Women With Autoimmune Conditions More Often Told Symptoms Are Psychological, Study Finds

LONDON — Women with autoimmune diseases are substantially more likely than men to be told their symptoms are psychological or psychosomatic and face longer waits for diagnosis and treatment, according to a study of more than 6,600 patients.

The research, led by the University of Cambridge and the University of East Anglia and published in The Lancet eClinicalMedicine, found that 43 percent of women reported being told their condition stemmed from a psychiatric cause, compared with 33 percent of men. Thirty-four percent of women said their symptoms were misdiagnosed as psychosomatic — triggered or worsened by stress or anxiety — versus 22 percent of men.

After adjusting for age, disease type, location and household finances, women were 46 percent more likely to report a psychiatric misdiagnosis and 74 percent more likely to report a psychosomatic misdiagnosis. Women also reported longer intervals between the onset of symptoms and a formal diagnosis. For men, the most common time to diagnosis was less than three months; for women, it was one to two years. Women reported more healthcare consultations before receiving a diagnosis.

"The damage caused to women by these types of misdiagnosis can be very long lasting in terms of trusting doctors and their own self-esteem," said lead author Melanie Sloan, a researcher in the department of public health and primary care at Cambridge and the University of East Anglia. Sloan said some women waited years for a diagnosis, delaying treatment. She added that psychological or mental-health explanations "can be given too soon" and that "females may be particularly vulnerable to these types of misdiagnoses."

"It is really important that symptoms are not automatically assumed to be psychological and for doctors to just say, 'I believe you,' to patients with symptoms that the doctors cannot see," Sloan said.

Most participants were female and from the United Kingdom. Nearly a quarter of the women had autoimmune thyroid disease (Hashimoto's or Graves' disease). One in seven women had systemic lupus. Among men, rheumatoid arthritis, vasculitis and antiphospholipid syndrome were the most common conditions reported.

Autoimmune conditions occur when the immune system mistakenly attacks the body. They can produce fatigue, muscle pain, rashes and other symptoms that overlap with more common complaints, making diagnosis difficult for both sexes. The researchers wrote that "broader diagnostic challenges affect both sexes" but that "females may face additional disadvantages." They noted that "historical biases in medicine may persist, including positioning females as less credible and emotional reporters of symptoms than males."

Shaista Tayabali, a patient and co-author of the study, said: "The differences between the sexes in misdiagnoses for people with autoimmune diseases is stark. The fact that females reported higher rates of psychiatric and psychosomatic misdiagnoses than males ... suggests that historical gender biases remain a challenging aspect of the diagnostic journey. Although labels such as hysteria are outdated, and fortunately rarely used nowadays, as women we still often have a harder time having our symptoms believed and therefore addressed accurately."

The study is observational and based on patient self-reports. It does not establish causation or quantify how often initial psychiatric attributions later proved incorrect. Researchers said the findings highlight the need for clinicians to avoid premature psychological explanations when evaluating persistent symptoms that could indicate autoimmune disease.