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Are You a Victim of Diagnostic Overshadowing?

It is a well-known fact that women with chronic pain are not taken as seriously as their male counterparts. It can take months or even years for a woman to receive a proper diagnosis because doctors are more likely to dismiss women as having a mental illness, stress, anxiety, or, in the worst case scenario, just making up their symptoms for attention.

Now, imagine you’re a woman with a mental illness, a learning disability, or you’re on the autism spectrum? (I don’t have to imagine any of that because I fit into ALL THREE of those categories.)

In this article, I’m going to talk about diagnostic overshadowing. Simply put, diagnostic overshadowing occurs when a doctor assumes that the physical symptoms a patient with a mental illness complains about is simply an extension of said mental illness.

In other words, it almost gives the doctor the perfect excuse to say “It’s all in your head”. Which, of course, is neither fair to the patient nor good for their health. It’s a lazy way of practicing medicine, but there is something you can do about it if it’s happening to you.

Physical Pain Dismissed Due to Mental Illness

People living with anxiety disorder, depression, OCD, PTSD, bipolar disorder, schizophrenia, or any other mental illness are often dismissed when they present with symptoms of a physical health problem.

I believe this happens for two reasons:

  1. Mental illness CAN manifest physically.

A doctor who says, for example, that your stomach pain or chronic headaches are related to your mental illness might not be entirely wrong. After all, stomach pain and chronic headaches are two very common symptoms of anxiety disorders and depression.

  1. Doctors jump to conclusions.

However, and herein lies the problem, stomach pain and headaches have LOTS of physical causes, as well, and for a doctor to say that the pain you’re experiencing is only due to your mental illness and not look for another cause is negligence, pure and simple.

Oftentimes, because of this bias, patients with mental illness may not receive adequate diagnosis and treatment for their physical health conditions. This can lead to unnecessary pain and suffering, a worsening of mental illness due to pain, and, in severe cases, premature death.

People on the Autism Spectrum Have Difficulties, Too

According to a story published by the Interactive Autism Network, a young autistic patient’s life-threatening jaw infection was almost completely overlooked because the symptoms she presented with included banging her head repeatedly, hitting others, biting herself, and refusing to eat. Since these are common symptoms in individuals on the autism spectrum (especially those with high support needs), the doctors did not look deeper into the situation.

A stay in a special unit of the Children’s Hospital Colorado revealed that Sarah had a black molar and a horrible jaw infection, which must have caused her unbearable pain. Since she could not communicate that pain verbally, she did what she was capable of doing to express it.

As soon as her molar and infection were treated, she became calm and no longer had need of the helmet they’d placed her in to keep her from injuring herself.

Further examination also revealed that Sarah was partially deaf. Once she was given a hearing aid, she responded to communications from her dad and was eventually able to speak a few words.

Now, imagine if she’d just been left like that or given heavy doses of psychiatric medication to subdue her behaviors? She could have died from that infection!

Those With Learning Disabilities Also Have Their Health Problems Overlooked

From an article published by the University of Hertfordshire:

Gastrointestinal cancers are approximately twice as prevalent in people with a learning disability, coronary heart disease is the second highest cause of death for people with a learning disability and approximately 70% of people with a learning disability experience gastrointestinal disorders.”

Again, as with mental illness and autism, those with learning and intellectual impairment may experience diagnostic overshadowing because their doctors lump all of their symptoms into one category, or worse, believe the symptoms to be “imagined” by the person with the disability.

How to Combat Diagnostic Overshadowing

  • Calm your mind.

When a doctor is being dismissive and rude, it can be very difficult to be calm, especially if you already live with anxiety, PTSD, etc. For most people with these conditions, the reaction is fight or flight. You either want to yell at the doctor in the most colorful language possible or run out of the exam room.

Unfortunately, either response will only reinforce the doctor’s belief that your physical symptoms are brought on by your mental health condition.

To prepare for a stressful doctor’s visit, close your eyes and take a few deep breaths. Imagine yourself in the exam room talking with your doctor. Allow your shoulders to relax, and imagine exactly what you’ll say to the doctor about your symptoms when you see him.

Do this a few times before the day of your visit. You may still tense up, and the meeting may not go exactly as you pictured it in your head, but this practice should help make the process a bit easier.

  • Write it down.

If you’re anything like me, you forget things easily and you freeze up when asked a question. This is where it comes in very handy to write things down. Keep track of your symptoms in an app or just write them down in a small notebook you bring to the doctor with you. This way, if you get nervous or feel you might stumble over your words, you can look at your notes and get back on track.

  • Use the term.

I don’t feel like you’re taking my symptoms seriously because I have an anxiety disorder. This is called diagnostic overshadowing, and I’m very concerned about it.”

Saying something like this will give a doctor who is dismissing you pause because he or she does not want to be hit with a lawsuit for medical malpractice.

  • Bring an advocate.

If possible, bring an advocate with you. A parent, spouse, or friend who knows you well and can speak up on your behalf and corroborate your story. This will automatically give you more credibility. Furthermore, doctors are less likely to be dismissive and rude when there are witnesses.

  • Ask for confirmation.

If your doctor continues to insist that your physical symptoms are nothing more than a manifestation of your mental illness, ask your therapist or prescribing doctor to talk to your primary doctor. He or she will be able to confirm whether or not the symptoms you’re presenting with are solely related to your mental health condition (they rarely are), or if they could be indicative of a physical health problem.

  • Request further testing.

The best way to counteract a dismissive doctor is to ask for more testing and/or a referral to a specialist. Say you’re experiencing terrible stomach pain that you’re not used to having. This is a new symptom for you, but your doctor keeps putting you off. Ask him directly for an allergy test, stool test, etc., or have him refer you to a gastroenterologist.

If he tries to dismiss you again, tell him you want it noted in your chart that you requested a test or a referral and he refused to do it. He may get irritated, but stand firm. Remember, he works for you, not the other way around.

  • Be blunt.

If I came into your office with chronic stomach pain, but I was not being treated for depression, what would you think is causing it?”

Sometimes, you’ve got to be direct. A doctor may not even be fully aware of his or her own bias until you point it out.

It’s important to remember that you know yourself and your symptoms better than anyone. If your doctor won’t take you seriously or starts bullying you, find another doctor. You do not deserve to be mistreated or overlooked because you have a mental illness, are on the spectrum, or have a learning disability. You are a human being who deserves to be treated with dignity and respect.


Resources for People Who Experience Diagnostic Overshadowing

Although it may feel like it sometimes, you’re far from the only one who has experienced diagnostic overshadowing and not being taken seriously by doctors. Click on the book covers below to check out these popular stories of those who have been in similar situations.

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