May 3
Parents of daughter with mental illness share story of diagnostic overshadowing
Diagnostic overshadowing – the attribution of symptoms to an existing condition rather than a potential co-morbidity – can be an enormous barrier to providing proper care for individuals with a mental health diagnosis. Their aches, pains and other symptoms are often attributed to the mental illness, without consideration of potential physical causes.
In a recent article published online in Psychiatric Services, Mark R. Munetz, M.D., professor and chair emeritus of psychiatry at NEOMED, and his wife, Lois S. Freedman, M.D., a fellow psychiatrist, shared their harrowing experience as they sought help for their daughter “K.”
Certainly, with two psychiatrist parents advocating for her, “K” would not be subject to this bias, right?
Wrong.
In the essay, titled “Why Won’t They Believe Me?” the couple wrote:
“We knew that our daughter K was the archetype of a difficult patient. At a time when she had been sober from alcohol for more than 6 years, she also had multiple psychiatric diagnoses, including borderline personality disorder. When she first developed a skin infection with methicillin-resistant Staphylococcus aureus, it was seen as an unfortunate accident, blamed on contact with a drug-using girlfriend of a housemate. But after an initial scare with septicemia and surgical drainage came recurrent infections. With each recurrence, her doctors had more questions. Why did her condition not show a sustained response to antibiotics? Did she like attention from her physicians and nurses? Was she creating the recurrent wounds to gain attention?”
The recurring infections were not self-inflicted and were not related to K’s mental illness or past history of alcohol use, but rather to a unique autoinflammatory disease.
“We spent our careers teaching trainees not to blame families for their loved ones’ illnesses or to attribute medical complaints to psychiatric causes before first ruling out all other medical explanations,” Drs. Munetz and Freedman wrote. “It is ironic that at the end of our careers we and, sadly, our daughter experienced trauma at the hands of physicians who did not learn this lesson.”
