Dx 1
The undiagnosed – those who slip under the radar
[Dx = Diagnosis] Mental health conditions of relevance for this discussion include schizophrenia, anxiety, depression, ADD, and OCD.
Unrecognized mental health conditions occur often due to the following six reasons:
1.) Misdiagnosis
In today’s high tech society we expect diagnostic quality to be accurate. However, misdiagnosis is not uncommon in the real world. There is also the issue of over-diagnosing; for example we now see a new DSM category for ‘worrying’ which allows worry to be a diagnosable condition versus a symptom. There is also the issue of overlapping diagnosis which gives diagnosticians some flexibility in diagnosis. You often see schizophrenics diagnosed as schizo-affective when they clearly have over 6 months of psychotic history. I see several bipolar cases that have elements of bipolar but are clearly schizophrenic. Personality disorder is also commonly misdiagnosed. We often see cases of adult bipolar diagnosis without a clear history of productive overstimulation.
2.) Reluctance of practitioners to diagnose
Stigmatizing labels are often kept at bay until symptoms becomes more pronounced and chronic. Practitioners are also reluctant to diagnose severe conditions because they know that their treatments are often life-long and too often do not work or only work marginally with side effect profiles that progress insidiously with high risk for receptor decompensation. Practitioners for example are often loath to diagnose schizophrenia.
3.) Reluctance of patients to disclose symptoms
Fear, stigma and embarrassment are common reasons why people fail to disclose symptoms. We also see that the males psyche is prone to lack of disclosure issues. Women in society are more comfortable talking about emotions and tend to be more open-minded and involved in their health. Males rarely ask for help and are often reluctant to disclose deep seated emotions, thought processes or perceptual changes. Males are expected to handle things themselves and we see a greater number of males in society who commit suicide and abuse substances. Males tend also to be slightly more irritable than women and irritability and anger can be due to a ‘stuck-ed-ness’ commonly seen though not exclusively in depression.
4.) Compensating behaviours
People self-medicate with booze, street drugs and cigarettes or self-defeating behaviours. Compensatory mechanisms all have one thing in common and that is to avoid facing the reality of a situation that is perceived to be bleak or unstable. Compensatory mechanisms can be behaviors that defer for the short-term the inevitable: anger, irritability and over-controlling behaviors are not uncommon here.
5.) Lack of acknowledging symptoms in Psychosis
We all base our reality on the receipt of sensory information and the quality of sensory input influences the output of thoughts. If sensory information was distorted we would accept a new ‘reality’ unbeknownst and our thoughts would reveal a belief in mis-information (a delusion). For this reason it is almost impossible to convince a psychotic person that they are in a state of non-reality. We can point it out to them but it ends there, they ultimately refuse to believe you. As symptoms improve however, they entertain the notion that their reality is not real and start ‘reality gauging’. Early onset cases have the most trouble with reality gauging as their social development is incomplete and it takes a level of maturity to escape a path of least resistance that is ironically self-defeating and illogical.
6.) Reluctance of family to accept diagnosis
It should be noted that the family of a patient with a mood, behaviour or psychotic disorder is stigmatized and this can make it difficult to accept diagnoses. Family stigma can be a deterrent to getting the patient the help that they need.