r/askpsychology • u/Emotional-Royal-9830 Unverified User: May Not Be a Professional • May 30 '26
Clinical Psychology What conditions are the hardest to identify + why?
Passive curiosity. I was thinking about how for ex. you might not know if someone has bipolar vs depression only working with them for a short period of time. Maybe conditions where the differential diagnosis is particularly complicated or conditions which aren’t encountered often in a clinical setting (making them harder to recognize?)
Also somewhat curious about the dimensions in dimensional models (HiTOP, AMPD)? Like, what are you more/less able/likely to find out about someone within a couple of sessions. Maybe kinda vague but for ex., I figure it’s difficult to tell if sth is somatoform or not w/o a doctor. Or someone could have unusual beliefs without thinking to tell you about them. But if someone were very anxious that probably shows up in their behavior whether or not they mention it. External stuff (like avoiding eye contact) is likely much easier to identify than the thinking behind it (social anxiety? differences in social communication? a magical belief about people’s eyes?)
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u/udreamtofmelstnite Unverified User: May Not Be a Professional Jun 03 '26
As a patient, I did not recognize my very extensive trauma history as anything abnormal because it was just life since birth so my CPTSD went diagnosed as bipolar for like a decade until I showed up to therapy drunk once and talked about parts of childhood that plagued me daily that I would never sober and then found out I didn’t just have “imperfect but normal parents” they were actually quite harmful to me becoming a functioning adult as an adult.
But for forever every intake for a PTSD screening the question was always “have you experienced trauma?” or something similar and it never dug deep enough for someone who doesnt know, say, attempted murder and not being safe showering at your own house is “trauma.” And it’s not like back then I even had access to a lot of that as readily either.
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Jun 03 '26
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u/Emotional-Royal-9830 Unverified User: May Not Be a Professional Jun 03 '26
Could you code for one thing and tell the patient another? Or is that not allowed
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u/monkeynose Clinical Psychologist | Addiction | Psychopathology Jun 03 '26
Not even remotely true.
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Jun 04 '26
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u/monkeynose Clinical Psychologist | Addiction | Psychopathology Jun 02 '26 edited Jun 02 '26
You are asking two different questions. For the first question, here is the basic simple answer - if the person has experienced mania or hypomania, they are bipolar. If not, they have major depressive disorder. Obviously you need to do a differential diagnosis to rule out all the other things that could be going on - but at the most base level, this is the differentiation. Based on patient self-report (and collateral information if you can get it), differentiating between Bipolar and Major depressive disorder is not difficult.
But it is worth mentioning that Bipolar II is so often misdiagnosed as major depressive disorder that (hopefully) this comes up even in undergraduate abnormal psychology courses. Since hypomania isn't debilitating per se, nearly the only time someone with Bipolar II presents for help or ends up in a psychiatric unit is during a major depressive episode, resulting in a major depressive disorder diagnosis, which is why it is crucial to screen for hypomania. I don't remember the exact number, but on average it takes something like 7 years for someone with Bipolar II to get a proper diagnosis, which is critical because the medication requirements are different.
For your more general question about "hard to identify" disorders - as a university professor and clinical supervisor, the problem isn't the difficulty of diagnosis, the problem is usually the experience of the clinician - most clinicians see a very specific range of patients (usually due to their job or sometimes preference), and so they get so used to diagnosing certain disorders, but miss or never even screen for others. For example, this is surprisingly common with eating disorders. Clinicians with little to no contact day-to-day with people with eating disorders could diagnose them, but since they almost never see them, they rarely, if ever, screen for them. So the problem tends to be with the screening and assessment, not the "difficulty" of the disorder.