5 Mental Health Issues That Are Frequently Misdiagnosed

Most people with substance use disorders have one or more co-occurring mental health issues. Typically, the mental health issue comes first and drives addictive behavior, but drugs and alcohol also make mental health issues worse. Accurately diagnosing and effectively treating any co-occurring mental health issues is one of the most important parts of a strong recovery from addiction. Unfortunately, neither diagnosis nor treatment is as straightforward as one would hope. Mental health issues often come in clusters; symptoms overlap and present differently in different people. The following mental health issues are some that are both common in people with substance use disorders and are frequently misdiagnosed.

1.) Bipolar Disorder

Bipolar disorder may be the most commonly misdiagnosed mental health issue. Furthermore, treating bipolar incorrectly may have the most adverse effects. A number of studies have looked at the misdiagnosis of bipolar. One study found that 69% of people with bipolar disorder were initially misdiagnosed and about a third of those remained misdiagnosed for at least 10 years. 

Bipolar disorder is most frequently misdiagnosed as unipolar major depression--commonly known as depression. This is because the symptoms of a bipolar depressive episode--depressed mood, inability to feel pleasure, sleep disturbances, irritability, fatigue, sudden weight changes, poor concentration and memory, aches, slow movements, and thoughts of suicide or death--are indistinguishable from unipolar major depression. What’s more, when people seek help for bipolar symptoms, they typically seek help for depressive symptoms and they may neglect to mention manic symptoms, especially if they’re relatively mild. Depression is also more than twice as common as bipolar disorder, so it’s often a reasonable diagnosis.

As a result, people with bipolar are often prescribed antidepressants such as SSRIs, which help with depressive symptoms but may trigger manic symptoms. If you experience manic episodes, such as high energy, little need for sleep, delusions of grandeur or paranoia, hyper-productivity, or starting lots of new projects that you never finish, it’s important to mention those to your doctor or therapist when seeking help for depression.

2.) Borderline Personality Disorder

Borderline personality disorder, or BPD, massively increases your risk for developing a substance use disorder at some point in your life. Although it affects only about 2.7% of adults, about 78% of people with BPD will develop a substance use disorder. BPD is typically characterized by emotional volatility, sudden changes in self-identity, relationship problems, mood swings, suicidal thoughts or behavior, feelings of emptiness, and impulsiveness. 

Because these symptoms seem to be a mix of both depressive and manic symptoms, BPD can easily be mistaken for bipolar disorder. Although bipolar is also characterized by unstable moods, the changes tend to happen over longer periods, typically weeks or months. Bipolar is currently treated with some combination of therapy, antidepressants, and mood stabilizers, whereas BPD is treated with an intensive form of therapy called dialectical behavioral therapy, or DBT.

3.) PTSD

PTSD requires four kinds of symptoms for clinical diagnosis: re-experiencing symptoms such as nightmares or flashbacks, avoidance symptoms such as avoiding driving after an accident, changes in behavior such as becoming short-tempered or easily startled, and changes in cognition, such as becoming pessimistic or emotionally numb. There can be quite a bit of variation in the way these symptoms manifest and some kinds of symptoms may be far more prominent than others. It would be quite easy, for example, to mistake the behavioral and cognitive changes for symptoms of major depression.

While treating PTSD the way you would treat depression might help--some of the methods, such as cognitive behavioral therapy, or CBT, and antidepressant medications often help with both--PTSD is a more complicated issue and typically requires reprocessing the trauma for recovery. Considering that as many as 50% of people seeking help for a substance use disorder have symptoms of PTSD, it’s crucial to get this diagnosis and treatment correct. As with bipolar disorder, it’s important to tell your doctor or therapist about any trauma you may have experienced as well as avoidance or re-experiencing symptoms related to that trauma.

4.) ADHD

ADHD is a strange case because experts seem to agree that it is over-diagnosed in children but under-diagnosed in adults. If you happen to slip through the net of ADHD diagnosis as a child, it could be causing you problems as an adult. Typically, as we age, the symptoms of ADHD become less apparent. People learn to control their fidgeting and impulsive behavior to some degree so it’s not obvious they have ADHD but the cognitive symptoms, such as racing thoughts persist. Somewhere between 10 and 24% of people seeking help for a substance use disorder have ADHD, compared to less than 5% of American adults overall. 

ADHD isn’t usually mistaken for something else--it’s typically not recognized at all--but occasionally, the symptoms are mistaken for manic symptoms of bipolar disorder. This misdiagnosis might be confirmed if the person happened to have a depressive episode in the past, which is not terribly uncommon. The good news is that controlling ADHD with appropriate medication makes it much easier to stay sober.

5.) Depression

Like ADHD, depression typically isn’t misidentified as something else but rather isn’t recognized at all. While most of us are familiar with some of the symptoms of depression like depressed mood, lack of motivation, fatigue, excessive sleep, and thoughts of suicide, other common symptoms such as irritability, aggressiveness, reckless behavior, substance use, physical pain, and poor concentration are less often recognized. If these are your primary symptoms, you probably wouldn’t think to seek help for depression or any mental health issue and your loved ones might not recognize it either. This is especially true of men, who are both less likely to recognize depressive symptoms and less likely to seek help than women. 

It’s crucial to recognize that addiction isn’t only about substances. Most of the time, people with substance use issues have at least one mental health issue to go with it. Drugs and alcohol are often coping mechanisms. If you want to have a lasting recovery from addiction, then it’s vital to identify and treat the underlying causes, especially when those causes include a serious mental health issue. While we expect mental health professionals to diagnose and treat us correctly, it’s important to understand how murky the realm of mental health can be. Your doctor or therapist only knows what you’re willing to share with them. It’s important to be open about all of your symptoms so they can better help you. 

At Foundry, we know that addiction is complex, which is why we approach treatment from many angles, including DBT, 12-Step facilitation, family therapy, lifestyle changes, and more. We know that mental and physical health form the foundation of a strong recovery from addiction. To learn more, call us at (844) 955-1066.

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