How can Video / PC Games help address misdiagnosed Mental Health Issues?

How Common are Misdiagnosis in Mental Health?

When visiting medical professionals for treatment, we trust that they will make the right diagnosis. Getting the right diagnosis is always the first step towards recovery. Therefore, when the opposite happens and an individual suffers a misdiagnosed mental illness, or the medical professional fails to identify the disorder, it inevitably leads to severe complications for mental health sufferers and unfortunately occurs more frequently than anyone should be comfortable with in the medical field.

One study, published in February 2021 in the Annals of General Psychiatry, suggests that more than a third of patients with a severe psychiatric disorder have been misdiagnosed. The study included 309 patients in an outpatient clinic of a specialized psychiatric hospital in Ethiopia.

In this sample of patients, researchers found that schizoaffective disorder was the most misdiagnosed condition (75 percent of cases), followed by major depressive disorder (54.72 percent), schizophrenia (23.71 percent), and bipolar disorder (17.78 percent).

The study also showed that patients with bipolar disorder were 60 percent more likely to be misdiagnosed as having schizophrenia. And those with schizophrenia were found to be 56.25 percent more likely to be misdiagnosed with bipolar disorder. Of course, incorrect diagnosis means inaccurate medications being prescribed and taken, unnecessary side effects suffered from medications consumed, and avoidable delays in getting much needed help for the proper mental health issue.

Another such survey had equally dismal results. Of 706 people surveyed, only 15% received a prompt diagnosis, while 85% experienced diagnostic delay. Most of those were wrongly told they had depression. Among the 85% whose diagnosis was delayed, 71% said that their symptoms had become worse as a result of receiving inappropriate treatment, such as antidepressants or sleeping pills. A delay of this length has a significant impact for individuals and families, with sometimes devastating consequences, as bipolar has the highest rate of suicide of any psychiatric illness.

How do Misdiagnoses occur in Mental Health?

Unreported Symptoms : From adolescence to adulthood, people feel tremendous pressure to fit in and act as though everything is fine. They may worry about the social stigma attached to a mental health diagnosis. This pairs with a desire to act independently (for teens) rather than rely on their parents. As a result, teens are often reluctant to talk about psychological symptoms with their parents, or even their doctors. And adults are equally reluctant to speak to therapists or medical professionals until a level of certainty about their mental health issue is known.

Overlapping Conditions : Parents and even doctors may be satisfied that they have found the answer once a diagnosis is made. However, if someone is suffering from more than one physical or mental health condition at the same time with overlapping symptoms, treating one condition will not fix the other. This under-diagnosis can make it hard for people to understand why some of their symptoms are improving while others are not.

Undisclosed Trauma : When a patient has endured a traumatic event, it can manifest in a variety of symptoms that resemble other mental health issues. There are many reasons why a teenager or an adult may not tell anyone about their trauma. However, this secrecy can often result in misdiagnosis and slow their path to recovery.

Bottom Line: The more transparency in disclosing as accurately as possible what you feel, how long you have been feeling it, and what you think the causes might be, help tremendously in receiving the right diagnosis the first time around.

Impacts of Misdiagnosed Mental Health Issues

Confusion: A misdiagnosed mental illness is confusing for patients. Very few people know enough about mental illness to spot incongruence between their symptoms and their diagnosis, and fewer still would question the judgment of their clinician. A misdiagnosis will result in the patient becoming confused and potentially distraught when the course of treatment recommended isn’t working. They may feel it’s a personal failing, and even develop feelings of guilt or shame when they don’t make progress under the diagnosis. It can result in a breakdown in communication between the patient and provider, and is even more damaging in children who cannot communicate their symptoms effectively in the first place.

Incorrect Medication: Being prescribed a medication for a condition you don’t have can be dangerous. If, for example, a child who has simple anxiety gets diagnosed with ADHD, they will likely receive a prescription for a medication like Adderall. In people without ADHD, these prescription stimulant medications can cause impairments in working memory performance and other areas of cognition. Receiving the wrong medication can also lead to a person experiencing all the side effects of the medication without any of the benefits, causing undue distress and anxiety while leaving the root problem untouched.

Worsening Condition: If a mental health condition gets misdiagnosed or goes undiagnosed, the patient is likely to keep getting worse. Many medications prescribed for mental illness take several months to reach therapeutic levels in the patient’s system. Therefore, even people with a correct diagnosis often have to wait a while before seeing the benefits of their treatment. But when the diagnosis is incorrect to begin with, a doctor or therapist may tell a patient to “wait and see” while they are getting worse.

Most Commonly Mis-or-Underdiagnosed Mental Health Issues

1. Depression may be one of the most common mental health conditions, affecting an estimated 264 million people worldwide, but experts still warn it is under-recognized and under-treated. WHO states that up to 85% of people in middle- and low-income countries do not get treatment for depression. One challenge is that depression can vary widely from person to person. It can be mild, severe or anything in between. It can be triggered by sneaky, unexpected sources, from where you live to what you eat, so people aren’t always on the lookout for it in their own lives.

2. Bipolar Disorder is one of the most frequently misdiagnosed, as up to 20% of people with bipolar disorder may be mistakenly diagnosed with depression by their primary care doctors. Some bipolar disorder symptoms are similar to those of other illnesses, which can make it challenging for a health care provider to make a diagnosis. In addition, bipolar disorder is often associated with another mental disorders, such as anxiety, substance use disorder, or eating disorders.

3. PTSD: Experts have called post-traumatic stress disorder, or PTSD, the “missed diagnosis.” Roughly 70% of Americans will experience a traumatic event in their lifetime, and about 20% will go on to develop PTSD, which is an intense physical and emotional response to thoughts and reminders of a traumatic event. One reason PTSD sometimes flies under the radar is because it’s so strongly associated with people who serve in the military, but are by no means the only ones. In reality, the mental health condition can occur following any distressing event. This includes natural disasters, serious road accidents, terrorist attacks, sexual assault and mass shootings. It can also affect people of any age, from children to adults.

4. Eating Disorders: People often think of eating disorders as exclusively affecting thin, white, teenage girls. But that means the affliction often gets missed in groups like men and older people. Stereotypes about who develops eating disorders could contribute to disparities in diagnosis and treatment, with males, those of higher weight, people of color, and the non-affluent most likely to be slipping through the cracks.

5. Borderline Personality Disorder: Borderline personality disorder (BPD) is a serious mental health condition characterized by ongoing patterns of varying moods, self-image and behavior that causes significant difficulties in day-to-day functioning. And it also gets missed pretty frequently, though how often is unclear. One reason for that is the symptoms of BPD often look like something else, including depression, anxiety or even bipolar disorder. Another is stigma, which is an issue for people with borderline personality disorder and so many other types of mental health issues as well. Many people still have negative perceptions of mental health conditions and disorders which affects the number who seek treatment. Those struggling either don’t want to believe they have an issue, or do not want others to know they do.

What to do when you believe you have been misdiagnosed

If diagnosed with a mental illness, and the medication or method of therapy prescribed has failed to alleviate symptoms, the first thing to do is get a second opinion. Mental health misdiagnosis happens, so you must begin treatment with a thorough psychological assessment by a skilled provider, who will hopefully be able to better identify the condition or disorder, and offer a more effective treatment plan. Be honest, be openminded and be vulnerable. The more you are willing to disclose, the more your therapist, doctor or medical professional can help.

Making family and friends a part of the diagnostic process can help as well. Where possible, have those who are close to you speak with the specialist, so that they can bring up any observations regarding your emotions and pattern of behavior. This can help in covering the entire breadth of symptoms, in addition to providing another perspective on your mental health issues and how they are perceived to others.

To curtail the high rate of misdiagnosis in Mental Health, can Video/PC Games play a role in helping to accurately diagnose?

Almost all studies agree, including the one that @confidconvos previously published, that gaming in moderation, in addition to adequate sleep, healthy eating and exercise can be incredibly healthy to one's overall wellbeing. But @confidconvos expects games to do more. Specifically, can playing games help you assess what mental health issue you might have, rather than just offer a form of escapism?

It is clear from the research that professionals get it wrong about as often as they get it right, which means increased risk to mental health sufferers that need tailored support for their mental health. So, can games help to fill that need?

Yes, but with a few caveats:

We need to agree what it means to accurately portray an avatar with a mental health issue. According to @KelliNDunlap:

• One-Dimensional portrayals acknowledge that mental illness is something that exists in the world, but only through passing references. Another type of One-Dimensional representation are the “illness in name” characters whose names presuppose the presence of a mental illness. This includes the Psychos from Borderlands (Gearbox Software, 2009), just as an example. Naming these characters does nothing in terms of story or character development—other than signal to the player that there is something odd about the character or situation.

• Two-Dimensional representations often provoke commonly held views or beliefs about what mental illness is, what it does, and what it looks like. For example, have you ever played a game in which your character woke up in a psychiatric hospital and something good happened? Probably not. The stereotype of a psychiatric hospital as a terrifying place where terrible things happen is so pervasive that it serves as a convenient, easy way to tell players to be afraid and to expect trouble. It is critical that these kinds of neutral representations be included in assessments of mental illness representation; otherwise, researchers may overestimate the percentage of portrayals that are over the top or that propagate negative stereotypes. These representations also serve as a model for game developers on creating characters with mental illness symptoms in a neutral or non-stigmatizing way.

• Three-Dimensional representations do not need to be true to life in terms of narrative or design, but they do reflect authentic experiences. For example, Neverending Nightmares (Ifinitap Games, 2014) is a 2.5D psychological horror game with cartoon graphics with an almost entirely black-and-white color palette. Matt Gilgenbach, the game’s creator, (@InfinitapGames) has been very open about his experience coping with major depressive disorder and obsessive-compulsive disorder and how he integrated those experiences into gameplay. @NightInTheWoods (Finji, 2017) is another example of how a game with a cartoon aesthetic can portray and convey the experience of mental illness in a way that respects the complexity of mental health and the everyday experiences of those who cope with mental illness. This was the first game @confidconvos played that offered an authentic experience when it comes to accurate portrayal of mental health issues, in addition to an enjoyable immersive experience overall. It is listed as one of our recommended games, so do check it out.

Bottom line: An accurate portrayal of mental health issues utilizing some two-dimensional or three-dimensional characters can be a useful tool in assessing mental health issues of the user, severity of the issues, and lessons learned from the avatar on how to address it, to-dos, and not-to-dos. But as a stand-alone, the data is currently insufficient for video games to be able to perform accurate diagnosis on their own.

Video and PC games can help tremendously in assessing existing mental health issues and allowing users to experience their mental health on their own terms, without judgment, invasion or harm. And it does not stop there. Perhaps the ability for video games to actually diagnose misdiagnosed issues like anxiety, depression and bipolar is around the corner.

Meet @rasha_alqahtani, an 18 year old prodigy that is developing a video game to assess and diagnose anxiety among youth in Saudi Arabia. “I tried to heal myself, by myself, almost all of the time,” she says. “In Saudi Arabia, we are starting now to connect the dots and to raise awareness about mental health. Going to a psychologist does still have a negative effect on a person in society."

Fortunately, for people with clinical anxiety, standard treatments like cognitive behavioral therapy and medication have been demonstrated scientifically, to make a difference in their lives. However, less than half of youths [experiencing various mental health disorders] will access these treatments, due to lack of available resources and costly barriers to entry, such as therapy. Alqahtani herself reported wanting to see a therapist, but after doing the math, was completely out of budget for her.

Video games offer a different and fun perspective. It's a non-threatening space, because games are inherently a play space. Roughly nine out of ten American teens play video games, and “Minecraft” in particular is incredibly popular. When asked personal questions or confronted with a scenario in a game, it may frame these questions that are often very clinical and very cold in a way that is more relatable and maybe even more understandable to someone in that age group.

And it does not stop there. The FDA has greenlit two new tools for mental health, one of which is a game to help treat ADHD. So, the trend is clearly demonstrating that games of the future will be more than just pure escapism, but rather serve as a barometer for our mental health, with indicators of stress/anxiety levels of the avatar (and possibly the user), reminders to breathe or remain mindful while playing, and timers to help gamers switch off and switch back to reality.

Given the proliferation of games that offer a tailored experience and intelligent approach toward different facets of mental health, such as addressing stigma, symptoms, and potential coping solutions, we @ConfidConvos are optimistic that video games can and will offer a fully immersive and meaningful experience to those suffering from painful mental health issues. We will continue to watch this space very closely as we build a library of PC and video games tailored to specific mental health issues to complement the anonymous peer led support group service currently offered within our app. These games and more will be included in our upcoming digital media library, which will be released in the next iteration of the Confidential Conversations App on iOS and GooglePlay.