E2 ModerateModerate confidencePEM not requiredCross-SectionalPeer-reviewedReviewed
Standard · 3 min
Perceived misdiagnosis of psychiatric conditions in autistic adults.
Kentrou, Vasiliki, Livingston, Lucy A, Grove, Rachel et al. · EClinicalMedicine · 2024 · DOI
Quick Summary
This study found that many autistic adults, especially women, were given different psychiatric diagnoses (like depression, anxiety, or personality disorders) before being correctly diagnosed with autism. About 1 in 4 autistic adults and 1 in 3 autistic women reported receiving at least one psychiatric diagnosis that they felt was wrong. This delayed their access to proper autism support and treatment.
Why It Matters
While this study focuses on autism, its findings about diagnostic confusion and the overlap between autism and psychiatric conditions are relevant to ME/CFS patients, who similarly experience delayed diagnosis and psychiatric misattribution of symptoms. Both conditions involve complex symptom presentations that mental health practitioners may not recognize, leading to inappropriate treatment and prolonged diagnostic pathways. Understanding how diagnostic confusion occurs in similar neurodevelopmental and neurological conditions can inform better practitioner training and earlier, more accurate recognition of ME/CFS.
Observed Findings
24.6% (n=298) of 1,211 autistic adults reported at least one prior psychiatric diagnosis perceived as misdiagnosis
31.7% of autistic women versus 16.7% of autistic men reported perceived psychiatric misdiagnoses
Personality disorders were the most frequently reported perceived misdiagnosis, followed by anxiety disorders, mood disorders, and chronic fatigue syndrome/burnout-related disorders
Women reported prior psychiatric diagnoses more often overall (65.8% vs. 34.2% in men)
Within the subgroup of individuals with prior psychiatric diagnoses, perceived misdiagnosis rates were equally likely for men and women
Inferred Conclusions
Autistic women are at significantly higher risk of receiving psychiatric misdiagnoses, particularly for personality, anxiety, and mood disorders, before autism recognition
Improved training for mental health practitioners regarding autism presentation in adulthood and the complex relationship between autism and co-occurring conditions is needed to reduce misdiagnosis
Inaccurate psychiatric diagnoses contribute to prolonged diagnostic pathways and delayed access to appropriate autism-specific support
Remaining Questions
What is the true frequency of documented misdiagnoses (not just perceived misdiagnoses) in autistic adults across different healthcare systems?
What This Study Does Not Prove
This study does not establish whether perceived misdiagnoses were objectively incorrect; it relies on patients' perceptions rather than review of medical records or diagnostic criteria validation. The cross-sectional design cannot determine causality or establish whether autistic traits truly caused the misdiagnosis or whether other factors contributed. Results may not generalize to less-educated, non-Dutch populations or autistic individuals not engaged in research programs.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
Contribute
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Does earlier recognition of autism in women reduce unnecessary psychiatric treatment and improve outcomes?
How do autistic presentations of psychiatric conditions differ from primary psychiatric conditions, and what training modules could best teach clinicians to distinguish them?
Are similar diagnostic confusion patterns and gender disparities present in other neurodevelopmental or neurological conditions like ME/CFS?