Part 1
Part 1: When Mental Health Becomes a Diagnostic Shortcut
The Intersection of Medical and Mental Health Diagnoses: When Doctors Don’t Listen
“Once you have a mental health diagnosis, your symptoms are often seen through a distorted lens—‘It’s all in your head’ becomes the default response.”
Imagine walking into a doctor’s office with a sharp, persistent pain in your chest. You’ve felt it for weeks—worsening, radiating. You describe it in detail. But instead of further tests, the doctor gently asks, “Are you feeling anxious?” You leave with a prescription for anti-anxiety medication… and no answers.
This scenario isn’t rare—it’s a lived reality for countless people navigating the health system while carrying a mental health diagnosis. The term for this phenomenon is diagnostic overshadowing, and it’s one of the most insidious ways patients are dismissed.
What Is Diagnostic Overshadowing?
Diagnostic overshadowing occurs when a patient’s mental health diagnosis takes precedence in the clinical decision-making process—leading healthcare professionals to misattribute physical symptoms to psychiatric conditions. The result? Missed diagnoses, untreated diseases, worsening health outcomes, and sometimes, preventable deaths.
This isn't about malicious intent. Often, it's the product of overwhelmed systems, implicit biases, and gaps in training. Yet the consequences are real and deeply harmful.
A Misdiagnosis with Lasting Impact
Take Anna, a woman in her early 30s diagnosed with generalized anxiety disorder in college. Years later, she began experiencing dizzy spells and fatigue. Repeatedly, doctors chalked it up to stress. It wasn’t until she collapsed at work that she was rushed to the ER—where it was discovered she had been living with a serious cardiac arrhythmia.
“They told me to breathe through it. It wasn’t anxiety. It was my heart. And it almost killed me,” she says.
The Research Behind the Reality
Clinical studies have confirmed that patients with mental health diagnoses—especially those involving depression, anxiety, bipolar disorder, or schizophrenia—receive worse physical healthcare than the general population.
A 2008 study in Acta Psychiatrica Scandinavica found that people with mental illness often receive substandard care for physical conditions like heart disease or diabetes because their psychiatric diagnosis dominates the clinical picture.
A 2014 qualitative study in BMC Psychiatry revealed that healthcare professionals admitted to struggling with differentiating psychiatric symptoms from somatic illness, often “erring” on the side of assuming mental illness as the cause.
This systemic bias is even more concerning when patients have no current mental health symptoms—but a history of psychiatric care. Once that label is in their file, it often overshadows everything else.
Who’s Most at Risk?
While anyone with a mental health diagnosis is vulnerable, certain groups are disproportionately affected:
Women, especially those who are assertive about their symptoms, are more likely to be labeled “dramatic” or “hysterical.”
People of color often face racial stereotypes that compound the effects of diagnostic overshadowing.
LGBTQ+ individuals, who already experience higher rates of medical discrimination, may be dismissed even more quickly when reporting pain or illness.
Neurodivergent patients, such as those with ADHD or autism, are often not believed when describing pain or unusual symptoms.
Why This Matters: The Cost of Not Listening
When doctors default to “it’s just anxiety,” they don’t just make a clinical mistake—they fracture trust. Patients begin to second-guess their own experiences. Some stop seeking care altogether, fearing they’ll be gaslit again.
And the worst part? Many of these missed diagnoses are treatable—or even curable—when caught early.
How to Advocate for Yourself (or a Loved One)
If you’ve been in this situation, you’re not alone. Here are some steps to protect your health:
Bring Documentation: List your symptoms with dates, times, and severity.
Ask for Specific Explanations: Don’t settle for vague reassurance. Ask what else it could be.
Request a Second Opinion: Don’t hesitate to involve another provider.
Bring an Advocate: A friend or family member can help reinforce your experience in the exam room.
Use Your Voice: Politely, but firmly, say “I want this symptom investigated as a physical issue.”
Looking Ahead
This post sets the stage for the rest of our series. In Part Two, we’ll examine how systemic bias—particularly around gender and race—amplifies the problem, and why marginalized groups are especially vulnerable when doctors don’t listen.
Until then, remember: your body deserves to be believed.
📚 References:
Jones, S., Howard, L., & Thornicroft, G. (2008). ‘Diagnostic overshadowing’: worse physical health care for people with mental illness. Acta Psychiatrica Scandinavica, 118(3), 169–171.
Shefer, G., Henderson, C., Howard, L. M., Murray, J., & Thornicroft, G. (2014). Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness: A qualitative study. BMC Psychiatry, 14, 36.