mental health week 2025: why diagnosing mental health disorders is such a challenge
6 minute read
feeling negatively about yourself when dealing with a mental health disorder—also know as self-stigma—is another roadblock when it comes to reporting symptoms because it mars a person's view of their experience.
getty images
stay up to date on this topic
diagnosing mental health disorders is not always easy. unlike physical disorders, there are no tests, scans, or markers to indicate illness, and physicians and mental health specialists rely heavily on self-reported symptoms and the diagnostic and statistical manual of mental disorders (dsm-5). the dsm-5 holds the keys to diagnoses, with descriptions, common symptoms, and other criteria that give clinicians the knowledge needed to accurately diagnose patients.
unfortunately, even with the lengthy manual and people reaching out for help for their afflictions, patients often deal with misdiagnosis. in primary care, especially, a person is more likely to be misdiagnosed than get the answers they’re looking for.
for example, in canada, the rates for misdiagnosis in major depressive disorder (mdd) and anxiety disorders are roughly 65.9 per cent. anxiety-related illnesses, including panic disorder, generalized anxiety disorder, and social anxiety disorder, saw misdiagnosis rates at 85.8 per cent, 71 per cent, and 97.8 per cent, respectively. bipolar disorder is also a largely misdiagnosed condition in primary care and has a 92.7 per cent misdiagnosis rate.
dr. alexandra gold, a licensed clinical psychologist at massachusetts general hospital, works in the dutton family centre, mainly focusing on treatment innovation for bipolar disorder. she notes that “there’s so many” challenges in diagnosing mental health conditions that when the limitations work together, those high misdiagnosis rates are not hard to believe.
challenges with the dsm-5
the dsm-5 is in-depth and often revised as new information about mental health conditions comes to light, but that doesn’t mean it’s always on point. while it has symptoms, definitions and other information, it doesn’t make any distinctions in the way people experience mental health issues uniquely or account for various factors that play into the symptoms people may develop across conditions.
advertisement
“sometimes symptoms can cut across different diagnoses and they don’t always fit in a quote textbook way, so the way it’s written can be very specific and sometimes symptoms can be a little bit more nebulous and not exactly as clear cut as they are written in the manual or in a framework,” said dr. gold.
she notes that this specific challenge affects those who don’t have familiarity with all the conditions that could affect patients living with mental health disorders because without all the information, “you might not pick up on the subtle differences.”
for example, adhd is often underdiagnosed in females because the symptoms are not as textbook as they are in males. the dsm-5 doesn’t take those differences into account, and if someone isn’t specialized in adhd, a diagnosis could be missed quite easily.
dr. gold notes that the dsm also doesn’t consider “all the possible cultures and cultural manifestations of mental health conditions.”
“it’s an ongoing conversation. how do we integrate these cultural pieces?” she said. “that’s something that the dsm has actively started to do more, because someone might have depression and it might show up differently in one culture versus another and if our assessment tools only ask about how that depression might manifest in culture a and not culture b, then we might be missing those people.”
the dsm-5 also lacks the physical symptom piece that can often arise in people living with mental health disorders.
“(in) certain populations, their mental health symptoms might manifest more as physical ailments. like, i have a headache or stomach pain, for example. and so it might not present the same way that our tools are in now, and you might miss mental health symptoms,” said dr. gold, later continuing, “this is where i feel there’s still room for improvement.”
advertisement
a lack of time and access to care
the clinical load undertaken by doctors and other providers in the country is exceptionally high. a proper assessment can take up to two hours to complete, and dr. gold notes that “people who are in primary care settings or in really high clinical load community mental health centres” simply don’t have the time to give someone an in-depth assessment.
“if you don’t have the time to do a full assessment, and let’s say you’re only assessing three out of the many possible mental health conditions, you haven’t ruled out the other ones necessarily if you didn’t assess everything right,” she said. “time for assessment is so important.”
another issue with time is how long it can take for a person to get in to see a doctor in the country.
according to the canadian medical association, finding a primary care physician who can take on new patients can take months or even years if the patient doesn’t already have one. for those who already have one, booking an appointment with them can take days, weeks, or even a month or more, depending on their patient load.
while this step is an essential and integral one in getting a proper diagnosis for a mental health condition, it isn’t where people typically end up with their answers. they are often referred to specialists for more in-depth assessments of their symptoms and experiences.
according to a report conducted by the fraser institute, waiting to see a psychiatrist in canada can take a minimum of four months from the time of referral, with some adults waiting more than a year. in children and youth under 18, that number nearly doubles to an average of two and a half years to obtain psychiatric services, according to a report by children’s mental health ontario.
of course, these numbers may vary province to province, but they do paint a clear picture as to how a lack of time to see patients poses a significant challenge in diagnosing mental health conditions.
advertisement
self-reported symptoms, stigma and social media
since people living with mental health conditions are relied upon heavily when it comes to diagnosis, that too can pose an issue when looking for accurate and timely diagnostics. to diagnose mental health conditions, people must explain how they’re feeling and how those symptoms are affecting them.
but sometimes, insight and awareness aren’t always clear-cut in people with certain mental health disorders.
“one of the conditions … bipolar 2, as an example, sometimes there’s a lack of insight that’s actually one of the symptoms of a manic episode,” said dr. gold.
she notes that, because of a lack of insight in this case, those people living with bipolar 2 will not always be able to accurately report on their symptoms because they themselves are not aware of some of them as they’re happening.
“so, we’re relying on what people are telling us. that’s why i think it’s really helpful to have an informant, like a family member who the patient agrees to have involved or a friend in the diagnostic assessment, because people either are not able to or feel negatively about themselves in terms of reporting on their symptoms.”
feeling negatively about yourself when dealing with a mental health disorder—also know as self-stigma—is another roadblock when it comes to reporting symptoms because it mars a person’s view of their experience.
they may not accurately describe what they’re going through or invalidate what they’re going through by minimizing the impact the symptoms have on their lives. they may also use external factors to mask their symptoms, such as describing symptoms of depression but saying that it’s likely due to being stressed at work.
these self-invalidations can make it more difficult for clinicians to truly understand the scope of the symptoms and identify the mental health issue.
advertisement
the uptick in social media awareness and discussion of mental health disorders can help reduce stigma. still, according to dr. gold, that can be a “double-edged sword” because while online self-assessments can be helpful, they are being done in the “absence of a professional being present and doing a personalized assessment.”
“we want people to get personalized care, and just because someone has symptoms and those symptoms for them were autism, that doesn’t mean that those same symptoms are the same diagnosis in someone else.”
getting help regardless of the challenges
while the challenges in place make it more difficult for people to get accurate and timely diagnoses for mental health conditions, dr. gold wants people to know that there is help and that these conditions are treatable.
“sometimes it can feel hopeless for people, and i want people to have hope and know that their symptoms are treatable,” she said. “it’s just getting the right assessments.”
“that’s where it’s helpful to talk with their gp,” she said. “talk to them and ask them, ‘would this be helpful? here’s what i’m experiencing. i’m wondering if you think this would be helpful to get a comprehensive psych eval,’ and the gp can help them with that.”
share story
