Diagnostic overshadowing

Diagnostic overshadowing occurs when symptoms of a new or coexisting condition are attributed to an existing diagnosis, delaying recognition or treatment of the other condition.

Anchoring bias: A cognitive bias in which initial information disproportionately shapes later judgments. An existing diagnosis can anchor clinicians’ interpretations of symptoms that deserve fresh assessment.
Intellectual disability: A developmental condition involving significant limitations in intellectual functioning and adaptive behavior. Communication and support needs can make it harder to distinguish new symptoms from a person’s usual presentation.
Delayed diagnosis: Recognition of a disease or condition later than would be expected with timely evaluation. Symptoms assigned to an existing diagnosis may go unevaluated until the other condition progresses.
Comorbidity: The presence of two or more conditions in the same person. Coexisting diagnoses describe the clinical situation; overshadowing describes a failure to recognize one of them.
Confirmation bias: The tendency to seek or interpret evidence in ways that support existing beliefs. Once a diagnosis is assumed to explain symptoms, confirming evidence can receive more attention than contradictory signs.
Serious mental illness: A mental health condition that substantially interferes with major life activities. Physical complaints may be discounted when clinicians interpret them through an established psychiatric diagnosis.
Patient safety: The prevention of harm to patients during healthcare. Overshadowing creates avoidable risks when treatable conditions are missed or treatment is delayed.
Differential diagnosis: The process of distinguishing among conditions that could explain a person’s symptoms. Considering alternatives is the reasoning practice that helps prevent symptoms being assigned too quickly to one diagnosis.
Premature closure: Ending diagnostic reasoning before sufficient alternatives have been considered. Closing on the established diagnosis can prevent investigation of a second condition.
Autism spectrum: A neurodevelopmental spectrum characterized by differences in social communication and restricted or repetitive behaviors. Changes in behavior or communication can be mistaken for autism-related traits rather than signs of illness.

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