Counseling Services of Barbara Reade, L.C.P.C.
Bel Air, Maryland 21014

Phone: 410-803-1510

Email: reade.lcpc@yahoo.com  

WOMEN & MISDIAGNOSIS

ARTICLE AUTHOR: Barbara Reade, L.C.P.C., © 2003

Resource: Klonoff, Elizabeth A., and Hope Landrine, Preventing Misdiagnosis of Women, Sage Publications, Thousand Oaks, CA, 1997.

Women, historically, have faced problems with misdiagnosis with health and mental health problems. Women have had to experience misdiagnosis, often, not because of lack of concern by the health community, but because much  data used by the medical community that has been based on male population studies only. The majority of medical symptom, diagnosis, and treatment studies done in the last 50 years, have been based on responses of 18-22 year old college men in the U.S. Our medical health diagnostic and treatment system is based on these studies and these statistics. Therefore, women can experience health related misdiagnosis, fairly easily, and often without being aware of it due to being diagnosed and treated from a medical data base that does not address women's physiology. This is not an intentional act, by medical practitioners. Medical practitioners are bound, by their professional code of ethics, to practice medicine according to the training they have received in medical school and continuing education health / medical courses. The problem rests in the fact that medical school training often does not always encompass the differences of female symptoms, biochemistry, and therefore response to different illnesses and treatments. Or medical training may include information based on female studies in some areas of training, but not in all areas. Medical practitioners, therefore, do the best they can with the tools they have been given. When these tools do not work for you, the female consumer, then it becomes important for you to find out why, and find out how to receive treatment that better addresses your problems. If you are in the Baltimore area, our offices would be glad to assist you in this area, with additional information and support.

Below is groundbreaking infromation and research information that I personally researched in the late 1990's. This research does not, in my experience, appear to be used widely within the medical community, although some changes are occurring. Making yourself aware of these issues, therefore, could have a profound effect on your health and well being. 

In recent research, I have found that two main areas of misdiagnosis can occur for women: depression and anxiety. Studies show numerous cases of psychiatric misdiagnosis that should be categorized only in the area of physical illness. The disorders and conditions discussed in this book have, typically, symptoms that appear psychological in nature, like depression and anxiety, thus medical diagnoses are often overlooked when these symptoms appear. These physical disorder areas can include  endocrine disorders, thyroid disorders, adrenal, pituitary, and parathyroid disorders and seizure disorders . They also may include multiple sclerosis, lupus, hypoglycemia, and other disorders, somewhat less commonly found. Because women are much more frequently diagnosed with depression and anxiety, it is possible for professionals to overlook the sometimes physical causes for their symptoms. ( It is important to note, though, that anxiety and depressive disorders are also frequent in women, therefore, these conditions should not be discounted, if you have been diagnosed with clinical depression or anxiety). A surprising point sited by the writers was the fact that much of the medical research that does exist to validate these afflictions, most common to women, are not published in standard medical literature, but instead are buried in research journals and books that are infrequently accessed. Therefore, the likelihood of these types of misdiagnosis continuing, is quite plausible.

First is discussed the interaction of the hypothalamus and the other glands in this system. According to this publication, the effects of tumors in these glandular systems, and how such symptoms as total blindness, hypertension, uterus contraction, and lactation functioning can be primary.

Concerning thyroid conditions, the writers discuss symptoms ranging from manic,hypomanic, bipolar, psychosis, short attention span, impaired memory, generalized weakness,diarrhea, sweating, puffy eyelids, loss of weight but increased appetite, tension, flight of ideas,diffuse anxiety, and other symptoms, as being associated with hyperthyroidism.This book stresses that treatment of this condition with psychiatric medications results in clients with exacerbated symptoms. This is an important illustrating the strong need for women to begin to receive appropriate medical diagnostic evaluation, rather than being channeled into unnecessary psychological treatment. The book, also, clearly points out the important differential diagnostic characteristics to help the clinician more accurately pinpoint the correct diagnosis. An important statement is also made about the need to diagnose the "subclinical" levels of hyperthyroidism and hypothyroidism accurately also. This area appears to not be considered often in diagnostic workups.

Hypothyroidism is described as containing symptoms like fatigue and weakness, generalized motor retardation, depression, cold and tingling feelings, and numbness. These too can be easily seen as emotional in nature. An interesting case study of a college professor was given, siting symptoms that looked like early onset dementia. Because her colleagues confronted her to seek "medical" attention rather than psychological assessment for increasing depression, forgetfulness, and flight of ideas, she was properly diagnosed with the thyroid problem that was the cause for this disorder. This exemplifies the authors premise that simple medical testing can identify clinical levels of malfunction in the glandular system, thus diminishing the possibility for psychological misdiagnosis.

Bipolar symptoms that are caused by thyroid malfunction, are also looked at in this chapter along with the differential diagnostic criteria for this problem. Physical symptoms, it states, that show the true nature of this set of symptoms include: dry skin, weight gain, constipation, cold intolerance, fatigue, and hoarseness. Hypothyroidism can look like bipolar disorder, when it exists in sub-clinical levels. It is often misdiagnosed as affective disorder. If untreated for a number of years, it can turn into delirium. In all three disorders discussed in this chapter, the fact that is most emphasized is that with proper diagnosis and treatment, women with these disorders can avoid the deterioration and/or death that can occur due to misdiagnosis of these problems.

Adrenal disorders can present symptoms like apathy, fatigue, lack of initiative, chronic depression, poverty of thought, social withdrawal, motor retardation, and memory impairment. With one type of this disorder, called Cushings syndrome, intense suicidal ideation, depression, irritability, loss of libido, and difficult concentration all appear as the major symptoms. So misdiagnosis can occur easily.Pituitary disorders described here can cause the same symptoms, but also include drowsiness, dependent behavior, and severe loss of weight. The point is made that this could easily be confused with anorexia. Parathyroid and hypercalcemia disorders can appear with symptoms like depression and suicidality, apparent personality disorder-type symptoms( parathyroid), or dull back pain, urinary infections, gastrointestinal problems, and/or abdominal pain (hypercalcemia).

Seizure disorders are another area of possible misdiagnosis. Primary and secondary seizure disorders are possible causes for the emotional symptoms listed below . The original causes listed include: head trauma, anoxia at birth, infectious or vascular diseases, toxins, drug use or abuse, birth injury, and high fevers in infancy.

Two types of seizures are viewed: generalized and partial. Temporal lobe epilepsy is the type of epilepsy that is most frequently misdiagnosed as psychopathology. The explanation given involves the fact that in this type of epilepsy the areas of the brain affected are those that control behavior, skill, and emotion.  The type of symptom that occurs is dependent on the location of the epileptic activity. The symptoms of multiple sclerosis can even be pinpointed to one area of the brain, that orders or withholds orders of these body functions. Sensory skills, motor related skills, the somatic perception of certain symptoms,the ability to hallucinate both auditory and visually, can all be caused by temporal lobe epilepsy.

Memory and language function can also be affected, due to this localized type of epilepsy.Muscle tremors can be caused due to epilepsy located in the basal ganglia, as is Parkinson's disease. Chronic use of anti-psychotic drugs can cause the depletion of dopaminein the system, thereby creating severe Parkinson-like symptoms. One of the possibilities, caused by this type of drug, is called tardive dyskinesia. This is irreversible in nature.

Petite mal and grand mal epileptic seizures can occur with any of these types of symptoms .The blank stare caused by petite mal epilepsy, can be mislabeled,  especially in children, as inattention. Partial seizure disorder, with a symptom such as tingling,  may be misunderstood as anxiety disorder. An example is given of a client who experienced the room as spinning, and being pushed, at the same time. Accompanied by delusions concerning her mother, this client was perceived to be schizophrenic for many years. After weaning her off anti-psychotic drugs, this patient stopped experiencing these symptoms, her symptoms became framed in a more appropriate context in respect to the client's etiology, and positive progress was then made with her treatment.

Complex partial seizure disorders also can contribute to many types of psychological symptoms. This type of condition can cause a wide array and arrangement of psychiatric- looking symptoms. Moodiness, annoyance, irritablility, concentration difficulty, anxiousness, uptightness, and a general malaise are typical symptoms. These symptoms can last for as long as a week.Visual and auditory hallucinations (verbal or musical), particularly that are repetitive in nature, can be very important in the accurate understanding of this condition.

Amnesia and disorientation after the epileptic event are seen often. The dreamy state sometimes misdiagnosed as 'dissociation' can also be attributed to this cause. In the latter stages of the cycle the client may do repeated, simple actions, like singing or shining shoes. This type of client is often confused with either borderline personality disorder or affective disorder. Speech patterns of sticking only to one subject, and deepened emotionality, are also typical. Thus, there are many ways inwhich this type of epilepsy can be misdiagnosed. Again the symptoms that do present are more typically found in females.

Multiple sclerosis is another typically misdiagnosed disorder and typically occurs mainly in women. In the early stages of this disorder, the symptoms usually appear as psychological only (usually in the first 5 to 10 years). They typically appear as hysteria in a classical sense.

Hypomania, cyclothymia, emotional lability, and borderline symptoms will appear in exact proportion to the demylenation that has occurred. These patients tend to experience high rates of  suicidal feelings. Temperature change, stress, and dehydration, can make these symptoms escalate quickly. Because this disorder can be diagnosed on the MRI it can be more easily identified now, than in the recent past, as demylenation does appear on MRI tests.

Mitral valve prolapse also can be improperly labeled. Because of the heart malfunction inherent in this disease, often causing rapid heart beat, palpitations, and other similar symptoms, the symptom of anxiety or panic often appears. It can easily be misclassified, as anxiety or panic disorder.

Lupus is also described because 85% of it's population is female. It's presenting psychiatric symptoms can include psychotic thought disorder with hallucinations, deterioration of cognitive functioning, strokes, focal seizures, and sudden rage attacks. Headaches, pain, and stiffness, are all body symptoms that typically appear.  Lupus needs to be considered in cases of long term depression, schizophrenia, organic brain disorder, conversion disorder, hysteria, somatization, and anorexia, in women.

How can you to interact with the medical community to help your diagnosis be as accurate as possible? Learning the medical language, seeing doctors with whom you have built rapport or feel most comfortable and listened to, can make your medical experience much more effective for you.

Some licensed mental health professionals have specific expertise in this area, also. If you are having difficulty with your present medical care, and need assistance in getting further help, contact licensed mental health professionals in your area. Ask them what experience they have in helping their clients with these issues. Don't be afraid to ask them for detailed information. It is o.k. to talk to a number of licensed mental health professionals, until you find someone who clearly understands your concerns.  Because it is your body, and your health, that is at stake, it is important that you take charge, and seek treatment form those professionals who are truly addressing your concerns.