The three forms of medical gaslighting of people with GAD
From a GAD patient perspective, being medically gaslighted occurs when a HCP unjustifiably denies, rejects or downplays the patient’s expressed or reported symptom(s) of a physical health problem. MG may arise in one or more of three forms:
1. The GAD patient does have the physical health problem, and their complaint and symptoms are mistaken for or attributed by the HCP to their GAD symptoms, including the patient’s anxiety behaviour exhibited in their interaction.
2. The HCP has prior knowledge that the patient has or has had GAD in the past, and this informs their clinical judgment of the presence of, or need to investigate their physical health condition, even if no GAD symptoms are currently expressed or observed in the clinical encounter.
3. The person with GAD just believes the HCP’s judgment or decision to be wrong based on their own gut-feeling, knowledge or prior experience.
The three forms of diagnostic overshadowing of people with GAD
Unlike MG, DO is when a GAD patient is given a diagnosis for an expressed or reported physical health condition by a HCP in one of three ways,
1. The HCP overshadows a patient’s complaints of a physical health condition by attributing its expressed or observed symptoms to their GAD (similar to the first form above in the MG list). For example, they may attribute palpitations (a common GAD symptom) to someone’s GAD rather than to an actual or potential cardiac problem, and then decide not to investigate that cardiac issue.
2. A HCP overshadows a physical health condition by attributing its manifestation in anxiety behaviour and symptoms to a patient’s GAD. For example, they may assign someone’s heightened anxiety to a patient’s existing GAD condition, rather than to their genuine undiagnosed thyroid problem (where anxiety is a symptom).
3. Finally, the HCP may newly-diagnose GAD for a patient presenting with anxiety-related symptoms or showing anxiety behaviours instead of diagnosing or agreeing to investigate the reported physical health condition.
Design of survey instrument, sample and timing
Incorporating the above six inter-relating and overlapping forms of MG/DO arising in the experiences of GAD patients and HCPs, two quantitative survey instruments were defined, one for people with GAD and for people without GAD (for comparative purposes using the same survey), and one for GPs in primary care settings. Each was informed by primary literature research into MG/DO, 8 pre-survey one-hour qualitative telephone interviews with GAD persons of mixed gender and age living in England (conducted in March 2023), and 12 one-hour qualitative telephone interviews with a mix of HCPs in primary and secondary care settings in the UK (May 2023). Note that the GAD/non-GAD patient survey asked about people’s MG/DO experiences with several kinds of HCPs, not just GPs.
The two surveys were launched at different times in 2023. The GAD and non-GAD patient survey ran for three weeks in May 2023. The HCP survey ran for two weeks over the end of August and early September 2023.
For survey one (patient), 237 people aged 18+ who currently have Generalised Anxiety Disorder (GAD) were recruited from or in collaboration with the Anxiety UK membership network. For comparison, 259 people aged 18+ without Generalised Anxiety Disorder (GAD) were recruited from a market research company sample panel.
For survey two (GP), 200 GPs responded, all of whom having reported having a consultation about a physical health condition with at least one patient who had Generalised Anxiety Disorder (GAD) within the past two years. This sample included 154 GPs without extended roles/special interests and 46 with extended roles/special interests.
Next, we summarise the survey findings.