Psychiatric Misdiagnoses Linked to Long-Term Harm in Patients With Autoimmune Rheumatic Diseases
Published in Rheumatology, a new study highlights the lasting psychological and behavioral consequences of psychosomatic and psychiatric misdiagnoses in patients with systemic autoimmune rheumatic diseases (SARDs). The findings underscore the need for greater diagnostic accuracy and sensitivity in rheumatologic care.
Researchers analyzed data from 1543 and 1853 patients in 2 separate cohorts, using validated mental health measures and patient-designed questions to assess depression, anxiety, mental wellbeing, and health care behaviors. Patients who reported experiencing psychosomatic or psychiatric misdiagnoses demonstrated significantly worse outcomes across all mental health metrics and medical relationships.
More than 80% of patients said the misdiagnosis negatively affected their self-worth, and 72% reported ongoing emotional distress related to the experience. “Patients reporting psychosomatic and/or psychiatric misdiagnoses had significantly lower mental wellbeing, and higher depression and anxiety levels,” the study reported, noting that all findings were statistically significant (P < 0.001). Thematic analysis showed that many patients, after experiencing a misdiagnosis, struggled to rebuild trust in their providers.
The consequences of misdiagnoses extended beyond mental health. Affected patients reported lower satisfaction with all aspects of their medical care and showed altered health care behaviors. This included a higher tendency to underreport symptoms (P < 0.001) and a greater likelihood of avoiding health care interactions (P = 0.012). While these misdiagnoses did not significantly affect medication adherence (P = 0.2), qualitative data revealed that underreporting and avoidance were often driven by fear and distrust of being disbelieved again.
These findings emphasize the importance of early and accurate diagnosis in patients with complex autoimmune symptoms. Clinicians should be aware of the potential long-term psychological harm associated with misattributing autoimmune symptoms to psychiatric causes.
“Patient-reported psychosomatic and psychiatric (mis)diagnoses are associated with persisting adverse impacts in multiple domains,” the authors concluded. They recommend that health services offer appropriate support to address and mitigate these negative experiences.
For practicing rheumatologists, this study reinforces the critical need for empathetic communication, thorough diagnostic evaluation, and psychological support for patients with SARDs—especially those with a history of prior misdiagnoses.
Reference
Sloan M, Bosley M, Gordon C, et al. “I still can’t forget those words”: mixed methods study of the persisting impact on patients reporting psychosomatic and psychiatric misdiagnoses. Rheumatology. March 2025. doi:10.1093/rheumatology/keaf115
