Avoiding Diagnostic - Deficit Disorder

"Avoiding Diagnostic - Deficit Disorder"

By Steven A. Weisblatt, M.D.

Everyone would vote for accuracy in diagnosis; unfortunately, accuracy isn’t running. Patients often struggle with the wrong meds for years before a clinician gets the diagnosis right and treats appropriately. Tragically, classic bipolar disorder - let alone “soft” bipolar disorder - is missed most of the time. Frequent misdiagnoses include Depressive Disorder, Anxiety Disorder, PTSD, Panic Disorder and Attention Deficit Disorder – or even combinations of all five! Since an accurate diagnosis is so important to limiting pain and suffering, why do we so often get it wrong?

Diagnosis in Psychiatry

In medicine, everybody knows that if you have a fever, it doesn’t mean that you have a “fever disorder”. We expect the clinician to probe further, asking about and evaluating other symptoms in order to establish a comprehensive diagnosis (e.g. pneumonia) – that explains all of the symptoms being presented. In psychiatry, though, this often is not the case.

Typically, mental health clinicians focus on the first symptom they hear from a patient (e.g. poor attention, depression, panic), mistakenly believing that a single symptom justifies a syndrome. For example, “depression” (a symptom) is diagnosed as Depressive Disorder, “problems with attention” are diagnosed as Attention Deficit Disorder (ADD or ADHD) Since people tend to complain first about what bothers them most, it is little surprise that you may be (mis)diagnosed with a syndrome bearing that name.

Though you may have specific symptoms of depression, poor attention, anxiety and panic, these particular symptoms may be part of a syndrome more consistent with a diagnosis of either Bipolar Disorder or Bipolar Spectrum Disorder. However, because many clinicians inappropriately get stuck on the symptom that you first complain about, they may miss the presence of your other, less obvious symptoms (e.g. racing thoughts, irritability, mood swings, etc.). If your clinician were only to recognize these other symptoms, he/she would likely reach a different diagnosis – that of a Bipolar Spectrum Disorder.

The Impact of Misdiagnosis on Treatment

If you had a cough, would you accept a non-specific diagnosis of a “cough disorder”? Of course not. Why? Because you know that correct treatment depends on establishing a correct diagnosis (e.g. asthma). Short of a common cold, simply suppressing the cough with cough syrup just doesn’t cut it.

Yet surprisingly, in mental health care, these kinds of non-specific, symptom-based diagnoses and treatments are still the order of the day. The equivalent to this in a medical office would be a person with pneumonia getting Tylenol for their fever, Robitussin for their cough and photoshopping their x-ray!

I often see patients in consultation who for many years have carried multiple erroneous diagnoses and have been medicated on an irrational cocktail - a stimulant for inattention, an antidepressant for depressed mood, a valium-like medication for anxiety and an anti-psychotic drug to assist in sleep at night. Treating bipolar disorder, ultimately, can often be accomplished using mood stabilizing medications alone, though two or more may be required. There is seldom a need for long-term drugs for specific symptoms if the underlying disorder is completely treated.

If your clinician fails to diagnose a single disorder which encompasses all of your symptoms, the improper treatment that follows is likely to wreak havoc on your life. Granted, until your disorder is treated to remission, you could appropriately be prescribed meds designed to relieve symptoms. However, long-term use of these symptom-relieving drugs is sub-optimal care. Simply put, it would be like taking cough syrup for life.

How you can try to avoid a Misdiagnosis

The first words you speak often set the diagnostic “tone” for the interview, so make sure you don’t inadvertently contribute to an incorrect assessment. So, even if these symptoms bother you the most, report these symptoms last:

• depression / crying / decreased sleep
• anxiety / panic
• trouble with attention / focus

Instead, it’s imperative that you state manic and hypomanic symptoms first:

• irritability
• agitation
• impulsivity
• racing / obsessive / cluttered or busy thoughts
• hypersexuality / “hyperbuying”
• euphoria
• decreased need for sleep
• use of alcohol or other agents to relax

*Make sure you or your loved one gets diagnosed accurately and treated effectively by keeping the above in mind.