Women with autoimmune disease less likely to be believed

Clinical takeaway: When patients present with persistent, evolving, or multisystem symptoms, keep autoimmune disease on the differential and revisit early assumptions, particularly before attributing symptoms to psychiatric or psychosomatic causes.

Autoimmune diseases often begin with nonspecific symptoms such as fatigue, pain, sleep disturbance, and low mood, making diagnosis difficult. Delayed recognition can postpone treatment and contribute to worse outcomes, while perceived misdiagnosis may erode trust and discourage future care-seeking.

In an international cross-sectional survey of 6,607 adults with autoimmune diseases, women reported more difficult diagnostic journeys than men. About 43% of women said their symptoms had initially been attributed to a psychiatric condition, compared with 33% of men. Likewise, 34% of women reported a psychosomatic misdiagnosis versus 22% of men. After accounting for factors including age, disease type, geographic region, and financial status, women remained roughly 50% more likely to report a psychiatric misdiagnosis and about 75% more likely to report a psychosomatic misdiagnosis.

Women also described longer delays before receiving a correct diagnosis. Nearly half of men reported being diagnosed within 1 year of symptom onset, compared with about 40% of women. Long diagnostic delays of 4 years or more were reported by 32% of women versus 26% of men. Women were also more likely to report seeing 11 or more clinicians before diagnosis (26% vs 18%).

Patterns varied by disease. Conditions with clearer biomarkers or visible manifestations, such as type 1 diabetes and rheumatoid arthritis, had lower rates of psychiatric and psychosomatic misdiagnosis, whereas diseases with less definitive diagnostic features showed higher rates. Notably, high rates of perceived misdiagnosis were reported by both sexes, underscoring the broader challenges of recognizing autoimmune disease early.

“Our findings highlight that psychological or mental health explanations can be given too soon,” said lead author Melanie Sloan, PhD. “This is true for both sexes, but our study suggests that females may be particularly vulnerable to these types of misdiagnoses.”

Source: Sloan M, et al. (2026 Oct 12) eClinicalMedicine. Sex and disease differences in patients’ diagnostic experiences in autoimmune diseases: an international cross-sectional study