Misdiagnosis of Autism for Mental and Personality Disorders

A recent interview with Caragh McMurtry,¹ an ex-Olympic rower from the UK, revealed that she was diagnosed with autism after living with a misdiagnosis of bipolar disorder for five years.

In the interview, McMurtry stated that the symptoms that characterise bipolar disorder did not seem to explain how she felt. The treatment she received—which included mood stabilisers and anti-psychotics—gradually caused her to gain weight and had other side effects that negatively affected her athletic performance. As she researched, McMurtry came to believe that many of her symptoms could be explained as autistic, rather than bipolar.

McMurtry was determined to be reassessed, which ultimately found that she was autistic. After five years of living with a misdiagnosis, she slowly, safely, and with medical support came off her medication and received appropriate therapy.

By accepting herself as autistic, McMurtry says, she gave herself permission to be different and stopped moulding herself to fit into other people’s expectations and experiences. As a result, she gained 17 seconds on her time and went to the top of the UK Olympic team. She went on to establish a charity recognising neurodiversity in sport.

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Why, and When, Misdiagnosis Occurs

McMurtry was an adult when she received her bipolar diagnosis and later her autism diagnosis. This is not uncommon; many autistic people who do not have an intellectual disability first seek out a diagnosis in adolescence or adulthood.²

But because autistic adolescents and adults may also experience other psychiatric issues, such as mood disorders, suicidality, and anxiety, they often come into contact with healthcare professionals because of those symptoms, as opposed to because of autism itself.³ Mental health professionals may therefore mistake autistic characteristics for those of other psychiatric disorders.⁴

There are also gender differences in terms of which misdiagnoses people are likely to receive. One small study found that out of 10 women who were misdiagnosed, the most common misdiagnosis was a personality disorder (one person was diagnosed with an anxiety disorder and one with psychotic spectrum disorder). In contrast, the majority of a group of seven men were diagnosed with ADHD, while two received a diagnosis of psychotic spectrum disorders and one received a diagnosis of behavioural issues.⁵ This and other research strongly suggest that not only is misdiagnosis a possibility but that diagnosis may be influenced by the biases and past experience of psychiatrists.

I recently worked with a client who had previously been diagnosed with major depressive disorder, prior to seeking out an autism assessment. This client certainly experienced depression at times but she did not feel that she had underlying depression.

Instead, she became depressed because she felt that things in life were harder for her than they were for other people. She tended to become angry at herself because she was frustrated and felt like a failure. The medication she received did little to help her depression because the underlying cause—the fact that she processes and experiences the world in a particular way—had not been altered or addressed.

What Should You Do If You Feel You've Been Misdiagnosed?

If you have received a previous diagnosis and feel that it does not fit with your experience, or have begun to suspect you might be autistic from your own research, it is important to progress in a safe and sensible manner. I often see clients who, based on what they've read or seen online, think they are autistic but who do not fit the criteria for autism.

For some people, their original diagnosis is correct. And even if it turns out that it isn't, you should never stop taking medication or changing a treatment plan without medical support every step of the way. However, if you have a strong suspicion that you might be autistic and have, for example, taken the AQ-50 screening test, it may be worthwhile to contact your primary care provider to discuss your concerns.

Receiving an accurate autism diagnosis makes a huge difference. It allows you to access the right type of support. It enables you to focus on accepting that your brain works in a certain way that makes some aspects of life particularly challenging. And it helps you to more clearly identify the unique skills and processing abilities that you might have as a result of being autistic.

Like McMurtry, if you have been on medication for a condition that you don’t, in fact, have, discovering you are autistic can help you avoid being medicated in a way that might be doing you little good and which may even be harmful (to reiterate: consult with your doctor before stopping any prescribed medication). Receiving a correct diagnosis of autism might help you achieve the equivalent of becoming 17 seconds faster at rowing—whatever that means for you.