Written by: Matthew Supa
Edited by: Jonathan Cina
A patient walks into the emergency room with a broken arm. In most cases, the steps to follow are relatively clear: a doctor will diagnose the injury and a treatment plan will be determined. In this case, the treatment plan would likely involve the patient wearing a cast, going to physical therapy, and possibly using any other remedies advised by the doctor on the road to recovery. Hopefully, within a few weeks, the patient’s arm will be fully healed and they will be able to function as usual, returning to the quality of life they had before the injury.
While this is only one example, and there are certainly a variety of instances where even a physical wound might not be so easily diagnosed, it is often much more difficult to correctly diagnose and treat the mental health disorders so commonly faced within society today. This is a phenomenon which is often overlooked, and it is especially important to delve into the reasons for the prevalence of mental health misdiagnosis, the detrimental impacts it can have, and how diagnosis and treatment can be improved.
In determining how a patient should best be treated for any condition they may be facing, it is crucial to first correctly determine exactly what it is that needs to be treated. This is why people go to medical professionals in the first place – they want to know just what they need to do to face whatever they may be experiencing.
However, according to several studies conducted in the field, successfully accomplishing this goal can be significantly less simple than one might expect – and the numbers underscoring this point are incredibly revealing. Directly impacting close to 30% of the population of the United States, conditions classified as “mood and anxiety disorders” – which includes ailments ranging from major depressive order to generalized anxiety disorder and even to bipolar disorder – face wide numbers of people today (Vermani et al., 2011). Yet, for how many people these conditions affect – and how much of an impact they can have, especially without correct treatment – it is incredibly telling just how often they are misdiagnosed. For instance, in one study carried out in “7 primary care clinics in 3 Canadian provinces, Ontario, British Columbia, and Nova Scotia,” the misdiagnosis rate for major depressive disorder was 65.9%. In the same study, for generalized anxiety disorder, that number was 71%. And for bipolar disorder, the rate was a staggering 92.7% (Vermani et al., 2011).
However, this is not the only study that has revealed high rates of misdiagnosis. Another study, this time conducted in specialized psychiatry centers in Ethiopia, showed a similarly shocking trend: when attempting to diagnose severe psychiatric disorders “using the Structured Clinical Interview for DSM-IV (SCID),” over 39 percent of patients were misdiagnosed (Ayano et al., 2021). The takeaway from both of these articles is clear: in the diagnosis of mental health disorders today, there must be fundamental flaws preventing medical professionals from being able to recognize just what it is that people are facing. This is especially important to consider when, for physical conditions, there is not such vast and overlooked trouble when it comes to diagnostic processes.
There are a number of possible reasons for the high prevalence of mental health misdiagnosis when juxtaposed with the misdiagnosis of physical conditions. For one, mental and physical conditions have historically been looked upon very differently within society – a stigmatization of mental health which has continued even into the modern day. Despite progress which has been made, the “negative attitudes or beliefs” and “inaccurate stereotypes” which many continue to hold with regard to mental health are still a great concern when trying to tackle the issue (Healthdirect Australia, 2021). These attitudes not only seem to be much less prevalent in treatment of such ailments as a broken bone, but they, simply, do not exist in isolation; they are, unfortunately, widespread throughout society, and can permeate into the treatment of mental health disorders. There are, inherently, some differences in exactly how mental and physical conditions should be treated, and it is still important to recognize the “unique nature” of mental health conditions, especially considering the misunderstandings surrounding them which may exist (Malla et al., 2015). However, in treatment, there can be no difference in quality between the treatment of mental and physical illness; both are essential, and they should be treated with the attention they so critically deserve. While recent years have shown a considerable amount of progress made in understanding such conditions, there is also a great deal of work to be done in the field.
This is especially important to recognize considering that it is not only stigma which is holding back treatment of mental health disorders; often, it is simply a lack of understanding of mental health which might contribute to the widespread misdiagnosis of such disorders. Despite the “[a]dvances in neurosciences” which “have surely given us much better biological mechanistic explanations,” society as a whole is “far from being able to explain in neurobiological terms many of the behaviours and experiences that constitute the core presentations of mental disorders” (Malla et al., 2015). Other reasons which might explain the lack of more effective diagnosis and treatment of mental health disorders include complications within an individual patient’s history, the “masking” of symptoms, the possibility that patients have more than one condition, and the existence of biases and stigma in some cases, with a “lack of culturally competent care” (Akers, 2019).
Even further complicating the treatment of mental health disorders is another phenomenon which has shown to exist: the inextricable connection between mental and physical conditions. One study found that “[p]ast-year injury occurrence predicted increased risk for past-month anxiety disorders and decreased risk of past-month depressive disorders,” with “reciprocal associations between injury and mental disorders” (Jenness et al., 2017). There is, simply, so much that remains to be understood when it comes to mental health disorders – and, consequently, in recognizing such conditions in patients.
Regardless of the reason, the misdiagnosis of mental health conditions can have a wide range of detrimental impacts, ranging from the level of the individual to society as a whole. As an example, misdiagnosis may simply “confuse” the patient and consequently cause their condition to worsen if they feel they aren’t responding positively to the treatment that was provided for the incorrect illness (Akers, 2019). In a similar vein, a patient’s condition might become worse simply because they are provided with the wrong treatment or the incorrect medication, both of which can be incredibly dangerous to the individual (Akers, 2019). More generally, if the prevalence of misdiagnosis continues to remain so high, this could result in a broader distrust of professionals in the field (Akers, 2019).
While there is so much that is left to be understood when it comes to mental health, there are steps that can be taken to ensure progress is made in improving such critical care. From increasing understanding and awareness to simply expanding the vital research being done in the field, it is crucial that work be done to reduce the prevalence of misdiagnosis and prevent the harmful impacts which such flawed diagnostic processes might have. By taking such deliberate steps forward within this critical, long-overlooked issue impacting countless individuals across the globe, tangible progress can, truly, begin to be made.
Whether it is a physical injury or a mental health disorder which someone is facing, any condition which has a negative impact on an individual and their quality of life should be given the same degree of care and attentiveness. Considering not only how widespread the issue is, but also just how difficult it may be for an individual to reach out for help when it comes to mental health, it is impossible to understate just how crucial proper treatment is within society today. When someone seeks treatment, it is imperative that a medical professional has the tools to provide it. Just as one expects competent care for a broken arm, the same should be true for some of the most prevalent – and impactful – mental health conditions present in society today.
References:
Akers, G. (2019, October 18). The Impact of Mental Health Misdiagnosis. Hillside.
Ayano, G., Demelash, S., Yohannes, Z., Haile, K., Tulu, M., Assefa, D., Tesfaye, A., Haile, K.,
Solomon, M., Chaka, A., & Tsegay, L. (2021). Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia. Annals of General Psychiatry, 20(1). https://doi.org/10.1186/s12991-021-00333-7
Healthdirect Australia. (2021, September). Mental Illness Stigma. Healthdirect.
Jenness, J. L., Witt, C. E., Quistberg, D. A., Johnston, B. D., Rowhani-Rahbar, A., Mackelprang,
J. L., McLaughlin, K. A., Vavilala, M. S., & Rivara, F. P. (2017). Association of physical injury and mental health: Results from the national comorbidity survey- adolescent supplement. Journal of Psychiatric Research, 92, 101–107. https://doi.org/10.1016/j.jpsychires.2017.03.022
Malla, A., Joober, R., & Garcia, A. (2015). “Mental illness is like any other medical illness”: a
critical examination of the statement and its impact on patient care and society. Journal of Psychiatry & Neuroscience, 40(3), 147–150. https://doi.org/10.1503/jpn.150099
Vermani, M., Marcus, M., & Katzman, M. A. (2011). Rates of Detection of Mood and
Anxiety Disorders in Primary Care: A Descriptive, Cross-Sectional Study. The Primary Care Companion For CNS Disorders, 13(2). https://doi.org/10.4088/pcc.10m01013
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