In medicine and psychology, misdiagnosis is sadly a part of the profession. Whether it’s a doctor trying to diagnose a disease or a psychologist trying to diagnose a mental disorder or mental illness, there are no foolproof tests for most conditions (contrary to most people’s beliefs).

In medicine, we sometimes see physicians who intentionally misdiagnose a patient for financial gain. This is a horrible betrayal of a patient’s trust, and results in patients getting treatment they don’t need — which could even hurt their health.

Do therapists ever misdiagnose someone with a mental disorder? And if so, why?

Diagnosis — in both medicine and mental health — is not an exact science. Entire television shows have enjoyed successful runs due to this (e.g., House, MD). There is a lot of trial and error that goes with coming up with an accurate diagnosis. Most misdiagnosis is unintentional and done usually because the therapist doesn’t have all of the information about the patient’s symptoms. Or the symptoms follow a pattern indicative of two similar mental disorders.

One common type of misdiagnosis is in bipolar disorder. Because most forms of bipolar disorder includes the presence or history of one or more major depressive episodes, bipolar disorder can be misdiagnosed as major depression. Upon further examination and over time, however, most clinicians can identify and correct these kinds of misdiagnosis.

There are times, however, that therapists intentionally misdiagnose a patient. This is potentially unethical and may even be fraudulent, depending upon the exact nature of the misdiagnosis.

1. The therapist isn’t sure of the exact diagnosis.

Therapists often err on the side of underdiagnosis of a disorder if they’re not entirely certain what diagnosis is appropriate for a patient. This misdiagnosis often takes one of two forms: an adjustment disorder or the simplest, mildest form of the disorder.

An adjustment disorder will be diagnosed if it’s not clear the patient meets the criteria for a full-blown disorder diagnosis and has an identifiable stressor preceding the advent of the patient’s symptoms. In other cases, a therapist might diagnose the least severe form of a disorder (or the one with the least amount of stigma attached to it).

When a therapist is more certain of the diagnosis — through additional sessions, interviews, or assessments — they will often update the patient’s diagnosis to reflect their more in-depth understanding of the patient’s symptoms.

2. The therapist wants to get paid by insurance.

If you’re seeing a therapist that’s paid for by your health insurance plan, the therapist’s hands may be tied as to what kind of disorders they get paid to offer treatment for. For instance, many insurance companies either don’t pay for or limit treatment available for an Adjustment Disorder diagnosis.

In these cases, the therapist might use a diagnosis they likely know is incorrect so that they can get paid by the patient’s insurance company.

3. A patient asks the therapist to change their diagnosis.

You may think diagnoses are writ in stone, unchangeable once made. Nothing could be further from the truth. In reality, diagnoses can be changed as needed to accurately reflect a patient’s disorder. They can also be changed if a patient requests a change and the therapist agrees.

One reason for such a request might due to a job or something related to their career., such as a security clearance or specific job requirement. Other times it may be because they work in certain sensitive government, police, or military positions. Pilots and certain types of sensitive jobs — such as working at a nuclear power plant — also have mental health requirements.

While employers don’t ordinarily have access to your confidential mental health records, for some jobs it may be a requirement that such records are shared. In cases such as this, the therapist and patient may agree for the record to reflect a diagnosis that’s different the what the therapist may have ordinarily given.

4. The therapist is committing fraud for their own financial gains.

This is the rarest of reasons, but needs to be acknowledged since it does occasionally happen.

Unlike #2 above, in some instances a therapist might misdiagnose a patient in order to order additional testing. The therapist might get a kickback from the professional providing the additional assessment, or they may do it themselves, and also bill for that unnecessary assessment.

Some therapists may be engaging in Medicaid or Medicare fraud by diagnosing patients with a disorder they don’t have, then further bill those services for treatment the patient — unaware of their diagnosis — never receives.

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Most misdiagnosis is done inadvertently and can be the result of incomplete information. A lack of information could be due to a poorly conducted intake interview or a reticence on the part of the patient to be entirely truthful or share the whole picture when first talking with their therapist.

But in the cases outlined above, sometimes misdiagnosis is done on purpose. A misdiagnosis done on purpose is not always a clear ethical violation, but it can be. If you’re afraid that perhaps you’ve been the victim of a misdiagnosis, ask to see your formal diagnosis in your mental health record. You are entitled by law to see such records.

And if you’re still in doubt, get a second opinion. Because an accurate diagnosis is necessary and beneficial to patients, as it helps inform the treatment that is likely to be the most effective.