The truth about misdiagnosis in psychiatry

When it comes to your mental health, having a diagnosis that feels accurate matters. Sometimes, though, a diagnosis may not fully fit your experiences. This kind of psychiatric misdiagnosis isn’t very common, but when it happens, it can leave you feeling confused, discouraged, or unsure of what to do next.

If you’ve ever felt like your diagnosis doesn’t quite match what you’re going through, you’re not alone. Many people share this concern, even if their diagnosis turns out to be correct. The good news is that compassionate support is available. By understanding what can lead to a diagnosis that feels “off,” you can feel more confident about your care and take steps toward getting the help you need.

Most importantly, you don’t have to navigate these questions on your own. With the right provider, you can find clarity, feel supported, and move forward in your healing journey.

Understanding misdiagnosis in psychiatry

When people think about psychiatric misdiagnosis, it’s easy to imagine a big mistake. In reality, while misdiagnosis is possible, it’s not the norm. More often, what feels like a “wrong diagnosis” is actually one that evolves over time as new symptoms show up or your provider learns more.

1. Misdiagnosis vs. evolving diagnosis

Not every change in diagnosis means your provider was wrong. In psychiatry, some diagnoses evolve over time. This is because symptoms can shift ^[1] or become more noticeable at different points in your life.

For example:

• A teenager may first be diagnosed with an anxiety disorder but later show clear signs of attention-deficit hyperactivity disorder (ADHD) when school demands increase.

• Someone may be diagnosed with depression during a period of low mood ^[2] but later experience mania, leading to a diagnosis of bipolar disorder.

• A person may seem to have only insomnia or panic attacks. But, as their provider gathers more history, it becomes clear that these symptoms are connected to post-traumatic stress disorder (PTSD).

In each case, the earlier diagnosis wasn’t necessarily a mistake. It reflected the information available at the time. As symptoms changed or more details came forward, the diagnosis shifted to better fit the person’s experience.

This is why ongoing conversations with your provider are so important. Your mental health story can change, and your care plan should change with it.

2. Overlapping symptoms that complicate diagnosis

Some mental health conditions look very similar ^[3]. This can make them harder to tell apart. In these cases, the issue isn’t that symptoms change over time. It’s that different conditions can show up in almost the same way.

Examples of overlapping symptoms include:

• Obsessive-compulsive disorder (OCD) and generalized anxiety disorder (GAD): Both can be characterized by worry, restlessness, and poor sleep. In OCD, the worry comes with intrusive thoughts and compulsive behaviors.

• Borderline personality disorder (BPD) and bipolar disorder: Both can bring mood swings. In BPD, shifts are shorter and often triggered by relationships. In bipolar disorder, mood episodes last longer and may not have clear triggers.

• Autism spectrum disorder (ASD) and social anxiety disorder: Both can make social situations hard. In autism, challenges are often tied to communication or sensory overload. In social anxiety disorder, the struggle is fear of judgment.

• Post-traumatic stress disorder (PTSD) and panic disorder: Both can cause flashbacks, a racing heart, and fear. PTSD is linked to past trauma, while panic disorder isn’t always tied to a single event.

When symptoms overlap, it can take time to sort out what’s really going on. Follow-up visits, careful questions, and honest conversations with your provider can help make sure your treatment plan fits your needs.

3. Bias, culture, and masking

Diagnosis doesn’t happen in a vacuum. Cultural background, provider bias, and the way symptoms are expressed can all shape how someone is diagnosed.

For example, research shows that people of color are more likely to be misdiagnosed ^[4] with certain conditions, like schizophrenia. Cultural beliefs about mental health can also affect how a person describes their symptoms, which may lead to misunderstanding. Language barriers can make this even harder.

Masking adds another layer. Some people learn to hide or “mask” their symptoms to fit in or avoid stigma. This is common in people with autism and ADHD, where someone may appear calm and organized but feel exhausted inside. Masking can delay recognition of symptoms or lead to a diagnosis that misses the full picture.

A provider who listens closely, values cultural competence, and understands masking is less likely to overlook key details. This kind of care helps reduce the risk of misdiagnosis and builds trust between you and your provider.

4. Coexisting conditions

It’s not uncommon to live with more than one mental health condition at the same time. For example, someone might experience PTSD, depression, and substance use concerns. When conditions overlap, it can be hard to tell which symptoms belong to which diagnosis.

This overlap sometimes leads to misdiagnosis. For instance, depression may be treated while PTSD goes unnoticed, or anxiety symptoms may mask ADHD. In these cases, the earlier diagnosis wasn’t “wrong” — it was incomplete. Careful follow-up helps uncover the full picture so treatment addresses every condition and not just the most obvious one.

What to do if you think you’ve been misdiagnosed

It can feel unsettling if your diagnosis doesn’t seem to fit. The good news is that you don’t have to figure it out alone. 

If you think your diagnosis isn’t accurate, you can:

• Start with your current provider. Share your concerns openly, and explain what doesn’t feel right. Sometimes, a deeper conversation, more history, or updated testing can bring clarity.

• Track your symptoms. Write down when symptoms happen, how long they last, and what seems to trigger them. This record can help your provider see patterns that they may have missed at first.

• Seek a second opinion if needed. If your concerns remain after talking with your provider, it’s OK to ask for another perspective ^[2]. A second opinion may be especially helpful if your symptoms are worsening, your treatment isn’t helping, or you feel unheard.

• Look for compassionate support. The most important step is finding a provider you trust — someone who listens, explains clearly, and makes you feel understood.

Remember, seeking clarity isn’t the same as starting over. Rather, it’s taking an important step toward the care you deserve.

Clinician’s take

If you feel uncertain about a diagnosis, try to monitor how you’re feeling. Do you see any improvement? If you don’t, discuss this with your provider.

Halee Fullerton, PMHNP-BC

Clinical reviewer