Autoimmune Diseases in Women: Study Finds Higher Risk of Misdiagnosis and Delayed Diagnosis

Women living with autoimmune diseases may face a significant disadvantage when it comes to receiving an accurate diagnosis. A new international study of more than 6,600 patients found that women were more likely than men to report that their physical symptoms had previously been attributed to psychiatric or psychosomatic causes.

The research, published in The Lancet’s eClinicalMedicine and led by researchers from the University of Cambridge and the University of East Anglia (UEA), highlights the importance of listening carefully to patients when symptoms are persistent, complex or difficult to explain through routine diagnostic tests.

Among the 6,607 people with autoimmune diseases included in the study, 43% of female participants said their autoimmune symptoms had previously been attributed to a psychiatric cause, compared with 33% of male participants. Women were also more likely to report that their symptoms had been described as psychosomatic, meaning physical symptoms were considered to be caused or worsened by psychological factors. This was reported by 34% of women compared with 22% of men.

Why Autoimmune Diseases Can Be Difficult to Diagnose

Autoimmune diseases develop when the immune system mistakenly attacks the body’s own cells, tissues or organs. There are many different autoimmune conditions, including rheumatoid arthritis, lupus and multiple sclerosis, and their symptoms can vary considerably from one person to another.

One reason diagnosis can be challenging is that early symptoms are often not specific to one disease. Fatigue, pain, sleep problems and low mood can occur in many common conditions as well as in autoimmune disorders.

Symptoms may also involve several parts of the body and change over time. A patient may initially consult different specialists for apparently unrelated problems before a pattern becomes clear.

This complexity can create a long diagnostic journey, particularly when there is no single test that definitively identifies a particular autoimmune disease in every patient.

Women Reported Higher Rates of Psychiatric Misattribution

The study’s most striking finding was the difference between women and men in reported experiences of misdiagnosis.

These figures do not mean that psychological factors are never relevant to physical symptoms. Stress, anxiety and other mental health conditions can affect how people experience pain, fatigue and other symptoms. The concern raised by the research is that potentially important physical symptoms may sometimes be prematurely explained by psychological causes before an underlying autoimmune condition is adequately considered.

The researchers also found that female participants were more likely to report delays in receiving a correct diagnosis and, consequently, appropriate treatment.

Why Listening to Patients Matters

Patient history can be particularly important when symptoms do not fit neatly into a single diagnostic category. Patients often notice patterns that may not be obvious during a short clinical consultation, such as symptoms appearing in cycles, affecting different parts of the body or becoming progressively more frequent.

The study reinforces the value of taking these observations seriously, particularly when symptoms persist, evolve or involve multiple body systems.

David D’Cruz, quoted in the study’s reporting, emphasised that clinicians should remain open-minded when symptoms continue or change and consider whether an autoimmune disease has not yet been recognised. He also highlighted the importance of listening to patients.

Autoimmune Diseases Often Affect Multiple Body Systems

Unlike conditions that primarily affect one organ, autoimmune diseases can involve several systems. Depending on the specific disorder, patients may experience combinations of joint pain, fatigue, skin changes, neurological symptoms, digestive problems or other manifestations.

This can make the diagnostic process particularly complicated. A symptom such as persistent fatigue, for example, has many possible causes. Similarly, pain can be associated with musculoskeletal conditions, inflammatory diseases, infections, hormonal changes and numerous other disorders.

The challenge for clinicians is therefore not to assume that every unexplained symptom represents an autoimmune disease, but to recognise when the overall pattern warrants further investigation.

Women Are Disproportionately Affected by Many Autoimmune Conditions

The issue is particularly important because many autoimmune diseases are more common in women. Conditions such as lupus and rheumatoid arthritis disproportionately affect females, although the extent of the difference varies between individual diseases.

The reasons for these sex differences are complex and may involve interactions between genetics, hormones, immune-system regulation and environmental factors. Researchers continue to investigate why women are more susceptible to many autoimmune disorders.

Because autoimmune diseases can already be difficult to identify, any additional barriers to diagnosis may have consequences for treatment and quality of life.

What a Delayed Diagnosis Can Mean

Receiving a diagnosis is more than simply putting a name to symptoms. An accurate diagnosis can determine which treatments are appropriate and whether a patient needs monitoring for complications.

When diagnosis is delayed, patients may continue experiencing symptoms without a clear explanation. They may also undergo investigations or treatments aimed at conditions that do not fully account for their symptoms.

For some autoimmune diseases, early recognition can be particularly important because uncontrolled inflammation or immune activity may cause progressive damage. The impact of delayed diagnosis will differ depending on the specific disease and its severity.

The study therefore raises an important healthcare question: how can clinicians distinguish genuine psychological contributors to symptoms from situations in which psychological explanations may be obscuring an underlying physical disease?

Misdiagnosis Does Not Mean Mental Health Symptoms Are Not Real

It is important to avoid creating a false divide between physical and mental health. Psychological stress and mental health conditions can produce genuine physical symptoms, and people can simultaneously experience an autoimmune disease and anxiety, depression or other mental health concerns.

The central issue is appropriate evaluation. A psychological explanation should not automatically end the investigation when symptoms persist, evolve or fail to respond as expected to treatment.

Likewise, the presence of an autoimmune disease does not mean that every symptom is caused by that disease. A balanced clinical assessment remains essential.

What Patients Can Do When Symptoms Persist

Patients experiencing unexplained or persistent symptoms can help their healthcare team by keeping a clear record of what they experience. Useful information can include when symptoms began, how frequently they occur, factors that worsen or improve them and whether several symptoms appear at the same time.

• Describe the full pattern: Mention symptoms affecting different parts of the body rather than focusing only on the most noticeable complaint.
• Track changes: Note whether symptoms are becoming more frequent, severe or widespread.
• Bring relevant medical history: Previous diagnoses, laboratory results and family history may provide useful context.
• Ask questions: If symptoms remain unexplained, ask what other possible causes are being considered.
• Seek appropriate specialist care: Persistent or complex symptoms may require assessment by a relevant specialist.

Patients should not attempt to diagnose themselves based on symptoms found online. Autoimmune diseases can resemble many other conditions, and testing needs to be interpreted alongside the clinical history and examination.

A Broader Lesson for Healthcare

The study’s findings point to a wider issue in medicine: symptoms that are difficult to measure can sometimes be harder to validate. Fatigue, pain and cognitive difficulties may be deeply disruptive even when routine investigations do not immediately reveal an explanation.

That makes communication between doctors and patients particularly important. A patient’s account should form part of the diagnostic evidence rather than being dismissed simply because a clear biological explanation has not yet been identified.

At the same time, improving diagnostic accuracy requires more than simply ordering additional tests. It requires clinicians to recognise patterns, reassess an earlier diagnosis when the clinical picture changes and consider alternative explanations when treatment does not produce the expected result.

Conclusion

An international study involving 6,607 people with autoimmune diseases found that women were more likely than men to report that their symptoms had previously been attributed to psychiatric or psychosomatic causes. Women also reported greater delays in reaching a correct diagnosis.

The findings highlight the challenges of diagnosing diseases whose symptoms may be subtle, change over time or affect multiple body systems. They also underline why patient experiences and detailed medical histories remain important parts of clinical decision-making.

The key message is not that psychological explanations should be rejected, but that persistent or evolving symptoms deserve thoughtful reassessment. For patients and clinicians alike, recognising patterns, keeping communication open and remaining willing to reconsider an unexplained diagnosis can help move complex autoimmune diseases closer to accurate and timely care.