Mental health challenges and substance use disorders often go together. At least half of people with substance use issues also have a co-occurring mental health issue. Diagnosing and treating these issues is critical for a strong recovery from addiction. The problem is that brains are complicated, and mental health issues are often tricky to diagnose. Many disorders share one or more prominent symptoms and having one mental health issue often increases your risk of having other mental health issues.

For example, anxiety disorders and major depression often go together. As a result, it may take some time for a mental illness to be correctly diagnosed. This can prolong the suffering caused by the illness itself and ultimately slow progress in addiction recovery. The following mental health issues are some of the most commonly misdiagnosed.


Bipolar Disorder

Bipolar disorder is perhaps the most commonly misdiagnosed mental health issue. A misdiagnosis is especially problematic for anyone recovering from a substance use disorder, because bipolar disorder massively increases your addiction risk. One study found that people with bipolar had a stunning 56 percent chance risk of developing a substance use disorder at some point in their lives.

Unfortunately, bipolar is also frequently misdiagnosed. A study by the National Depressive and Manic-Depressive Association found that 69 percent of patients with bipolar disorder were originally misdiagnosed and that a third of those people remained misdiagnosed for at least 10 years. Other studies have found similar results.

There are a few reasons bipolar is so commonly misdiagnosed. The biggest one is that depressive episodes of bipolar are indistinguishable from unipolar major depression. People with bipolar are more likely to seek help during a depressive episode and since unipolar depression is by far more common, it typically makes sense as a diagnosis. At the other end of the spectrum, people with bipolar are sometimes admitted to the hospital during extreme manic episodes, which can appear delusional or psychotic.



ADHD affects somewhere between two and five percent of American adults, but it affects between 10 and 24 percent of people seeking help for a substance use disorder. While many experts believe that ADHD has frequently been overdiagnosed in children, it is likely underdiagnosed in adults, which may make it hard to get substance use issues under control. ADHD is characterized by difficulty sitting still, concentrating on one task, and even following a single line of thought. Adults typically learn to adapt their behavior so that these symptoms are less apparent, but they may still cause psychological distress leading to substance use.

ADHD is most commonly misdiagnosed as bipolar disorder because common symptoms are similar to those of someone with bipolar having a manic episode. Those symptoms include restlessness, impatience, talkativeness, outbursts, and unstable mood. The most telling difference between ADHD and bipolar is that bipolar includes episodes of major depression.


Borderline Personality Disorder

Borderline personality disorder, or BPD, affects about 2.7 percent of adults, but about 78 percent of adults with BPD develop a substance use disorder at some point in their lives. Clearly, BPD is a major risk factor for addiction, primarily because of emotional volatility and difficulty maintaining close relationships. BPD is also frequently mistaken for bipolar disorder. The prevalence in the general population is similar and both are characterized by unstable moods.

However, BPD and bipolar are different conditions requiring different treatments. Bipolar is typically treated with a combination of mood stabilizers and antidepressants, along with therapy, while BPD is typically treated with dialectical behavioral therapy, which emphasizes distress tolerance and relationships skills. The symptoms of bipolar are typically more episodic—a period of weeks or months of major depression, then sometime later, a manic period. The volatility of BPD is more constant, and characterized by an unstable self-image.



PTSD is another major risk factor for addiction, comparable to bipolar, but more prevalent in the general population. Studies on PTSD and substance use estimate that as many as half of people with a substance use disorder also have symptoms of PTSD. PTSD is a complex condition. Symptoms include reexperiencing the trauma through nightmares or flashbacks, avoiding things related to the trauma, inability to remember key aspects of the trauma, taking a darker, more pessimistic view of the world and other people, irritability, and becoming hypervigilant and easily startled.

You can see from these symptoms that it’s a pretty mixed bag. Some symptoms look a lot like depression, while others look like an anxiety disorder—and PTSD is often misdiagnosed as such. While it may seem like an obvious diagnosis for a combat veteran or someone who has been the victim of a violent crime, PTSD can result from other traumatic events, such as the unexpected death of a loved one, a serious illness or accident, or a natural disaster. Symptoms may also appear years after the trauma, which makes it harder to connect it to the symptoms.



Since depression is so common (and since most of us think we know the symptoms of depression), it may be surprising that it is often misdiagnosed. It’s likely that the more typical problem is that patients are diagnosed with depression when they really have another condition like bipolar, PTSD, or even a medical issue. However, depression often presents with atypical symptoms, especially in men.

People usually think of depression as a sort of intense, prolonged sadness, but this is only one possible symptom. Depression commonly presents with symptoms such as irritability, aggression, poor concentration, disturbed sleep, slow movements, physical aches, reckless behavior, and substance use. Sometimes depression in men is only diagnosed after they go to the doctor complaining of headaches or chest pain.

While many people make the mistake of trying to stay sober while neglecting a mental health issue, treating the wrong mental health issue can be just as big of a problem. If you have a commonly misdiagnosed mental illness, it may be worth doing a little research to see if you really have what you think you have. Otherwise, you may be making your recovery from addiction harder than it needs to be.

At Hired Power, we know that recovery from addiction is an ongoing process. Improving your mental health is a lifelong project. We can provide support services, such as case management, that are designed to ensure all of your recovery needs are being met now and for the foreseeable future. To learn more, call us today at 800.910.9299.