The misdiagnosis of women: development of gendered clinical assumptions

By understanding the history of how healthcare was developed combined with societal expectations of women and girls, we can analyse how gendered clinical assumptions have contributed to misdiagnosis or dismissal of symptoms. Diagnostic frameworks, research, and healthcare guidance all underpin the healthcare system; however, for centuries, these have been developed predominantly around male experiences and interpretations. For women, the consequences can be significant, ranging from delayed treatment to iatrogenic harm. The focus of this commentary is on two key patterns of misdiagnosis: the risk of overdiagnosis of emotionally unstable personality disorder and the under recognition of neurodevelopmental conditions in women. Both may be influenced by the availability heuristic, confirmation bias, and diagnostic tools validated predominantly on male populations. This is influenced by some women being more likely to present with internalising symptoms in some clinical contexts, leading to mental health difficulties and disproportionate exposure to interpersonal trauma. The response to trauma exposure is then attributed to a personality pathology, rather than an expected emotional response. Trauma-informed practice, gender-sensitive screening, and mandatory training in female presentations are argued to be achievable and necessary, and their inclusion in policy and healthcare guidance is urgently needed.