety, bipolar disorder’s depressive phase, even sometimes in ADHD or thyroid dysfunction.
Restlessness, racing thoughts, distractibility might be ADHD, anxiety, or even early mania.
Because of this overlap, if the clinician doesn’t dig into the history (duration, triggers, onset, presence of alternating mood states etc.), they may pick the “most obvious” condition rather than the correct or full one.
Incomplete or Inaccurate Clinical History
Patients may forget to mention past episodes (for example hypomania), or may not connect current symptoms to earlier ones.
Sometimes key information like substance use, family psychiatric history, trauma exposure, medical comorbidities, or developmental history is missing.
Time constraints, rushed appointments, or poor communication can further reduce how complete the picture is.
Cognitive Biases on the Part of Clinicians
Anchoring bias: Once a clinician gets an early impression (say “this is anxiety”), they may give too much weight to information that supports that view, ignoring signs of other disorders.
Confirmation bias: Searching for evidence that supports a current diagnostic hypothesis, rather than seeking disconfirming evidence.
Diagnostic overshadowing: Attributing new or unusual symptoms to an existing diagnosed disorder rather than considering that something else—or something additional—might be happening.
Cultural, Gender, and Socioeconomic Biases
Symptoms can be expressed differently depending on cultural background; behaviors interpreted as “normal” stress in one culture may be pathologized in another.
Gender expectations: women’s symptoms (especially mood and anxiety) may be minimized or misattributed; men’s emotional distress may be underrecognized or miscast.
Access issues: people of low socioeconomic status or with limited health literacy may not get full assessments, or may have barriers to follow-ups. Systemic issues may contribute.
Diagnostic Manual Limitations & Overreliance on Checklists
Manuals like DSM-5 or ICD provide criteria, but they cannot capture every nuance. Rigid application without contextualizing to the person’s lived experience often leads to errors.
Sometimes the diagnosis is based on symptom counts alone, without considering severity, timing, functional impact, comorbid physical health issues.
Medical / Physical Conditions Not Ruled Out
Sometimes what looks like depression or anxiety has an underlying medical cause (thyroid disease, vitamin deficiencies, neurological conditions, infections). If clinicians don’t screen or test for these, mental symptoms may be misattributed.
Similarly, medication effects, substance use (alcohol, stimulants, etc.), withdrawal or intoxication states can mimic psychiatric symptoms. Missing that history or not asking about substances may lead to misdiagnosis.
Patient‐Related Factors
Some patients are reluctant to fully disclose symptoms due to stigma, shame, or fear (e.g. about being labeled).
Memory bias: people may mis-remember onset or severity.
Misinterpretation of their own symptoms (e.g. attributing physical symptoms to anxiety when they’re due to sleep apnea, or vice versa) complicates history gathering.
Systemic & Contextual Pressures
Time constraints / rushed sessions: clinicians may not have enough time to explore thoroughly.
Insurance limitations or organizational policies may push for faster diagnosis or limited session times.
Fragmented care: seeing many providers, or receiving care in settings where communication is poor can lead to gaps or contradictory diagnoses.
Changing Symptom Patterns Over Time
Many psychiatric disorders evolve; someone may start with depressive symptoms and later develop manic or hypomanic episodes, making diagnosis of bipolar vs unipolar depression hard early on.
Comorbidity: having more than one disorder (anxiety + depression + ADHD + PTSD) can muddy the picture.
Misuse of Self-Diagnosis or Diagnostic Labels
Patients may research, see descriptions online, and start using labels without professional assessment. This can lead to miscommunication, or skewed expectations.
Also, providers may rely too much on patient-reported symptoms without objective or collateral data.
Consequences of Misdiagnosis
Misdiagnosis is not just a technical error—it has real consequences:
Delayed relief / inappropriate treatment → suffering continues longer.
Harm from inappropriate treatment (wrong medications, side effects).
Worsened trust: patients may disengage from help when treatments “don’t work.”
Extra costs: more appointments, more medications, more suffering.
Impact on identity, self-esteem, sometimes stigma.
How Favor Mental Health Helps Reduce Misdiagnosis
At Favor Mental Health, we take steps to ensure diagnoses are as accurate as possible:
Comprehensive initial evaluations: thorough history (medical, psychiatric, developmental, substance use), often including collateral information (family, past records).
Regular review: If treatment isn’t working as expected, we re-evaluate the diagnosis rather than simply increasing dose.
Use of structured assessment tools, validated questionnaires, and continuous symptom tracking.
Sensitivity to culture, gender, trauma, and individual experience: asking how symptoms are expressed in your life, not assuming they look a textbook way.
Building enough session time and follow-ups to explore evolving symptoms.
Practical Advice for Patients
If you want to reduce the chance of misdiagnosis (or correct one), here are things you can do:
Be as detailed and honest as possible about your symptoms: their onset, duration, intensity, triggers.
Share medical history, substance use, sleep patterns, trauma, family history accurately.
Be open about past treatment responses: what worked, what didn’t, what side effects you had.
Ask questions: “What else might this be?”, “Why are you ruling out X?”, “Could there be medical causes or other conditions overlapping?”
Seek second opinions when things aren’t improving, or when diagnosis seems unstable.
Conclusion
Misdiagnosis in mental health is complex and usually unintentional—but its effects can be serious. What matters is recognizing the causes, being open to reassessment, and partnering with a mental health provider who listens, investigates, and treats you as a full person.
At Favor Mental Health, our goal is not just to assign a label—but to understand you deeply, so that treatment matches the real issues and gives you the relief you deserve. Book an appointment with us today.
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