5 Diagnoses Before the Right Answer: My Approach to Psychiatric Misdiagnosis
The Pattern I See
About 90% of the people I see have already been diagnosed with something. Sometimes it's depression or anxiety. Sometimes it's much more. Someone I saw recently had been through five or six prior psychological evaluations, with diagnoses ranging from autism to ADHD to bipolar disorder to personality disorder.
I've seen this pattern often, especially with people who have been in and out of treatment programs or have tried therapy for years without moving forward. Most people already arrive with a diagnosis. The question is whether it explains the whole picture.
A label can describe a real symptom without explaining why it is there. Distractibility, mood changes, and impulsivity occur across many conditions.
“It’s hard to successfully treat something if you don’t know what you have.”
The point is not to collect more diagnoses. It is to identify which findings matter, which do not, and what treatment is most likely to help.
Why Diagnoses Multiply
A brief appointment can recognize distress. It often cannot sort through years of history, records, family patterns, prior treatment, cognition, and personality data.
Symptoms overlap. Trauma can look like distractibility. Depression, bipolar disorder, and ADHD can all affect concentration. A single slice of the picture can make several diagnoses seem plausible.
I also start with a more basic question: “What do you want to know about yourself?” That changes the evaluation. Someone who wants to know whether they have ADHD needs ADHD-related measures. Someone with a history of head injury, changing memory, or a family history of bipolar disorder needs a different set of questions and tests.
The history matters. So does the family perspective. I often speak with a parent, spouse, or other family member, with permission, because they may notice changes or longstanding patterns the patient cannot see from the inside.
When ADHD Was Not the Whole Answer
A lot of people come in convinced they have ADHD. That makes sense. ADHD symptoms are nonspecific: you don't focus, you don't follow through, you get distracted. But distractibility is also part of the criteria for depression, anxiety, and bipolar disorder.
Often, I find it's a mental habit the person built in childhood. It made sense in that environment. At 25 or 35, it gets in their way, and they don't realize they're doing it.
I had a young man in recently who laughed nervously at the end of his sentences. When I pointed it out, kindly, he said, "No, I don't," and laughed. Then he caught himself. He did it for the next three sentences and said, "Oh my gosh, I didn't realize I did it that much." Joking when nothing is funny, apologizing when there's nothing to apologize for, putting yourself down: these habits manage uncomfortable feelings, and they cost people more than they think. Once you're aware of one, you can change it.
ADHD also gets complicated in recovery. Many people I see from treatment centers were diagnosed with ADHD along the way. Sometimes it's genuine and sometimes it's not. Some got hooked on stimulants prescribed when they were younger and still believe they need them, even after substance use problems. Clarifying the diagnosis can help them stay off those medications and stay sober.
When Bipolar Was Not the Answer
I saw one case where everyone thought the person had a brain injury, and that her executive function problems came from it. That was a psychiatric misdiagnosis. She actually had undiagnosed bipolar disorder. Once it was treated properly, she was able to stay sober.
I see a lot of confusion between bipolar disorder, borderline personality disorder, and trauma. The distinction matters because the treatment is different. Bipolar disorder needs the right medication. If you're not on it, you won't get better. If the real issue is personality and you're being treated with bipolar medication, you won't get better either.
Family history is part of how I sort this out. Bipolar disorder has strong genetic loading, so when I suspect it, I always ask what runs in the family. I also look for the same theme showing up across more than one test. One answer rarely settles it. The pattern does.
What Comprehensive Testing Adds
Comprehensive testing is not a rating scale on a tablet. It is an extended clinical process that combines interview, records, standardized measures, observed behavior, and test results.
For a psychological or psychoeducational evaluation, I often spend six or seven hours with a person. I begin with an extensive interview and a core set of measures. I then tailor the rest of the day to the questions that remain.
Partway through, I stop and talk with the person. I ask whether the first set of data helps them understand themselves or answers a question they brought in. The next tests may be different depending on what we have learned. At the end, I have another conversation and often obtain family input.
The final report can support or rule out a diagnosis, clarify treatment, document accommodations, or identify another contributor. It makes the next decision more informed.
When to Get a Second Opinion With a Psychiatric Misdiagnosis
A second-opinion neuropsychologist may be useful when any of these are true:
You have several diagnoses, but none feels like a complete explanation.
Medication changes have not helped, or symptoms persist despite treatment.
Your diagnosis changes from year to year without a clear reason.
You are being asked to make a major treatment decision based on a brief evaluation.
You or your family have a steady sense that something important is being missed.
I do not assume a prior clinician was careless. Many people arrive after good-faith treatment that never had the information it needed. A fuller evaluation can bring that information into view.
Key Takeaways
Overlap does not establish cause.
History and testing clarify the pattern.
The right diagnosis changes treatment.
A second opinion is reasonable when care stalls.
Frequently Asked Questions
Can a neuropsychologist diagnose ADHD or bipolar disorder?
Yes, as part of an evaluation. Medical context still matters.
Why do I have so many mental health diagnoses?
Symptoms overlap. Different clinicians may see different pieces.
Can ADHD be misdiagnosed as anxiety or depression?
Yes, it can. All three can affect focus.
Should I get a second opinion before changing psychiatric medication?
It can help when diagnosis is unclear. Do not change medication alone.
How long does a comprehensive psychological evaluation take?
Often six or seven testing hours. Feedback and records work add time.
Can testing show that I do not have the diagnosis I was given?
Yes, it can. It may show a better explanation.
Sources & Further Reading
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