In the shadows of diagnosis

Diagnostic overshadowing is when physical health problems, pain, or not yet diagnosed health conditions are not taken seriously, or are seen as delusional, attention-seeking, or made up because someone has a mental health diagnosis and/or self-injury scarring.


Invalidating someone else is not merely disagreeing with something that the other person said.
It is a process in which individuals communicate to the other that the opinions and emotions of the target invalid, irrational, selfish, uncaring, stupid, most likely insane, and wrong, wrong, wrong.
Invalidators let it be known directly that their target’s views and feelings, do not count for anything to anybody at any time or in any way.

David M. Allen. MD

*(slide used by Sue Phillips Survivor Activist, ‘Much More Than a Label, CAPS Advocacy, with thanks by RITB)

One of our members ended up in ITU recently because of diagnostic overshadowing as her diagnosis of BPD, makes her especially vulnerable to diagnostic overshadowing. It can be a life threatening norm for service users with that diagnosis. She had spent a year suffering with physical ill health being disbelieved until she became critically ill.

These are other examples from members of their experiences of diagnostic overshadowing;

“I went to a GP twice a few years ago in agony. For two days she explained away every symptom & told me to go & tell CMHT about the pain. Told me no need to go to A&E it would pass, left me in worst pain imaginable.
Family member found me on day 3 & got me to hospital. I had a hole in my stomach from a perforated ulcer & had septicaemia. Literally hours to live as organs were shutting down. Now left with hefty surgical scar & developed epilepsy & have kidney damage because of the amount of time I had septicaemia for. All because a GP refused to look beyond PD label & consider that I may actually have been ill”.

“I’ve had similar it was an embolism, the terror of not being able to breathe and being told you’re basically making it up will never leave me”.

“Around 10 years ago I went to the GPs stating my asthma had got worse. I was put on a course of steroids and I have a nebuliser at home. Months and months went by and my breathing got worse. I continued going to the surgery but saw many different doctors. They ALL told me that it was anxiety due to my mental ‘illness’. I tried to disagree.
Approximately 4 months later I collapsed in the street. Was rushed to A&E. Don’t remember much for weeks after that. Apparently I had pneumonia and suspected pulmonary embolism was in ICU on a ventilator”.

“I have had two major experiences of diagnostic overshadowing. My symptoms of thyrotoxicosis were said to be panic attacks. To make it worse the thyroid issues were a side effect of lithium. Some years later my abdominal pain was thought to be psychosomatic when I actually had appendicitis. My GP was my hero on that occasion for insisting they operate”.

“various things being put down to be me being over-anxious. I used to use a stick because of pain in feet and knees but a SHO was adamant that I was using the stick in a pathological way and wanted me to stop using it. Not sure if he thought my pain wasn’t real or I was using the stick for attention or I was in the sick role… (Pain is mostly sorted through podiatry diagnosing it properly and giving me orthotics and physio exercises.)”

“Told that being transgender is just a phase and due to my mh ‘illness’. Arguing that my voices are real. Stating that some of my medication gives me suicidal side effects and makes voices worse. Physical illnesses being put down to mh difficulties”

“I was first given a MH dx age 12 which coincided with my mother convincing doctors I was a not to be trusted and was attention seeking as usual when in fact I had developed septicaemia from a burst appendix. I almost died and was in PICU for 6 weeks. I can still remember my mum standing at the end of my hospital bed post op calling me a liar.
There are many other examples from my childhood and I believe that abusive care givers are often complicit with medics re dx overshadowing. After all a dead child can’t tell…”

“The whole Venlafaxine withdrawal process was a nightmare of diagnostic overshadowing. GPs and MH workers don’t acknowledge it exists. Physical and mental symptoms attributed to pre-existing MH diagnoses or not existing at all”.

“I needed cornea transplants, there’s a strict criteria for eligibility which I fitted but the ophthalmologist had a problem with loonies. It took staff a year of persuasion to see me in clinic. He referred to me as “that girl” and assumed that history of self-harm meant I would bang my head against the wall after surgery. I had no history of head banging. He didn’t speak to me, my GP, or a psychiatrist. He made a clinical judgement based on his prejudice and I was partially sighted. I was deeply depressed because of my sight.
He also interfered with optometry when I had substantial difficulties with medical lenses. They came up with a novel method of assisting me and he vetoed it, threatening them that he would not see me”.

“I tend to let my peak flow get lower before seeking help because I worry they will think I’ve not blown hard enough into the peak flow meter or not used my inhalers.
I agonise over seeing GP unless I can justify it, it must be ‘bad enough’ and couldn’t be construed as in my imagination”.

“I have known of service users to receive late cancer diagnoses because of diagnostic overshadowing and one woman’s husband was asked when she was in labour, “is she sure?” as her baby’s head started crowning”.
“I collapsed on a MH ward and when the paramedics arrived the staff nurse said ‘she’s PD’ as if to suggest ‘don’t bother, she’s faking’. My BP was critically low and they found I had heart problems that were causing the sudden drop”.

From hypermobility, to autism, any physical illness or pain which causes anxiety, drug withdrawal symptoms, bowel impaction through psychiatric medication being left to the point of obstruction and rupture, to poor management of long term physical conditions, to late cancer diagnoses – diagnostic overshadowing can kill.

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A critical theorist and activist collective.