Diagnostic overshadowing

Last updated

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.

Contents

History

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]

Impact

Diagnostic overshadowing can lead to inadequate medical treatment for physical health conditions in people with mental illnesses, leading to increased mortality and poorer treatment outcomes. [8] [9] The World Health Organization attributes lower life expectancy in people with intellectual disability or mental illnesses in part to diagnostic overshadowing. [10] In addition to diagnostic overshadowing, people with intellectual disabilities experience barriers to accessing quality health care, increasing the likelihood of developing complex health conditions. People with intellectual disabilities are more likely to be impacted by diabetes, hypertension, obesity and on average die 16 years earlier than their peers without ID. [11]

Diagnostic overshadowing can also lead to delays in treatment or support. When a developmental disorder- such as Autism- is not diagnosed due to diagnostic overshadowing, this can lead to a delay in appropriate support being provided. [12]

Prevention

In the UK, the NHS recommends that local NHS trusts "have effective safeguarding arrangements" to prevent diagnostic overshadowing in people with intellectual disability and autism spectrum disorder. [13] Healthcare providers play a significant role in helping to eliminate the risk of diagnostic overshadowing.

Related Research Articles

<span class="mw-page-title-main">Catatonia</span> Psychiatric behavioural syndrome

Catatonia is a complex syndrome, most commonly seen in people with underlying mood or psychotic disorders. People with catatonia have abnormal movement and behaviors, which vary from person to person and fluctuate in intensity within a single episode. People with catatonia appear withdrawn, meaning that they do not interact with the outside world and have difficulty processing information. They may be nearly motionless for days on end or perform repetitive purposeless movements. Two people may exhibit very different sets of behaviors and both still be diagnosed with catatonia. Treatment with benzodiazepines or ECT are most effective and lead to remission of symptoms in most cases.

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

<span class="mw-page-title-main">Asperger syndrome</span> Formerly recognized subtype of autism

Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, was a diagnosis used to describe a neurodevelopmental condition characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other conditions into autism spectrum disorder (ASD) and is no longer a diagnosis in the WHO's ICD-11 or the APA's DSM-5-TR. It was considered milder than other diagnoses which were merged into ASD due to relatively unimpaired spoken language and intelligence.

<span class="mw-page-title-main">Hypochondriasis</span> Medical condition

Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

<span class="mw-page-title-main">Pica (disorder)</span> Compulsive eating of non-food items

Pica is the craving or consumption of objects that are not normally intended to be consumed. It is classified as an eating disorder but can also be the result of an existing mental disorder. The ingested or craved substance may be biological, natural or manmade. The term was drawn directly from the medieval Latin word for magpie, a bird subject to much folklore regarding its opportunistic feeding behaviors.

Pervasive developmental disorder not otherwise specified (PDD-NOS) is a historic psychiatric diagnosis first defined in 1980 that has since been incorporated into autism spectrum disorder in the DSM-5 (2013).

<span class="mw-page-title-main">Conditions comorbid to autism</span> Medical conditions more common in autistic people

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that begins in early childhood, persists throughout adulthood, and is characterized by difficulties in social communication and restricted, repetitive patterns of behavior. There are many conditions comorbid to autism spectrum disorder, such as attention deficit hyperactivity disorder, anxiety disorders, and epilepsy.

High-functioning autism (HFA) was historically an autism classification to describe a person who exhibited no intellectual disability but otherwise showed autistic traits, such as difficulty in social interaction and communication, as well as repetitive, restricted patterns of behavior. The term is often applied to autistic people who are fluently verbal and of at least average intelligence. However, many in medical and autistic communities have called to stop using the term, finding it simplistic and unindicative of the difficulties some autistic people face.

Developmental disability is a diverse group of chronic conditions, comprising mental or physical impairments that arise before adulthood. Developmental disabilities cause individuals living with them many difficulties in certain areas of life, especially in "language, mobility, learning, self-help, and independent living". Developmental disabilities can be detected early on and persist throughout an individual's lifespan. Developmental disability that affects all areas of a child's development is sometimes referred to as global developmental delay.

Medical model is the term coined by psychiatrist R. D. Laing in his The Politics of the Family and Other Essays (1971), for the "set of procedures in which all doctors are trained". It includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment.

<span class="mw-page-title-main">Muteness</span> Medical condition

In human development, muteness or mutism is defined as an absence of speech, with or without an ability to hear the speech of others. Mutism is typically understood as a person's inability to speak, and commonly observed by their family members, caregivers, teachers, doctors or speech and language pathologists. It may not be a permanent condition, as muteness can be caused or manifest due to several different phenomena, such as physiological injury, illness, medical side effects, psychological trauma, developmental disorders, or neurological disorders. A specific physical disability or communication disorder can be more easily diagnosed. Loss of previously normal speech (aphasia) can be due to accidents, disease, or surgical complication; it is rarely for psychological reasons.

Child and adolescent psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.

<span class="mw-page-title-main">Intellectual disability</span> Generalized neurodevelopmental disorder

Intellectual disability (ID), also known as general learning disability, and formerly mental retardation, is a generalized neurodevelopmental disorder characterized by significant impairment in intellectual and adaptive functioning that is first apparent during childhood. Children with intellectual disabilities typically have an intelligence quotient (IQ) below 70 and deficits in at least two adaptive behaviors that affect everyday living. According to the DSM-5, intellectual functions include reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience. Deficits in these functions must be confirmed by clinical evaluation and individualized standard IQ testing. On the other hand, adaptive behaviors include the social, developmental, and practical skills people learn to perform tasks in their everyday lives. Deficits in adaptive functioning often compromises an individual's independence and ability to meet their social responsibility.

<span class="mw-page-title-main">Classic autism</span> Former neurodevelopmental disorder now classified under autism spectrum disorder

Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism, Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

Autism, or autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by repetitive, restricted, and inflexible patterns of behavior, interests, and activities, as well as deficits in social communication and social interaction, and the presence of high or low sensory sensitivity. The underlying spectrum of ASD results in a variety of manifestations and support needs of the disorder. For example, some are nonverbal, while others have proficient spoken language.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

Somatic symptom disorder, also known as somatoform disorder or somatization disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.

Autistic catatonia is a term used to describe the occurrence of catatonia in autistic people. Catatonia is a complex behavioral syndrome typically characterized by immobility, withdrawal, abnormal movements, and abnormal behaviors. According to current diagnostic guidelines, its primary feature is that it causes patients to demonstrate one or more of the following: 1) decreased movement; 2) "decreased engagement during an interview or physical examination," and/or 3) "excessive and peculiar movement."

Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses, which can be misdiagnosed. Misdiagnosis may involve erroneously assigning a BPD diagnosis to individuals not meeting the specific criteria or attributing an incorrect alternate diagnosis in cases where BPD is the accurate condition.

Autism spectrum disorder (ASD) is a neurological disorder affecting one's social interaction, communication, routine, etc. The disorder is observed across the globe. Autism in China is known as 自闭症 or 孤独症 in Chinese. It is also common for autistic individuals to be metaphorically called 来自星星的孩子.

References

  1. 1 2 Shefer, Guy; Henderson, Claire; Howard, Louise M.; Murray, Joanna; Thornicroft, Graham (2014-11-04). "Diagnostic Overshadowing and Other Challenges Involved in the Diagnostic Process of Patients with Mental Illness Who Present in Emergency Departments with Physical Symptoms – A Qualitative Study". PLOS ONE. 9 (11): e111682. Bibcode:2014PLoSO...9k1682S. doi: 10.1371/journal.pone.0111682 . ISSN   1932-6203. PMC   4219761 . PMID   25369130.
  2. ↑ "Diagnostic Overshadowing: See Beyond the Diagnosis". www.intellectualdisability.info. Retrieved 2020-03-28.
  3. ↑ Nash, Michael (2013-02-28). "Diagnostic overshadowing: a potential barrier to physical health care for mental health service users". Mental Health Practice. 17 (4): 22–26. doi:10.7748/mhp2013.12.17.4.22.e862 . Retrieved 2020-03-28.
  4. ↑ S, Jones; L, Howard; G, Thornicroft (2008). "'Diagnostic Overshadowing': Worse Physical Health Care for People With Mental Illness". Acta Psychiatrica Scandinavica. 118 (3): 169–71. doi:10.1111/j.1600-0447.2008.01211.x. PMID   18699951.
  5. ↑ Oxford handbook of learning & intellectual disability nursing. Gates, Bob, 1955-, Barr, Owen. (1st ed.). Oxford: Oxford University Press. 2009. ISBN   9780199533220. OCLC   843212345.{{cite book}}: CS1 maint: others (link)
  6. ↑ Kanne, Steve (2018), "Diagnostic Overshadowing", Encyclopedia of Autism Spectrum Disorders, Springer New York, pp. 1–3, doi:10.1007/978-1-4614-6435-8_398-5, ISBN   978-1-4614-6435-8
  7. ↑ Shefer, Guy; Henderson, Claire; Howard, Louise M.; Murray, Joanna; Thornicroft, Graham (2014-11-04). "Diagnostic Overshadowing and Other Challenges Involved in the Diagnostic Process of Patients with Mental Illness Who Present in Emergency Departments with Physical Symptoms – A Qualitative Study". PLOS ONE. 9 (11): e111682. Bibcode:2014PLoSO...9k1682S. doi: 10.1371/journal.pone.0111682 . ISSN   1932-6203. PMC   4219761 . PMID   25369130.
  8. ↑ Guerin, Bernard (2017-03-16). How to Rethink Mental Illness. doi:10.4324/9781315462615. ISBN   9781315462615.
  9. ↑ "New York Times Survey, December 1985". 1987-10-12. doi:10.3886/icpsr08690.v2.{{cite journal}}: Cite journal requires |journal= (help)
  10. ↑ Senior, K. (2009-04-01). "Greater needs, limited access". Bulletin of the World Health Organization. 87 (4): 252–253. doi: 10.2471/blt.09.030409 (inactive 5 December 2024). ISSN   0042-9686. PMC   2672575 . PMID   19551229.{{cite journal}}: CS1 maint: DOI inactive as of December 2024 (link)
  11. ↑ Hosking, Fay J.; Carey, Iain M.; Shah, Sunil M.; Harris, Tess; DeWilde, Stephen; Beighton, Carole; Cook, Derek G. (2016). "Mortality Among Adults With Intellectual Disability in England: Comparisons With the General Population". American Journal of Public Health. 106 (8): 1483–1490. doi:10.2105/AJPH.2016.303240. ISSN   0090-0036. PMC   4940652 . PMID   27310347.
  12. ↑ Milen, Mathew T.; Nicholas, David B. (2017-05-16). "Examining transitions from youth to adult services for young persons with autism". Social Work in Health Care. 56 (7): 636–648. doi:10.1080/00981389.2017.1318800. ISSN   0098-1389. PMID   28506122. S2CID   13769643.
  13. ↑ "The learning disability improvement standards for NHS trusts" (PDF). www.england.nhs.uk. June 2018. Archived from the original (PDF) on 2023-07-03. Retrieved 2023-07-03.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.