Diagnostic Overshadowing: When the Wrong Diagnosis Blocks Recovery
Mental health treatment can be a long process where real, consistent change takes time. Knowing this, however, you may feel like treatment simply isn’t working, or that something still feels off. In some cases, you may feel like your diagnosis was never quite right in the first place or that the treatments you’ve tried just haven’t worked as they were supposed to.
If this is the case, it may not be something that you’re imagining. Misdiagnoses are well-documented, relatively common, and can potentially keep you stuck in ineffective treatment for years. Understanding accurate mental health diagnosis importance is the first step toward getting the care you need. Here, we’ll cover:
- What diagnostic overshadowing in mental health is.
- How diagnostic overshadowing leads to misdiagnosed mental illness in adults.
- How to know if a diagnosis is wrong.
- When to seek a psychiatric evaluation second opinion.
- Steps for correcting a mental health diagnosis.
What Is Diagnostic Overshadowing in Mental Health?
Diagnostic overshadowing happens when a mental health condition you already have (such as depression or anxiety) becomes a lens through which care providers see everything else about you.[1][2]
That existing diagnosis can block clinicians from considering alternatives, which allows new symptoms you develop to be explained as part of your existing condition rather than investigated as a possible new issue.[3]
This isn’t usually an intentional mistake. Diagnostic overshadowing often occurs unintentionally and is partly a product of how the brain processes information under pressure. Without all the necessary data and in a busy clinical environment, the correct diagnosis can sometimes just be hard to determine.[2][4]
How a Known Diagnosis Can Hide Other Conditions
When you’re diagnosed with a psychiatric condition, it goes in your medical file. It follows you to every clinical appointment you have, whether that’s a visit to a specialist, a trip to the emergency room, or a visit to your general practitioner. When your health provider reviews your file before seeing you, your diagnosis might shape what they look for.[1]
It isn’t just that diagnostic overshadowing makes the process of mental health evaluation more difficult. Another part of what makes it so hard to catch is that it often stems from thinking errors that even experienced mental health providers aren’t aware of.
Unconscious Thinking Errors That Contribute to Diagnostic Overshadowing
Three thinking errors often contribute to diagnostic overshadowing:[2]
- An anchoring bias occurs when a clinician sticks to their initial impression of your symptoms, even when new information contradicts it.
- A premature closure occurs when a clinician stops their diagnostic search too soon.
- An implicit bias occurs when a clinician’s unconscious assumptions about your race, gender, or age impact your diagnosis.
Anchoring Bias
Here is an example of an anchoring bias: you have an anxiety disorder. When you visit the emergency room with chest pain and shortness of breath, the attending physician gives you a mild sedative and sends you home, assuming you’re having an anxiety attack.
No tests are then done on your heart, even though you may have actually been having a dangerous cardiac episode.
Premature Closure
To understand premature closure, let’s assume you have schizophrenia. You tell your therapist that you’ve been gaining weight for several months and have been feeling exhausted all the time.
Your therapist attributes these changes to your antipsychotic medication and doesn’t investigate further.
Years later, a different therapist wonders if you have a thyroid problem and refers you to get tested. It is then discovered that you have had an untreated thyroid issue the whole time, which might have been caught if it weren’t for the initial clinician’s premature closure.
Implicit Bias
Imagine someone of a certain race has bipolar disorder. At a yearly physical exam, they tell their doctor that they drink two glasses of wine most evenings to help them sleep. The doctor diagnoses them with an alcohol use disorder.
But when a patient of another race reports the same situation to that same doctor, they are referred to a sleep specialist. The symptoms were the same, but the care was not.
Misattributing Symptoms to Another Disorder
No matter which thinking error occurs, the result may be that:
- New symptoms are misattributed to an existing psychiatric disorder.
- Physical illnesses are mistaken for mental health symptoms.
- Separate conditions go undetected.
This is especially pronounced in emergency room situations, where the pressure to see patients and move to the next one is very high.[3]
It isn’t just about how healthcare providers think. Overlapping mental health disorders, like bipolar disorder, depression, schizophrenia, and anxiety, share many symptoms. When you already have a diagnosis for one, it can make detecting the symptoms of a different disorder genuinely difficult.[5]
This is also part of why undiagnosed mental illness in adults remains common, even among those already receiving care.
Who Is Most at Risk for Mental Health Misdiagnosis?
While a mental health misdiagnosis is possible for anyone, some people are more vulnerable than others:[1][2][3][6]
- If you have a pre-existing psychiatric diagnosis, you are at the highest risk of being misdiagnosed.
- If you’re a woman or a racial minority, you may be up to 30 percent more likely than a white male to have a missed or delayed diagnosis.
- If you’re an older adult, you’re more likely to have more co-occurring conditions and have heavier medication use. Both increase your risk of an incorrect or missed diagnosis.
- If you’re a patient with complex symptoms that are difficult to explain, you’re at higher risk of an incorrect diagnosis.
Misdiagnosed Mental Illness in Adults
Knowing you might be at risk for misdiagnosis is one thing. Knowing which conditions are most commonly misdiagnosed is another.
Bipolar disorder, anxiety disorders, and early schizophrenia are at the top of the list. In each case, the cost of a misdiagnosis is far greater than a late start on proper treatment.[7] The wrong treatment can:[7][8]
- Make your symptoms worse.
- Make you lose trust in the mental healthcare system.
- Cause the stigma of the wrong psychiatric diagnosis to follow you and influence how future providers treat you.
Beyond that, there are financial and functional costs. Repeated care, unnecessary treatments, lost productivity, and loss of time are all secondary effects of a misdiagnosis. Conditions also become harder to treat the longer they go without a correct diagnosis.[4]
Bipolar Misdiagnosed as Depression
Bipolar disorder is one of the most often misdiagnosed psychiatric illnesses. Some studies have found that 40 percent of the time, it is diagnosed as major depressive disorder.[7] This isn’t a coincidence, as depression is often the first phase of bipolar disorder, and many people with it only have one manic episode in their lifetime.[7][9]
The defining characteristic of bipolar disorder might not have shown up yet during your initial appointments with a therapist.[7][9]
When a bipolar disorder diagnosis is missed, there is often a ripple effect. With an incorrect major depression diagnosis, you might be put on antidepressants, which can trigger rapid cycling, mania, or mixed episodes. This means you can become even more unstable when you’re already struggling.[7]
It can take five to ten years between the first symptoms you experience and getting the correct bipolar diagnosis. During that time, you might go through multiple treatments that aren’t effective, have worsening episodes, and lose faith in the system and the professionals who are trying to help you.[7][10]
What Research Says About Misdiagnosis Treatment Failures
Bipolar disorder isn’t the only condition that is frequently missed. Nearly 70 percent of major depressive disorder cases, for example, go undetected in primary care settings.[11]
This is a larger issue than mental health, though. Nearly 20 percent of hospitalized adults have some kind of diagnostic error each year. But the reality is that since most errors aren’t recorded, the incidence is likely much higher.[6]
How to Get a Proper Mental Health Diagnosis (And When to Question the One You Have)
Now that you know diagnostic overshadowing exists, you’re in a better position to recognize the mental health misdiagnosis effects. Here are a few actionable steps to combat this issue.
Confirm Your Diagnosis Is Wrong
Perhaps the clearest sign your diagnosis is wrong is if the treatment you’re currently getting isn’t working, particularly if you’ve followed your treatment plan from the outset.[6]
Another of the most common wrong psychiatric diagnosis symptoms is new or changing symptoms. If these changes have been attributed to your existing condition without any further investigation, your healthcare provider should take another look at your diagnosis.[1][2]
It can be helpful to track your own symptoms to look for changes as they happen. To give your mental health provider a clearer picture of what’s going on, so a proper diagnosis is more likely, note:[6]
- When your symptoms occur.
- What they feel like.
- What makes them better or worse.
- How they differ from previous symptoms.
It also helps to bring a family member or friend to your appointments. This is helpful in two ways. First, they can provide their account of your symptoms to your health provider, which, again, helps paint a more thorough picture of your current situation. Second, they can help you advocate in the moment if you feel like your concerns about your diagnosis are being dismissed.[6]
Psychiatric Evaluation Second Opinion (And Why You Shouldn’t Hesitate to Get One)
One of the most important takeaways from this discussion is this: if you have any doubts about your diagnosis, ask for a second opinion. In nearly one-third of psychiatric cases, a second opinion results in a different diagnosis. And in more than two-thirds of cases, a second opinion leads to a new treatment plan.[12]
Asking for a second opinion doesn’t have to be a formal request. Studies show that a simple, “What else could this be?” can prompt your mental healthcare provider to consider a different diagnosis.[2][6]
This phrasing takes some of the pressure off asking while minimizing worry about seeming like a difficult patient. The doctor-patient relationship in psychiatry is uniquely close, so questioning your provider’s diagnosis might feel like you’re attacking their expertise.[12]
You might feel like the stress or uncertainty of getting a second opinion isn’t worth it. You may have to find a new provider, repeat your mental health history to them, and relive the difficult experiences that led you to treatment in the first place.
That cost might feel too high, especially when you’re already finding things hard to manage. However, research shows that 94 percent of patients who seek a second opinion are satisfied with the outcome.[12]
While it can seem like a lot to take on right now, correcting a mental health diagnosis can be the difference between years of ineffective treatment and finally finding an approach that works.
Mission Connection is here to help you or your loved one take the next steps towards an improved mental well-being.
Find Mental Health Treatment That Understands You With Mission Connection
Whether you’re questioning your diagnosis or simply haven’t found the right treatment yet, you don’t have to keep going down the same path or face your symptoms alone. Getting a thorough and accurate mental health evaluation can be a life-saving process.
At Mission Connection, we provide comprehensive mental health treatment that’s founded on the understanding of who you are, not just what your medical chart says.
Our expert team will take the time to listen to you, ask you the right questions, and take your point of view into consideration to make sure you get the care that fits your needs.
We offer flexible outpatient treatment in various formats to accommodate your schedule. Choose from in-person treatment at one of our locations, virtual telehealth, or a hybrid approach that combines in-person and virtual care.
If you’re ready to get answers about your symptoms, reach out to us online or call us at 866-833-1822. Getting the right diagnosis isn’t the end of your mental health journey, but where real recovery begins.
Diagnostic Overshadowing FAQ
What are anxiety misdiagnosis symptoms that might be mistaken for something else?
Anxiety symptoms are often physiological, such as:
- Fatigue.
- Gastrointestinal distress.
- Chest tightness.
- Headaches.
Since these symptoms don’t necessarily suggest a mental health issue, you might go to a medical provider first, who looks for physical causes rather than psychological ones.[3][11]
If your treatment doesn’t resolve your symptoms, it’s worth asking about the possibility of an anxiety diagnosis.
What are differential diagnosis psychiatry practices, and how do they protect you?
A differential diagnosis involves systematic steps clinicians take to rule out other explanations for your symptoms before determining the final diagnosis. Rather than matching your symptoms to the most obvious option and stopping there, they consider what else your symptoms might indicate.[1][2]
If your provider doesn’t discuss other options with you, or if your diagnosis hasn’t been revisited after ineffective treatment, you might ask your provider what other diagnoses they might consider.