The hidden harms of medical gaslighting

Tens of millions of people in the United States live with chronic, complex medical conditions that lack clear biomarkers and are often dismissed by health care providers. This experience is so prevalent that it has become a silent epidemic eroding patient-physician relationships and perpetuating unnecessary disability (Burke, M. J., JAMA Neurology, Vol. 76, No. 12, 2019opens in new window).

In fact, conditions that are not easily designated for a particular illness accounted for the largest share of medical services spending in the United States in 2021, according to a report from the Kaiser Family Foundation. Fifteen percent of medical expenditures were in this category, more than twice as much as cancer and nonmalignant tumors and almost 3 times as much as mental illness (Cox, C., et al., Health Care Costs and Affordability, Kaiser Family Foundation, 2025opens in new window).

These conditions, which include fibromyalgia, long COVID, endometriosis, chronic fatigue syndrome, and autoimmune disorders, put patients at high risk of experiencing “medical gaslighting,” a term used to describe actions that invalidate a patient’s genuine clinical concerns without proper medical evaluation (Ng, I., et al., American Journal of Medicine, Vol. 137, No. 10, 2024opens in new window). The conditions are often difficult to recognize because many lack objective diagnostic tests that inform clinical diagnosis, or they present as a host of seemingly unrelated symptoms.

Emerging research suggests that this form of dismissal can lead to harmful outcomes, including shame, anxiety about health care visits, avoidance of the health care system, diagnostic delays, and even suicidality for some patients. These burdens also fall heaviest on women, people of color, and individuals with higher weight who already face structural inequities in health care (Shane, K., & Slonim, A. D., Journal of Racial and Ethnic Health Disparities, Feb. 4, 2026opens in new window).

Lessons on Medical Gaslighting, Stigma, and Health Psychology

The following prompts (organized by topic) can support psychology educators in discussing medical gaslighting, health disparities, and the psychology of chronic illness in the classroom.

1. Health psychology and the patient-provider relationship

Research links medical gaslighting experiences to shame, self-doubt, avoidance of medical care, and delays in diagnosis. Using what you know about health psychology and the factors that shape health behavior, explain how repeated experiences of medical invalidation might affect a patient’s willingness to seek help in the future. What role can psychologists play in rebuilding trust between patients and providers?

Reinforces: Health psychology, health behavior, patient-provider communication, nonadherence, delay behavior

Awareness of medical gaslighting and medical invalidation—both terms used to describe when health care providers call into question the reality of a patient’s symptoms—has gained momentum in recent years as researchers explore the causes and consequences of these experiences and how to prevent them. Psychologists are leading efforts to educate providers about medical invalidation and how to better support patients who are suffering from conditions that are difficult to diagnose and treat.

“The experience of medical gaslighting is often cumulative, and it can cause lasting psychological harm and hinder patients’ engagement with the health care system,” said Anna Hayburn, PsyD, a clinical health psychologist at the Cleveland Clinic Neuromuscular Center in Cleveland, Ohio, who works with patients with dysautonomia, postural orthostatic tachycardia syndrome (POTS), long COVID, and other conditions involving autonomic dysfunction. “By learning how the experience of medical trauma can influence behavior, providers can incorporate a trauma-informed approach that rebuilds trust and helps patients receive the care they need.”

Tamara Brand was 15 years old when she encountered medical invalidation for the first time. During menstruation, her abdominal pain felt like someone was stabbing her repeatedly, and sometimes it was so severe that she would vomit or pass out. “My doctors told me it was part of being a woman,” said Brand, who lived in a small town in Minnesota at the time. Her mother, who had endometriosis, advocated for her to undergo a procedure that led to a diagnosis, but the pain continued for years despite treatment. Multiple doctors suggested that she become pregnant because this was known to help some women reduce the symptoms of endometriosis.

“Anytime I saw a new doctor, I couldn’t sleep the night before, and I felt like I was not going to be believed,” said Brand, who is now 46. “I wish I’d had a doctor who took 5 minutes to ask open-ended questions rather than simply looking at my chart to see what I had done for treatment.”

Many researchers of medical gaslighting have encountered medical invalidation personally or worked with patients who were harmed by these interactions. Allyson Bontempo, PhD, a health communication scholar and faculty affiliate at the Center for Prevention Science at Rutgers University, suffers from a complex condition that providers dismissed, and her experience fueled her interest in identifying the processes that lead to symptom invalidation.

She analyzed survey responses from more than 1,000 women with endometriosis, a condition affecting up to 10% of women that is often misdiagnosed because symptoms are minimized or mistaken for irritable bowel syndrome, pelvic inflammatory disease, or mental health issues. The average diagnosis is 5 to 12 years after the onset of symptoms, with most women consulting three or more health care professionals prior to diagnosis (As-Sanie, S., et al., JAMA, Vol. 334, No. 1, 2025opens in new window).

Bontempo identified eight domains in which providers and patients reported dissimilarities, including the cause of symptoms, the label for the diagnosis, the impact of the symptoms on patients’ lives, and patients’ motives for seeking a diagnosis (Qualitative Health Research, Vol. 35, No. 2, 2025opens in new window). For example, pain during sex is a common symptom of endometriosis and other conditions, and some patients reported that clinicians attributed the pain to inadequate lubrication during intercourse. Others reported that their clinicians ascribed their symptoms to psychological factors, such as stress, anxiety, depression, or hypochondriasis. Clinicians also contested the severity of women’s symptoms and the subsequent impact on their ability to function at school or work.

Stigma is another factor that increases the risk of symptom invalidation for patients with endometriosis. Women with this condition often confront stigma on three fronts: menstrual issues, chronic pain, and infertility (European Journal of Obstetrics & Gynecology and Reproductive Biology: X, Vol. 19, Article No. 100228, 2023opens in new window). “Stigma can contribute to diagnostic delay when providers dismiss pain or when people avoid discussing menstrual symptoms,” said Deniz Koçaş, PhD, an assistant professor in the department of psychology at Pace University in New York City.

To better understand the consequences of invalidating patients’ symptoms, Bontempo reviewed studies representing more than 11,000 patients with 13 conditions known to generate clinical uncertainty (Psychological Bulletin, Vol. 151, No. 4, 2025opens in new window). These conditions included endometriosis, POTS, long COVID, and chronic fatigue syndrome. The data showed that self-doubt was the most prevalent feeling among patients who experienced symptom invalidation, and it was characterized by thoughts such as: Is it all in my head? Am I psychologically making myself have this pain? And, am I doing it for attention? Negative moral emotions were also common, such as shame, guilt, humiliation, and feeling foolish.

Hayburn started studying medical gaslighting because many of her patients were suffering from conditions that other providers had dismissed. She coauthored a paper suggesting that the harm people experience as a result of these interactions is often insidious—and that it even mimics the symptoms of post-traumatic stress disorder (PTSD) (Current Psychology, Vol. 43, No. 45, 2024opens in new window).

Many patients have persistent intrusive thoughts or memories of such interactions with health care professionals. “This may present as reactivity, guardedness, or irritability that may be misperceived in subsequent medical encounters,” said Hayburn. “Some people then disengage from health care because of avoidance, while others may overutilize services as a result of health anxiety, such as requesting unnecessary tests or excessive messaging outside of appointments.”

Though this type of medical trauma does not currently meet the diagnostic criteria for a traumatic event, she hopes that the criteria will be revised in the future to help patients access mental health treatment.

Hayburn’s 2024 paper details a fictional case—based on a composite of real patient experiences—of a young Black patient named Kiara whose experience highlights how medical gaslighting becomes a vehicle for medical trauma. Kiara, 24, started suffering from symptoms of dizziness, chest pain, temperature dysregulation, and increased anxiety after a viral illness in early 2020. She was referred to several specialists, but her labs and testing were normal. When she visited the emergency department after feeling faint because of an unusually high heart rate, clinicians told her the symptoms were because of anxiety. She was given prescriptions for antianxiety and antipsychotic medications.

Throughout the next 2 years, Kiara felt providers often treated her dismissively and with suspicion, and that her gender and race contributed to their perceptions of her as irrational and manipulative. She ultimately started avoiding medical care and turned to cannabis for symptom management. Kiara was finally referred to a neurology team that diagnosed her with POTS, a condition that causes alterations in blood pressure and heart rate when transitioning from lying down or sitting to standing.

“I worry about how medical gaslighting might reintroduce harms to patients who are already lacking in privilege or respect from providers because of race, gender, or disabilities,” said Devora Shapiro, PhD, HEC-C, an associate professor of medical ethics at Ohio University–Heritage College of Osteopathic Medicine who coauthored the 2024 Current Psychology paper with Hayburn. Having multiple marginalized identities like Kiara’s—Black, female, contested illness, and suspected psychological diagnoses—can increase the risk that medical gaslighting will magnify the harms patients have already experienced and delay appropriate treatment.

Psychologists such as Hayburn have also seen how weight stigma—the systemic devaluation of people based on the size of their bodies—can influence how providers respond to patients with complex medical conditions. “I frequently see patients whose providers told them that they have symptoms because they are overweight when this is likely not the main contributor,” said Hayburn.

Internalizing negative messages from providers can also lead patients to stop engaging in positive behaviors that help them manage their complex, chronic conditions. “When people feel badly about themselves, they often take poorer care of themselves,” said psychologist Rebecca Pearl, PhD, director of the Body Image and Stigma Lab at the University of Florida. “They might think they are lazy or are not worthy of self-care, which can undermine efforts to adhere to a medication regimen or engage in healthy eating and physical activity.”

While it is difficult to immediately shift away from deeply ingrained societal beliefs that lead to medical gaslighting, psychologists are at the forefront of efforts to prevent these harmful interactions and support patients who have been invalidated. Hayburn teaches medical students at the Cleveland Clinic Lerner College of Medicine that medical gaslighting is a form of trauma and that they will need to rebuild trust with affected patients. One way they can do this is by being clear about the plan of care and following through with the plan. Providers can also be attentive to signs that a patient may have previously experienced medical invalidation, which helps prevent misinterpretation of their concerns or behaviors. These signs could include questioning provider recommendations, delaying or resisting care, or appearing distressed, guarded, or withdrawn (The American Journal of Medicine, Vol. 139, No. 2, 2026).

Hayburn acknowledges, however, that providers often work in systems that breed burnout and give them little time with each patient, making it difficult to help people with complicated health conditions—or even to know which patients have suffered this kind of medical trauma. She also encourages medical students to refrain from claiming greater certainty than is warranted and to acknowledge that there are limits to their medical understanding. “Providers might be tempted to reassure patients that nothing is wrong, but patients know if they are sick,” said Bontempo. “Reassurance may provide short-term psychological relief, but it can perpetuate anxiety.” It is also important for doctors to refer the patient to a specialist or consult with other physicians on symptoms if they do not have a medical explanation.

When providers offer platitudes, they need to remember that those can have serious health consequences. If physicians do in fact suspect that patients have a mental health condition, they need to both refer them to a mental health professional for evaluation and continue to investigate the patient’s symptoms from a medical standpoint, explained Bontempo. Even if a mental health condition is present, it does not automatically rule out the possibility that medical conditions are contributing to a patient’s symptoms as well.

Psychologist James Jackson, PsyD, director of behavioral health at the ICU Recovery Center at Vanderbilt University Medical Center, became aware of medical gaslighting when he started getting referrals for patients with long COVID. He noticed a recurring theme in support groups: Patients knew something was wrong in their bodies, but physicians frequently told them it was anxiety or that they needed more rest. “People were being mildly or aggressively dismissed by sometimes well-meaning providers,” said Jackson, author of Reclaiming Your Life from Medical Trauma, Recognize the Symptoms, Find Treatment That Works, and Heal Your Brain and Body (Little, Brown Spark, 2026). “This dynamic helped me begin to understand that medical gaslighting was a profound problem.”

To better support these patients, he enlisted a social worker to help them access resources such as a disability attorney. He also referred patients to providers who were more open to the idea that certain illnesses are not easily diagnosed and may require a lengthy process to find the best treatment approaches.

In addition, Jackson encouraged doctors to discuss their uncertainty with patients. “Patients want to be listened to and respected, and they are aware that their conditions are complicated,” said Jackson. “We need more providers who are willing to admit that they don’t know what is going on, but they are willing to help patients walk through the journey.”

Psychologists are also developing interventions to help patients struggling with stigma and other challenges related to their complex illnesses. Pearl recently led a study of a counseling group formed to reduce internalized health-related stigma among adults with chronic physical health conditions (JMIR Formative Research, Vol. 9, 2025opens in new window). The participants learned about health-related stigma and how to use therapy techniques to change their thoughts, advocate for themselves, and promote healthy behavior. She is conducting a large, randomized controlled trial of the intervention.

Similarly, in medical trauma support groups at the Vanderbilt Critical Illness, Brain Dysfunction, and Survivorship Center, patients learn how to advocate for themselves during appointments with doctors. Jackson encourages patients to bring a partner, friend, or ally to appointments to help validate their symptoms with providers—and discern if medical gaslighting is occurring.

Psychologists like Jackson who see the consequences of medical invalidation share a sense of urgency to train providers and patients to collaborate in managing illnesses that are chronic, medically complex, and heavily stigmatized. “People who have a negative interaction with one provider often stop trusting other providers who did not gaslight them, and this can morph into a pervasive lack of trust,” said Jackson. “Providers can stop this cycle by partnering with patients to seek healing when conditions do not fit inside the traditional categories for diagnosis and treatment.”