Women with autoimmune diseases are up to 74% more likely than men to be told their symptoms are psychological or psychosomatic, and have to wait much longer for diagnosis and treatment, a study suggests.
Hundreds of millions of people – around one in ten people worldwide – are affected by autoimmune diseases, which can lead to a range of health problems, including fatigue, muscle pain and skin rashes.
But research from the University of Cambridge and the University of East Anglia suggests a stark gender divide when it comes to how doctors treat signs of the disease.
According to the study, women are more likely to have their illness misattributed to psychiatric causes, more likely to have symptoms misdiagnosed as psychosomatic, and more likely to experience delays in obtaining a diagnosis.
Lead author Melanie Sloan said: “The damage done to women by these types of diagnostic errors can be very long-lasting in terms of their trust in doctors and their own self-esteem. »
Sloan, a researcher at Cambridge and UEA’s Department of Public Health and Primary Care, said some women were forced to wait years for a diagnosis, leading to long delays in treating their illness.
The study, published in the journal Lancet eClinicalMedicine, included more than 6,600 people with autoimmune diseases. Most were women and came from the United Kingdom.
Patients listed their primary medical condition, with nearly a quarter of women suffering from autoimmune thyroid disease, which can cause the gland to be 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 symptoms of Graves’ disease include bulging eyes, palpitations and weight loss.
One in seven women in the study had systemic lupus, which can cause fatigue, rashes and muscle pain.
In male patients, rheumatoid arthritis, vasculitis and antiphospholipid syndrome (APS), also known as “sticky blood” syndrome, were the most common conditions.
Researchers found that 43% of women reported being told their condition was due to a psychiatric cause, compared to a third of men (33%).
A third (34%) of women also reported having symptoms misdiagnosed as psychosomatic, meaning they were triggered or made worse by stress or anxiety, compared to 22% of men.
Overall, after accounting for factors such as age, disease group, continent and household finances, the researchers said women were 46% more likely than men to report receiving a psychiatric misdiagnosis, and 74% more likely to report a psychosomatic misdiagnosis.
The researchers also found that women reported significantly longer periods between the onset of symptoms and receiving a diagnosis, as well as more medical visits. Among men, the most commonly reported time to diagnosis was less than three months. For women, it was one to two years.
Autoimmune diseases, which occur when the immune system attacks the body by mistake, can be complex to diagnose because they often present with symptoms common in the general population.
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The study team said that “wider diagnostic challenges affect both sexes” but that “women may face additional disadvantages.”
They added: “Historical biases in medicine may persist, including positioning women as less credible and less emotional reporters of symptoms than men. »
Sloan said the findings “highlight that psychological or mental health-related explanations may be given too early.”
She added: “This is true for both sexes, but our study suggests that women may be particularly vulnerable to these types of diagnostic errors.
“It’s really important that symptoms aren’t automatically dismissed as psychological and that doctors just say, ‘I believe you,’ to patients with symptoms they can’t see.
Shaista Tayabali, an autoimmune disease patient who was part of the research team and co-author of the study, said: “The gender differences in diagnostic errors among people with autoimmune diseases are striking.
“The fact that women reported higher rates of psychiatric and psychosomatic diagnostic errors than men…suggests that historical gender bias remains a difficult aspect of the diagnostic journey.”
“Although labels such as hysteria are outdated and, fortunately, rarely used these days, as women we still often find it more difficult to make our symptoms believe and therefore treat them accurately.”
Gn Health
