Perceived misdiagnosis of psychiatric conditions in autistic adults 2024 Kentrou et al

Summary

Background
Many autistic people, particularly women, do not receive an autism diagnosis until adulthood, delaying their access to timely support and clinical care. One possible explanation is that autistic traits may initially be misinterpreted as symptoms of other psychiatric conditions, leading some individuals to experience misdiagnosis of other psychiatric conditions prior to their autism diagnosis. However, little is currently known about the frequency and nature of psychiatric misdiagnoses in autistic adults.

Methods
Using data collected in the first half of 2019 from an ongoing longitudinal register of autistic adults in the Netherlands, this study explored the frequency of perceived psychiatric misdiagnoses before receiving an autism diagnosis. Gender differences were also explored. A sample of 1211 autistic adults (52.6% women, mean age 42.3 years), the majority of whom were Dutch and relatively highly educated, was evaluated.

Findings
Results showed that 24.6% (n = 298) of participants reported at least one previous psychiatric diagnosis that was perceived as a misdiagnosis. Personality disorders were the most frequent perceived misdiagnoses, followed by anxiety disorders, mood disorders, chronic fatigue syndrome/burnout-related disorders, and attention-deficit/hyperactivity disorder. Autistic women (31.7%) reported perceived misdiagnoses more frequently than men (16.7%). Women were specifically more likely than men to report perceived misdiagnoses of personality disorders, anxiety disorders, and mood disorders. Women also reported prior psychiatric diagnoses more often in general (65.8% versus 34.2% in men). Within the group of individuals with a prior diagnosis, perceived misdiagnoses were equally likely for men and women.

Interpretation
One in four autistic adults, and one in three autistic women, reported at least one psychiatric diagnosis, obtained prior to being diagnosed with autism, that was perceived as a misdiagnosis. Inaccurate diagnoses are linked to long diagnostic pathways and delayed recognition of autism. These findings highlight the need for improved training of mental health practitioners, in order to improve their awareness of the presentation of autism in adulthood and of the complex relationship between autism and co-occurring conditions. The current study constitutes a first step towards showing that autistic adults, and particularly women, may be at greater risk of experiencing misdiagnoses. Future studies based on larger, more representative samples are required, to replicate current findings and provide more reliable estimates of the overall frequency of misdiagnoses as well as the frequency of misdiagnoses for specific psychiatric conditions.

Open access, https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00165-2/fulltext

 

"Perceived misdiagnoses

When entering the register, participants were asked if they had received any additional psychiatric diagnoses in the past, before receiving a diagnosis of autism (“Have you received any other (psychiatric) diagnose(s) in the past before receiving your diagnosis within the autism spectrum?”). This was followed by the question “Which earlier diagnosis (diagnoses) have you received, other than autism spectrum disorder?” A drop-down list of conditions was presented, including attention deficit/hyperactivity disorder (ADHD/ADD), mood disorders (including major depressive disorder, dysthymia, and bipolar disorder), anxiety disorders (including specific phobia, generalised anxiety disorder, and obsessive-compulsive disorder), personality disorders, post-traumatic stress disorder (PTSD) or other trauma-related disorders, chronic fatigue syndrome (CFS) or burnout-related disorders, and fibromyalgia."

 

Misdiagnosing autism as CFS has that "finding an octopus inside a computer because someone misinterpreted the problem and this was judged to be the appropriate solution to that problem" feel to it.

It legitimately raises concerns over the validity of psychiatry. Not of psychiatric diagnoses or the process itself but of the discipline as a valid thing. It's a necessary thing, for sure, but it doesn't appear to be much better than old divination, or maybe a thousand monkeys with typewrites. You can pretty much read old "causes of death" records and it's as if not much had changed in there.

 

They are linked to not requiring that the psychiatric profession understand autism properly - just like health conditions if a patient has one - they should be capable of understanding what is explained by these in calibrating any assessments if there were potential comorbidities and knowing what is a normal reaction to an inappropriate situation

thd thing is the profession doesn’t require thud in its diagnoses so whilst you apparently get some very good psychiatrists who do there are lots who almost see it as purist tgat if distress hits a certain level it doesn’t mattercegsf it was provoked by and repeat that for other things.

we can categorise clinically under different terms all we want but the majority of these diagnoses also seem to be under what youd call ‘behavioural’

which is a particular problem child of the area gif being lowest common denominator and other issues

it’s not a psychiatric diagnosis but given many outside he profession learn to understand these things for their jobs in order that they are appropriate and can refer on as relevant I really don’t get the excuse