Advocating for yourself: Helpful responses when physical symptoms are attributed to mental health

Doctor’s Office, Thomas Anderson

Medical gaslighting, medical invalidation, or diganosistic overshadowing are all terms for when healthcare providers attribute physical symptoms to mental health conditions. Bias on the part of medical professionals can delay proper medical care, exacerbate mental health issues, and in sever cases lead to death. Here' are some specific ideas to help redirect the conversation toward thorough medical evaluation:

Clarifying the relationship between symptoms and mental health

• "I understand anxiety can cause physical symptoms, but I've had this pain consistently whether I'm feeling anxious or not."

• "I'm hearing that you think my stomach issues are due to anxiety, but I think most people would feel anxious to see blood in their stool."

• "My depression symptoms have been well-managed with my current treatment, yet these physical symptoms continue to worsen."

• "While I do have anxiety, these symptoms feel distinctly different from my typical anxiety responses."

• "I recognize that stress affects my body, but these symptoms began before my recent stress and haven't responded to my usual stress management techniques."

• “My mental health counselor suggested that we rule out any medical issues. She said that my rapid onset of voice-hearing coupled with bulging eyes could be an indication of an underlying health condition. I've been having trouble with communication too, which isn't normal for me.”

Addressing diagnostic overshadowing

• "I have experienced paranoia, but people with psychosis diagnoses have medical issues just like everyone else. How can you be sure this is just paranoia and not [condition] when I'm experiencing 5 out of the 6 known symptoms for it?"

• "I'm concerned we might be missing something if we attribute these symptoms solely to my mental health diagnosis. Can we rule out other potential causes?"

• "My psychiatrist has noted that my mental health is currently stable, yet these physical symptoms persist. Could we explore other potential explanations?"

• "I've lived with depression for years and have become familiar with how it affects me physically. This feels distinctly different and concerning to me."

• "If someone without my mental health history reported these exact symptoms, what tests would you order for them?"

Requesting specific evaluation

• "I understand your perspective, but I'd feel more confident if we could run some basic tests to rule out physical causes before concluding it's related to my anxiety."

• "Given my family history of [medical condition], would it be reasonable to investigate whether these symptoms might be related to that?"

• "I've tracked my symptoms for the past month, and there's no correlation with my anxiety levels. Could we consider other potential causes?"

• "The timing and nature of these symptoms don't align with my mental health fluctuations. Could we consider [specific test] to rule out [specific condition]?"

• "I respect your expertise, but I'm concerned about missing a diagnosis. What specific symptoms would convince you that this requires further medical investigation?"

Setting boundaries

• "I'd like my concerns about these physical symptoms to be documented in my medical record, including my request for further evaluation."

• "While I appreciate your perspective, I need to advocate for my physical health. What would be our next step if these symptoms continue or worsen?"

• "I understand resources are limited, but my quality of life is significantly affected by these symptoms. What options do we have for further investigation?"

• "I've lived with my mental health condition for years and have become familiar with how it affects me physically. This feels distinctly different and concerning to me."

• "I'm not comfortable dismissing these symptoms without further investigation. Can you help me understand what specific tests or referrals might be appropriate?"

• "Unfortunately, I've had medical symptoms dismissed before due to my borderline diagnosis. Last time, I was discharged from the ER without any diagnosis despite severe pain. When I went to a different ER later that day, they diagnosed appendicitis and performed emergency surgery. I'm simply asking for a thorough evaluation of my current symptoms."