When Doctors Say “It’s Just Anxiety”: Medical Gaslighting and Why Patients Stop Trusting Themselves

Medicine is intended to support healing, clarity, and collaborative care. For many patients, however, the clinical encounter becomes a source of uncertainty when symptoms are dismissed as “anxiety” or treated as psychological without adequate evaluation. This article examines current research on misdiagnosis, diagnostic error, and the lived experience commonly described as “medical gaslighting.” The goal is to contextualize why these experiences occur, how they affect health outcomes, and why they contribute to growing mistrust between patients and healthcare systems.

Medical Error, Misdiagnosis, and the Public Health Impact

Diagnostic error refers to a missed, incorrect, or delayed diagnosis that leads to harm. Research has shown that diagnostic error represents a significant source of preventable morbidity and mortality in the United States.

A widely cited analysis published in The BMJ estimated that medical error may contribute to approximately 250,000 deaths per year in the United States. If recorded formally, this estimate would place medical error as a leading cause of death behind heart disease and cancer. This work argues that current public health reporting systems do not adequately capture medical error as a cause of death, which obscures the scope of the problem in national mortality statistics.

Although the “third leading cause of death” framing remains debated within academic and policy communities, subsequent research confirms that diagnostic error and medical harm are both prevalent and consequential. Methodological disagreement does not erase the underlying reality. Patient safety researchers consistently identify diagnostic failure as a major system-level problem.

A 2023 report from Johns Hopkins researchers found that a concentrated group of conditions accounts for a large share of serious harms related to misdiagnosis. Stroke, sepsis, pneumonia, venous thromboembolism, and lung cancer together accounted for an estimated 38 to 40 percent of severe harms linked to diagnostic error. These findings suggest that targeted improvements in high-risk diagnostic categories may prevent substantial amounts of disability and death.

Across multiple studies, the consensus is clear. Diagnostic error is common, it has significant clinical and psychological consequences, and it represents one of the most important opportunities for improving patient safety.

What Patients Describe as “Medical Gaslighting”

The term “gaslighting” originates in psychology and describes a pattern in which a person’s perception or lived experience is invalidated to the point that they question their own reality. In healthcare contexts, “medical gaslighting” is an informal but meaningful descriptor that patients use when their symptoms are minimized, reframed as anxiety, or dismissed without thorough investigation.

Clinicians may describe these encounters in more technical terms, such as diagnostic misattribution or premature closure. Regardless of terminology, the patient experience remains the same. When a complaint is attributed to psychological causes without adequate assessment, diagnostic pathways may be delayed and trust is weakened.

This pattern is more likely to occur in populations that already experience health inequities. Women, autistic and neurodivergent patients, Black and Indigenous patients, and individuals with chronic or poorly understood conditions are disproportionately likely to report dismissal or disbelief in clinical encounters. These disparities mirror broader structural inequities within healthcare delivery and access.

Why Dismissal Causes Harm

1. It Undermines Self-Trust

Repeated invalidation of a person’s bodily experience can erode their ability to interpret and trust their own symptoms. Over time, this may contribute to learned helplessness, confusion about bodily signals, and distress around decision-making related to health.

Patients often describe a slow process of doubting themselves. They begin to ask whether symptoms are “real” or whether they are “overreacting.” This erosion of self-trust can make it harder to seek care when symptoms worsen, which compounds the risk of delayed diagnosis.

2. It Delays Correct Diagnosis

When symptoms are prematurely attributed to stress, anxiety, or psychological factors, further diagnostic evaluation may be postponed. In time-sensitive conditions such as stroke, sepsis, pulmonary embolism, or certain cancers, diagnostic delay can significantly worsen outcomes. Researchers consistently link delayed or missed diagnoses with higher rates of disability, complications, and mortality.

In many cases, dismissal is not intentional harm. It reflects systemic pressures, cognitive shortcuts, and fragmented care environments. The impact, however, remains deeply consequential.

System-Level Contributors to Diagnostic Error

Research identifies several structural and cognitive contributors to misdiagnosis:

• Time constraints and fragmented primary care environments that limit thorough assessment and longitudinal follow-up

• Cognitive bias and premature diagnostic closure, especially when symptoms are nonspecific or do not fit expected patterns

• Underrecognition of atypical presentations in women, older adults, and racially diverse populations

• Inadequate systems for diagnostic review and feedback, which limits learning after errors occur

• Documentation and reporting limitations that prevent medical error from being formally captured in mortality data

These factors highlight that diagnostic error is not solely the result of individual provider behavior. It is also a systems and safety design problem.

Rebuilding Trust and Improving Outcomes

Patient safety researchers emphasize approaches that improve diagnostic reliability while supporting more humane clinical communication. Recommended strategies include:

• Structured second-opinion processes for complex or high-risk presentations

• Focused improvement initiatives in conditions most frequently tied to severe misdiagnosis harms

• Longer or staged appointments for medically complex patients

• Trauma-informed and patient-centered communication practices

• Clear pathways for follow-up when symptoms persist or evolve

Trust is strengthened when clinicians acknowledge uncertainty, validate symptoms, and remain open to diagnostic re-evaluation.

Why This Conversation Matters

When a patient hears “it is just anxiety,” the impact extends beyond a single appointment. It can shape identity, self-perception, and the willingness to seek care in the future. The research on diagnostic error reinforces an important truth. Many individuals who question themselves are not “imagining” their symptoms. They are navigating a healthcare system that is still learning how to recognize complexity, uncertainty, and variability in human illness.

Recognizing this reality creates space for more compassionate medicine. It also empowers patients to trust their lived experience, ask questions, and seek clarification when something feels wrong.

Resources and References

Makary, M. A., & Daniel, M. (2016). Medical error: The third leading cause of death in the United States. The BMJ.

Johns Hopkins Armstrong Institute for Patient Safety and Quality. (2023). Report on serious harms related to diagnostic error.

National Academy of Medicine. (2015). Improving Diagnosis in Health Care.

Singh, H., & Graber, M. Research on diagnostic delay and system-level contributors to error.

Agency for Healthcare Research and Quality (AHRQ). Patient Safety Network resources on diagnostic safety and cognitive bias.

Peer-reviewed literature on disparities in diagnostic accuracy across gender and race (various sources, law and health policy scholarship).