Why Brief Screeners Miss Bipolar, ADHD, and OCD

And what it means for the patients behind the paperwork.

We all want to catch what matters. That’s the goal of screening tools: fast, structured ways to flag potential concerns and start the diagnostic conversation. But for some conditions, especially Bipolar Disorder, ADHD, and OCD, those conversations don’t always get started.

Not because patients aren’t struggling.
Not because the symptoms aren’t there.
But because brief screeners weren’t built to see the full story.

Here’s why these three diagnoses often get missed and why a few quick questions usually aren’t enough.

Bipolar Disorder: If you don’t ask, they might not tell

Most patients with bipolar don’t walk into the room saying “I had a manic episode last month.” What they say is: I’m exhausted. I feel numb. Nothing is fun anymore.

And if your screener focuses only on depressive symptoms, that’s where the story ends. Hypomania often goes unrecognized by both patients and providers. Some people don’t even think of it as a problem. After weeks of low mood, a few days of energy and optimism can feel like relief, not risk.

But here’s the thing: missing mania means misdiagnosing depression. Which means the wrong treatment, and potentially, the wrong meds.

If we don’t ask the right questions, we don’t get the right answers.

ADHD: Hidden behind anxiety, hustle, and high IQs

The old-school ADHD checklists don’t always hold up. Especially not for adults. Especially not for women. Especially not for people who’ve spent years masking their symptoms or working twice as hard to keep up.

“I’m always anxious.”
“I just need to get more organized.”
“I thought this was just how my brain worked.”

If that sounds familiar, it’s because ADHD often blends into the background, misdiagnosed as anxiety, depression, or even perfectionism. And brief screeners don’t always tease that apart. They rarely account for executive dysfunction. They usually ignore emotional dysregulation. And they definitely don’t ask about that deep, bone-tired mental fatigue from trying to function in a world not built for your brain.

You can’t spot ADHD with a checklist built for hyperactive 9-year-old boys.

OCD: Easy to miss, even when it’s loud

OCD is not just about handwashing. Or organizing. Or checking the stove 12 times. But you wouldn’t know that from most screeners.

Many people with OCD don’t even realize they have it because their compulsions are internal. Because they’ve never heard anyone talk about intrusive thoughts. Because they’re too ashamed to name what’s really going on.

If a patient is struggling with violent or taboo thoughts, they’re probably not going to mention it in the first five minutes. They may not even bring it up unless you create space for it. And brief screeners? They’re not known for making space.

OCD hides in plain sight and shame keeps it there.

So what do we do instead?

When symptoms are complex, chronic, or hard to pin down, don’t hesitate to use a more comprehensive assessment. Structured tools that explore diagnostic criteria across multiple domains, including daily functioning, symptom clusters, & comorbidities, can uncover what brief tools miss. They give providers a fuller picture, and patients a better chance at being truly understood.

Because that’s what a good diagnostic process does. It listens. It lingers. And it’s willing to question the surface.