Most Incorrect Self-Diagnoses in Mental Health Practice

As a mental health professional in an acute hospital setting, one of the most fascinating yet challenging experiences is encountering patients who attempt to self-diagnose and misinterpret their symptoms. Often, these self-diagnoses are far from accurate and can lead to significant misunderstandings about the patient's true condition. In this article, we will explore some of the most incorrect self-diagnoses I have encountered during my practice, with a particular focus on Bipolar Disorder and the Past Incidence of Multiple Personality Disorder (now known as Dissociative Identity Disorder).

Common Misdiagnoses and the Case of Bipolar Disorder

One of the most prevalent incorrect self-diagnoses I have encountered is Bipolar Disorder. Many individuals believe they fit the criteria for bipolar disorder due to occasional mood swings. However, the term "bipolar" can be misleading, as true bipolar disorder involves significant changes in mood and energy levels to the point of interfering with daily life and functioning. In reality, individuals often cannot remember experiencing episodes of extreme depression, which is a hallmark of bipolar disorder. Instead, they might attribute their occasional mood swings to less severe conditions such as stress or fatigue. Moreover, a history of other mental health issues, such as hard work, financial obligations, and family responsibilities, sometimes overshadows more nuanced symptoms that could indicate bipolar disorder.

The Case of Multiple Personality Disorder

Multiple Personality Disorder, which is now referred to as Dissociative Identity Disorder (DID), is another self-diagnosis that is often fabricated or misunderstood. This complex condition involves the presence of two or more distinct personality states that recurrently take control of an individual's behavior.

One of the most common—and often incorrect—self-diagnoses in this regard is linked to patients on an adult acute unit. On such units, I have frequently encountered individuals who, out of curiosity or desperation, tried to fabricate their own cases of DID. These patients often boasted about the number of alters they claimed to have, engaging in more talk about their alters than in actual "switching." It was not uncommon for these patients to present themselves as Borderline Personality Disorder (BPD) patients, which they saw as a more socially acceptable explanation for their symptoms.

However, the true cases of DID were far less extravagant. Often, these individuals were quiet and hid the fact that they had this disorder, filled with doubts about whether they really had it at all. This made them feel like they were going crazy, so they had protective alters who ensured that no revealing information slipped out. While not an easy disorder to fake, the subtle switches among alters could be detected by the staff. We observed changes in body language, eye contact, and overall attitude, which would sometimes indicate the presence of a different alter.

Implications and Diagnostic Challenges

The mistaken self-diagnoses of bipolar disorder and DID present significant challenges in mental health practice. They can lead to incorrect treatment plans, inadequate support, and avoidance of necessary interventions. Misunderstanding these conditions can also result in a lack of appropriate care, leaving patients at risk of worsening symptoms and potential harm to themselves or others.

Accurate diagnosis and understanding of these conditions require a thorough evaluation, including a detailed history, clinical interviews, and, in some cases, advanced psychological tests. Mental health professionals must be vigilant and resist the temptation to jump to conclusions based on self-reported symptoms alone.

Conclusion

Encountering incorrect self-diagnoses in the field of mental health underscores the importance of nuanced and comprehensive evaluation in clinical practice. Bipolar disorder and Multiple Personality Disorder (DID) are complex conditions that require careful assessment and understanding. By recognizing the signs and challenges of these mistaken diagnoses, mental health professionals can provide more accurate and effective care to their patients.