Autoimmune Diseases That Are Mistaken for Psychological Problems: Why They Are More Common Among Women

Fatigue that does not go away even after resting, pains that change in intensity, concentration problems, or a persistent feeling of discomfort for which no one finds an explanation. These are symptoms that can appear in various autoimmune diseases, but also in disorders such as anxiety or depression. And when medical tests do not provide clear answers, some patients end up receiving a psychological diagnosis that, months or even years later, turns out not to explain their illness.

An international study with more than 6,600 patients has found that women with autoimmune diseases are more likely than men to have initially received an incorrect psychiatric or psychosomatic diagnosis. In addition, they usually take a longer path to find out what is really happening to them.

The research, led by the universities of Cambridge and East Anglia and published on October 13 in eClinicalMedicine, from The Lancet group, puts numbers to an experience that many patients have been denouncing for some time: the difficulty in getting certain physical symptoms recognized and properly studied.

Symptoms that do not fit a diagnosis

Autoimmune diseases appear when the immune system, whose usual function is to protect us against infections and other threats, begins to mistakenly attack the body's own tissues.

Among them are lupus, rheumatoid arthritis, multiple sclerosis, and some thyroid diseases, such as Hashimoto's thyroiditis. Although they affect different organs and present very diverse manifestations, many share a characteristic that complicates their identification: the initial symptoms are not always sufficiently specific.

A person may visit a doctor due to exhaustion, muscle pain, difficulty sleeping, or mood changes. Sometimes, these discomforts appear and disappear, affect different parts of the body, or take time to be accompanied by more recognizable clinical signs.

For this reason, healthcare professionals need to consider different explanations before reaching a diagnosis. The problem arises when a psychological interpretation is established too quickly and ends up conditioning subsequent assessments, especially if the symptoms persist or evolve.

Having anxiety, stress, or depression does not exclude the presence of a physical illness. Likewise, a symptom without an immediate explanation does not necessarily have a psychological origin. This distinction is especially important in the face of pathologies that are difficult to identify during their early stages.

43% of women had received an incorrect psychiatric explanation

To investigate these experiences, the Cambridge and East Anglia team conducted an international survey of 6,607 people diagnosed with autoimmune diseases. They asked how much time had passed from the first symptoms to obtaining their diagnosis, how many consultations they had needed, and what explanations they had previously received.

The results showed quite significant differences between men and women.

43% of the female participants stated that their symptoms had been wrongly attributed to psychiatric causes, compared to 33% of men. When psychosomatic diagnoses were specifically analyzed, those that relate physical symptoms to psychological factors, the figures were 34% and 22%, respectively.

After adjusting the results considering factors such as age, type of disease, region of residence, and economic situation, women had almost 50% higher odds of reporting an incorrect psychiatric diagnosis and approximately 75% higher in the case of psychosomatic diagnoses.

In contrast, when the error consisted of attributing symptoms to another physical illness, the differences between sexes were smaller and not statistically significant.

This contrast is relevant because it suggests that the discrepancies are not limited to the general difficulty of identifying these pathologies but also affect the type of explanation patients receive.

Up to two years to receive a diagnosis

The time it took to receive a diagnosis was also different between men and women. While among men the most common was to get an answer in less than three months from the appearance of the first symptoms, among women the most frequent interval was one to two years. In addition, they needed to attend more medical consultations before knowing what was happening to them.

Spending so much time without a diagnosis has consequences. Many autoimmune diseases require specific treatments to control symptoms and avoid complications, and each delay means more time without receiving the necessary care. Added to this is the uncertainty of living with persistent discomfort without knowing exactly what causes it.

After months, or even years, searching for answers, some people end up losing trust in healthcare professionals. An experience that can also influence how they face new consultations or how long it takes them to seek help again when other symptoms appear.

Why does it happen more among women?

Autoimmune diseases affect women more frequently, although this data varies considerably depending on the pathology in question. Hormonal, genetic, and immunological factors help explain part of this difference, but they do not justify the inequalities observed during the diagnostic process. The researchers suggest that certain historical biases may continue to influence how the discomfort reported by female patients is interpreted.

For centuries, numerous female symptoms were attributed to supposed emotional disturbances. Although concepts previously used, such as hysteria, have disappeared from current medical practice, it is still questioned to what extent certain ideas about women's credibility or their way of expressing pain persist. This possibility draws attention when observing the differences found in the study, although it must also be taken into account that autoimmune diseases are difficult to identify in many cases, because their symptoms are confused with those of other pathologies and tests do not always provide conclusive answers, especially during the early stages.

Added to these difficulties are some limitations of the research itself. The results come from experiences reported by patients, without an independent review of each medical decision, and the sample was mostly composed of women and people residing in the United Kingdom. Therefore, the figures should be considered cautiously, although the observed differences deserve further investigation to better understand what happens during consultations and why certain explanations are used more frequently depending on the patient's sex.

Listening to the patient is also part of the diagnosis

The study involved patients, associations, and healthcare professionals to learn about experiences that are not always reflected in medical records. Among them, the difficulties in obtaining a diagnosis and the feeling that their symptoms had not received enough attention.

Based on these testimonies, the researchers highlight the importance of reviewing initial medical assessments when discomfort persists or new symptoms appear. They also remind that psychological problems can coexist with autoimmune diseases, so identifying one should not prevent further investigation of the other.

Listening to the patient, monitoring their progress, and reconsidering a diagnosis when necessary are fundamental aspects to avoid delays in care. The authors hope that delving into these experiences will help identify what is failing and improve the diagnostic process, especially among women.