The Reason Behind Anxiety and Depression Misdiagnosis
Neff, 2021
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Introduction
Anxiety and depression are disorders that can hide in a multitude of ways, from disguising as other conditions to staying unnoticed completely by outside perspectives. From this point onward, the former will be referred to as “camouflaging” and the latter as “masking.”
Masking
Anxiety and depression can hide through automatic high-functioning behaviors and/or conscious effort to disguise the effects.
Masking is a term most commonly used to describe disorders such as autism or attention deficit hyperactivity disorder (ADHD) but much less thoroughly studied in other areas, such as with depression. However, the term “masked depression” has existed since over 60 years ago. “High functioning” has also been used to describe those affected by disorders such as anxiety or depression but able to keep up their day-to-day responsibilities and keep up an outward appearance of being unaffected. This can lead to emotional buildup and somatic symptoms such as headaches, body pains, fatigue, sleep problems, and more (Brown, 2025).
Masking is known about things like autism or ADHD but not as thoroughly studied in areas such as depression (“smiling depression” / “masked depression”).
Camouflaging/Misdiagnoses
Anxiety and depression can “camouflage” as other disorders.
Anxiety & ADHD
For instance, anxiety shares many common symptoms with attention deficit hyperactivity disorder (ADHD).
Examples of overlap between symptoms of ADHD and anxiety:
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Sleep issues
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Fatigue
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Difficulties concentrating
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Intrusive thoughts
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Impacted working memory
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Restlessness
This is made even more difficult by the high comorbidity rates between ADHD and anxiety; up to half of those who experience ADHD also have some form of anxiety. Additionally, ADHD can cause specialized anxiety relating to the disorder itself, which has its own complications.
Unlike anxiety disorders, however, ADHD is centered around attention regulation and hyperactivity. In contrast, anxiety disorders focus around excessive and disproportionate worry that interfere with everyday life (Neff, 2021).
Depression & Bipolar Disorder
Depression misdiagnosis can occur in particular with those experiencing other mood disorders—more specifically, bipolar disorder (BD). BD is characterized by a cycle of high and low mood—mania or hypomania and depression. These periods of depression share many similarities in presentation with major depressive disorder (MDD), leading to misdiagnoses in which BD is incorrectly diagnosed as MDD. As Mooney (2022) writes, “Nearly 70% of bipolar patients are initially misdiagnosed, and a third or more still haven’t gotten an appropriate diagnosis a decade later.”
Overall
There are several consequences that arise from these misdiagnoses, and the implications of anxiety and depression misdiagnosis range from obvious to inconspicuous. Inappropriate treatment will lead to the symptoms not being alleviated, which will in turn lead to a natural distrust in the medical system, especially since a significant amount of time and money will need to be sunk into doctor visits and medications, inadequate and useless as they may be. In the meantime, the patient will be at increasing risk of their symptoms becoming more severe.
An additional consequence of improper diagnosis can often mean the prescription of medication that does not treat the correct issue, which can exacerbate the problem in the first place. For instance, Adderall (dextroamphetamine-amphetamine), an ADHD medication, can worsen anxiety symptoms because it is a stimulant that boosts the systems that trigger stress and the fight-or-flight response. “Crashes” after Adderall wears off can also occur, meaning that though the person taking the medication may feel little to no negative effect before the medication wears off, there may be rebound effects afterward that worsen anxiety and increase irritability (Patel, 2025).
Conclusion
Through both camouflaging and masking of anxiety and depression, whether conscious or not, can lead to physical symptoms or mental fatigue as well as misdiagnosis and incorrect prescriptions. This is why the effects of these behaviors should be kept in mind during treatment of anxiety, depression, and related disorders.
Brown, S. (2025). Camouflaging depression. Discover Mental Health, 5(1).
https://doi.org/10.1007/s44192-025-00200-x
Mooney, B. (2022, May 29). Bipolar Disorder Often Misdiagnosed as Major Depression,
Leading to Improper Treatment - U.S. Medicine. U.S. Medicine.
Neff, M. A. (2021, December 6). ADHD vs. Anxiety: Understanding the Overlap and Co-Occurrence. Neurodivergent Insights. https://neurodivergentinsights.com/adhdvsanxiety/?srsltid=AfmBOoowheCRHY7RXu1Xl9zFkn8GAMLm1k03Ze3JagULlE07PJpk8ikJ
Patel, P. (2025, April 15). Does Adderall help with anxiety or make it worse? TMS Institute of Arizona.
https://tmsinstitute.co/does-adderall-help-with-anxiety-or-make-it-worse/
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