Women with autoimmune diseases face nearly 50% higher psychiatric misdiagnosis rates

A study of more than 6,600 patients with autoimmune diseases has documented a stark disparity in how doctors diagnose women versus men. When women present with symptoms of conditions like rheumatoid arthritis, lupus, or multiple sclerosis, they are far more likely to be told their illness is psychiatric in nature—a misdiagnosis that delays proper treatment and leaves them untreated for years.

Researchers from the University of Cambridge and University of East Anglia analyzed the diagnostic experiences of 6,607 people across multiple countries. The findings, published in The Lancet's eClinicalMedicine, reveal that 43 percent of women reported having their autoimmune symptoms initially attributed to psychiatric causes, compared with 33 percent of men. When researchers accounted for age, disease type, geographic location, and income, women emerged as nearly 50 percent more likely to receive a psychiatric misdiagnosis than men. The gap widened further for psychosomatic diagnoses—the notion that physical symptoms are caused or worsened by psychological factors—with 34 percent of women reporting this versus 22 percent of men. After adjusting for other variables, women were nearly 75 percent more likely to receive a psychosomatic misdiagnosis.

The diagnostic journey for autoimmune disease is inherently difficult. These conditions occur when the immune system attacks the body's own tissues, and they often announce themselves through symptoms that could belong to many different illnesses: fatigue, pain, sleep disruption, low mood. Symptoms can shift across different parts of the body and evolve over time, making early diagnosis elusive for both sexes. Yet the data shows women bear a disproportionate burden of misattribution. Among men, the most common time to diagnosis was less than three months. Among women, it was one to two years. Women also reported more healthcare consultations before reaching a correct diagnosis.

Interestingly, when it came to being misdiagnosed with a different physical disease altogether, men reported slightly higher rates than women—48 percent versus 44 percent. This pattern suggests something more specific than general diagnostic incompetence: women's symptoms are being filtered through a particular lens. Shaista Tayabali, a patient partner in the research, noted the persistence of historical gender bias. "Although labels such as hysteria are outdated, and fortunately rarely used nowadays, as women we still often have a harder time having our symptoms believed and therefore addressed accurately," she said.

Dr. Melanie Sloan from Cambridge and the University of East Anglia emphasized that psychological explanations are being offered too quickly, particularly to women. "Patients with autoimmune diseases can present with symptoms that can initially be difficult to explain medically, and sometimes it can take months or years before a diagnosis becomes clear," she said. "Our findings 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."

The research was deliberately designed to capture what medical records typically miss. Unlike studies that rely solely on hospital documentation, this work centered on patients' own accounts of their diagnostic journeys—when symptoms began, how many doctors they saw, what diagnoses they received along the way. Wendy Diment, another patient partner, explained why this matters: medical records rarely capture when patients first became unwell or the full difficulty of obtaining a diagnosis. They are also unlikely to be corrected when a psychosomatic diagnosis is later proven wrong.

Professor David D'Cruz, a consultant rheumatologist at Guy's Hospital, stressed that the issue is not whether psychiatric diagnoses can be correct—they can be, and people can have both autoimmune and psychiatric conditions simultaneously. Psychiatric symptoms can even be part of an autoimmune disease, particularly in lupus, which can directly affect the brain. But the critical message is different: when symptoms persist, change, or involve multiple body systems, clinicians must remain open to the possibility of an underlying autoimmune disease and listen carefully to what patients are telling them.

The researchers are calling for systemic change. Doctors should consider autoimmune diseases before offering psychiatric or psychosomatic explanations. They should acknowledge diagnostic uncertainty, provide clear guidance about when further assessment is needed, and revisit previous diagnoses when new symptoms or information emerge. Continuity of care and genuine attention to patient accounts—especially when no clear explanation yet exists—are essential. The work ahead involves understanding why these gender differences persist and designing interventions that reduce diagnostic delays and improve care for all patients with autoimmune disease.