Women’s autoimmune symptoms more likely to be dismissed as psychological, study finds

Women presenting with autoimmune conditions that trigger symptoms such as fatigue, muscle pain and rashes are significantly more likely to have their illness attributed to psychological causes, according to a new study.

Analysis further indicates that female patients also endure longer delays in receiving a formal diagnosis when compared with men.

While these diagnostic difficulties affect both sexes, researchers stated that women "may face additional disadvantages", highlighting how "historical biases in medicine may persist".

Autoimmune conditions, which occur when the body’s immune system mistakenly attacks healthy tissue, can prove difficult to identify because they frequently present with common symptoms.

Dr Melanie Sloan, of the department of public health and primary care at the University of Cambridge, and Norwich Medical School, University of East Anglia (UEA), said it can sometimes "take months or years before a diagnosis becomes clear".

The study, led jointly by the University of Cambridge and UEA, surveyed more than 6,600 individuals living with autoimmune conditions. The vast majority of respondents were female and based in the UK.

Patients listed their main condition, with almost a quarter of women having autoimmune thyroid disease, which can cause the gland to become underactive – known as Hashimoto’s disease – or overactive, known as Graves’ disease.

Hashimoto’s disease can cause weight gain, hair loss, fatigue and joint pain, while the symptoms of Graves’ disease include bulging eyes, palpitations and weight loss.

Roughly one in seven women in the study had systemic lupus, which can cause tiredness, rashes and muscle pain.

Among the male patients, rheumatoid arthritis, vasculitis and antiphospholipid syndrome (APS) – also known as “sticky blood” syndrome – were the most common conditions.

The analysis found that 43% of females reported being told their condition was down to a psychiatric cause compared with a third of men.

More than a third (34%) of women also reported having symptoms misdiagnosed as psychosomatic – meaning they are triggered by stress or anxiety – compared with 22% of men.

However, reports of being misdiagnosed with a different physical disease was slightly higher among men.

Researchers said the “broader diagnostic challenges affect both sexes” but “females may face additional disadvantages”.

They added: “Historical biases in medicine may persist, including positioning females as less credible and ’emotional’ reporters of symptoms than males.

“Additionally, female health has historically received less research funding, and less pre-clinical research is based on the female anatomy.”

Dr Sloan said the findings, published in The Lancet’s eClinicalMedicine, “highlight that psychological or mental health explanations can be given too soon”.

“This is true for both sexes, but our study suggests that females may be particularly vulnerable to these types of misdiagnoses,” she added.

Shaista Tayabali, co-author and patient partner, 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, yet reported lower misdiagnoses for other physical diseases, 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.”

Professor David D’Cruz, consultant rheumatologist at Guy’s Hospital, said: “This is not about saying that a psychiatric diagnosis is never correct.

“People can have both autoimmune and psychiatric conditions, and it is increasingly understood that psychiatric symptoms can be part of an autoimmune disease, especially in diseases like lupus which can directly affect the brain.

“They can also be a very natural response to living with life-changing illnesses.

“The important message is that when symptoms persist, evolve or involve multiple systems, clinicians must be open minded and consider whether there is an underlying autoimmune disease that has not yet been recognised – and to listen to patients.”