Diagnostic overshadowing
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Diagnostic overshadowing is the attribution of a person's symptoms to a psychiatric problem when such symptoms actually suggest a comorbid condition.[1] Diagnostic overshadowing occurs when a healthcare professional assumes that a patient's complaint is due to their disability or coexisting mental health condition rather than fully exploring the cause of the patient's symptoms. Often, once a patient has a confirmed diagnosis, there is a tendency to attribute all new behaviors or symptoms to the original diagnosis.[2] Diagnostic overshadowing increases the risk of further health complications and delay in accurate treatment.[3] An example of diagnostic overshadowing may be a patient being diagnosed with a psychiatric problem and prescribed medication due to head banging behavior, but the patient actually has communication challenges and can't express pain in their mouth due to a dental abscess.
The term was first used to describe the underdiagnosis of mental illness in people with intellectual or developmental disabilities.[1] In recent years, the term has also been used when physical illnesses are overlooked in people with mental illness.[4]
Causes
Diagnostic overshadowing can occur for several reasons. Diagnostic shadowing most often occurs when a new behavior develops or previous abnormal behaviors increase.[5] Staff inexperienced with working with people with intellectual disability are also more likely to mistakenly attribute symptoms of a physical illness to a person's intellectual disability.[6] Time pressures of healthcare providers and stigma have been found to be additional causes of diagnostic overshadowing.[7]