A Closer Look at Gaslighting in Gastroenterology.

Wayne Persky

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If you've been told "your colonoscopy looks normal, so nothing is wrong" despite ongoing debilitating diarrhea, or if a physician has suggested your symptoms are "just stress" or "probably IBS" without taking biopsies or investigating further, you've experienced what medical research now formally recognizes as medical gaslighting — the dismissal or minimization of patient-reported symptoms without adequate justification.

A recent review published in Hepatology Advances brings long-overdue attention to this problem in gastroenterology, confirming what many microscopic colitis (MC) patients have known from painful experience — certain commonly followed policies in modern medicine make certain patients, and certain conditions, particularly vulnerable to being dismissed, delayed in diagnosis, or told their very real symptoms aren't credible (Mustafa, Nima, Klaus, and Anthony, 2026).1

Gastroenterology is particularly vulnerable to patient dismissal.

The review highlights a fundamental issue. Many gastrointestinal disorders, including MC, rely heavily on subjective symptom reporting rather than easily visible objective findings. This creates what researchers call "a perfect environment for dismissal."

Unlike a broken bone visible on X-ray or elevated glucose confirming diabetes, MC requires specific diagnostic criteria, including taking multiple biopsies during colonoscopy, and examining them under a microscope. The colon typically looks normal to the naked eye during the procedure. If the gastroenterologist doesn't take biopsies, or doesn't take enough biopsies from the right locations, the patient will be told that everything is fine despite chronic, watery diarrhea that's destroying the patient's quality of life.

This diagnostic gap, where the patient experiences severe symptoms but standard visualization shows nothing, is precisely where medical gaslighting thrives. When confirmation isn't immediately obvious, clinicians may default to skepticism rather than deeper investigation.

Our own survey verifies the negative effects of gaslighting.

Our own survey, done a couple of years ago, shows that of 1451 MC patients who responded to the survey, only about 59% of them were diagnosed in a year or less. About 24% required from one to 5 years to receive a diagnosis, and about 17% required more than 5 years to receive a diagnosis.

Why MC patients tend to be dismissed:

The research identifies several factors within the system that contribute to this problem, all of which apply directly to MC.

Diagnostic uncertainty is mismanaged.
When physicians cannot immediately explain symptoms, they can downplay them, attribute them to stress or anxiety, or avoid deeper investigation, rather than acknowledging uncertainty and continuing to search for answers. For MC patients, this often means being labeled with IBS and sent away with fiber supplements despite ongoing severe diarrhea, even though the conditions are completely different and require different treatments.

The review emphasizes that uncertainty itself isn't the problem. The problem can be found in how that uncertainty is managed. Saying "I'm not sure what's causing this yet, so let's take the next diagnostic step” would be appropriate. Saying "your tests are normal, so it's probably just stress" is gaslighting.

Time constraints are a factor.
Modern clinical practice often allows only 10 to 15 minutes for appointments, with limited time for complex symptom histories. For MC patients whose symptoms may involve food triggers, medication reactions, fluctuating patterns, systemic effects like joint pain or fatigue, and complex bathroom urgency that's difficult to describe briefly, this time constraint makes thorough evaluation nearly impossible.

Multi-system conditions get oversimplified into single complaints, complex symptom patterns are missed entirely, and the rushed physician focuses only on the most obvious presenting symptom rather than the full clinical picture. The complete story, describing the progression of symptoms, the patterns noticed, and the things that make it better or worse, almost never gets heard.

Implicit bias is common.
Certain groups are disproportionately affected by medical dismissal, and the research documents this clearly. Women's symptoms are more likely to be attributed to psychological causes rather than investigated medically. Patients from marginalized racial and ethnic backgrounds have their pain and symptoms taken less seriously. Socioeconomic factors influence how credible physicians find patient reports.

Since MC affects women far more than men (particularly collagenous colitis, which occurs in women at rates 7 to 9 times higher than men), and primarily affects people over 60 who may already face age-based dismissal, MC patients are especially vulnerable to these biases. Consequently, a 65-year-old woman reporting chronic diarrhea is more likely to be told "it's just part of getting older" or "you're anxious about aging" than a 45-year-old man with identical symptoms.

Communication failures are common.
Gaslighting isn't always intentional. It often arises from poor explanation of diagnostic thinking, failure to validate the patient's experience, and overreliance on false reassurance without actual evidence. When a gastroenterologist says "everything looks fine" after a colonoscopy without biopsies, they may genuinely mean the visual inspection was normal. But the patient hears "nothing is wrong with you," which is categorically false if MC is present.

The physician's failure to explain that "the colon looked normal visually, but we need microscopic examination to rule out certain conditions" creates a communication gap that leaves patients feeling dismissed and confused about why they're still suffering.

Distinguishing gaslighting from appropriate medical uncertainty:

The research makes a critical distinction that MC patients should understand: not all diagnostic uncertainty or physician disagreement constitutes gaslighting. Medicine involves genuine uncertainty, and sometimes multiple evaluation steps are needed before reaching a diagnosis.

Appropriate care includes:

• Acknowledging when something is uncertain or unclear
• Explaining the diagnostic reasoning process
• Continuing to investigate when symptoms persist despite initial negative findings
• Saying "I don't know yet, but let's figure this out together"
• Referring to specialists when symptoms fall outside the physician's expertise
• Validating that the patient is genuinely experiencing the reported symptoms even when the cause isn't yet clear

Gaslighting occurs when:

• Symptoms are dismissed without adequate evaluation (no biopsies taken during colonoscopy for chronic diarrhea)
• Patients are made to feel unreliable, irrational, or overly anxious
• Symptoms are attributed to psychological causes without ruling out medical causes firstThe physician stops investigating despite persistent, severe symptoms
• Patient reports are treated as less credible than test results, even when the test wasn't designed to detect the condition in question

The clinical consequences of dismissal:

The effects of medical gaslighting aren't merely emotional—they're clinically significant and well-documented:

Delayed diagnosis: MC patients may go years, literally years, without correct identification of their condition, during which time they suffer preventable complications like malnutrition, electrolyte imbalances, dehydration, bone loss, and severe quality of life impairment.

Worsening disease: Untreated or mismanaged MC can progress, and complications like severe electrolyte depletion can become dangerous. Additionally, being told to increase fiber intake or take standard anti-diarrheal medications without addressing the underlying inflammation can worsen symptoms.

Loss of trust in healthcare: Patients who have been repeatedly dismissed often disengage from the medical system entirely, avoiding care even when they need it, or delaying seeking help until symptoms become emergencies.

Psychological harm: Patients begin to doubt their own perceptions and reality, wondering if they're imagining symptoms or if something is genuinely wrong. This gaslighting-induced self-doubt can be deeply damaging and can persist even after diagnosis is finally obtained.

Why MC Is particularly vulnerable.

MC has several characteristics that make patients especially susceptible to diagnostic invalidation:

Invisible to standard examination: The hallmark of MC is that the colon looks completely normal during colonoscopy, and diagnosis absolutely requires microscopic examination of biopsies. If biopsies aren't taken, diagnosis is impossible.

Symptom fluctuation: MC often has periods of relative remission followed by flares, making it easy for physicians to dismiss symptoms as exaggerated if the patient happens to be seen during a calmer period.

Highly individualized triggers: Food and medication triggers vary dramatically between patients, making it hard to fit MC into standardized treatment protocols. Physicians unfamiliar with MC may not understand this variability.

Systemic effects are often unrecognized: Fatigue, joint pain, brain fog, and other extra-intestinal symptoms are common in MC but are rarely mentioned in brief diagnostic criteria, leading physicians to view these as separate, unrelated complaints rather than part of the disease pattern.

Overlap with common diagnoses: Because chronic diarrhea is also a symptom of IBS, and because IBS is far more widely known than MC, many physicians stop at IBS diagnosis without considering MC as a differential.

Older patient population: MC primarily affects people over 50, and age-based bias means symptoms in older adults are more likely to be dismissed as "normal aging" or "just part of getting older."

What research shows as solutions.

The review proposes several evidence-based strategies to reduce medical gaslighting, which MC patients can use as a framework for advocating for better care:

Bias-aware communication: Clinicians should recognize their own assumptions, validate patient experiences explicitly, and avoid premature diagnostic closure. For MC patients, this means that physicians should acknowledge that chronic watery diarrhea is not normal, regardless of age or gender of the patient, that symptoms are real and warrant investigation, and that initial negative findings don't close the diagnostic process.

Transparent diagnostic reasoning: Instead of simply dismissing symptoms, providers should explain what has been ruled out with specific tests, what remains uncertain and requires further investigation, and what the logical next diagnostic steps are. For example: "The colonoscopy showed no visible inflammation, which rules out ulcerative colitis and Crohn's disease. However, we haven't yet ruled out MC, which requires biopsies. Let's schedule that next."

Use of standardized diagnostic frameworks: Diagnostic criteria and symptom severity scales provide structure, increase diagnostic confidence, and reduce subjective bias. For MC, this means following established diagnostic algorithms that include biopsy protocols rather than relying solely on clinical impressions.

Multidisciplinary care: Complex conditions often require collaboration across specialties and integration of multiple perspectives. This directly addresses the fragmentation problem in modern medicine where each specialist sees only one piece of the puzzle.

Practical strategies for MC patients facing dismissal: If you're experiencing medical gaslighting in your attempts to diagnose or treat MC, these strategies can help:

Before the appointment:

Keep a journal: Keep a detailed symptom diary including number of bowel movements per day, stool characteristics, foods eaten, medications taken, and any patterns you notice. Objective data is harder to dismiss than general descriptions.

Research your symptoms: Understand that chronic watery diarrhea warrants colonoscopy with biopsies to rule out MC. Being informed helps you advocate effectively.

Prepare specific questions: Write down exactly what you want to ask and bring the written list. Time pressure makes it easy to forget critical questions during an appointment.
g support: Having another person present can help ensure you're heard and can corroborate your account if the physician seems skeptical.

During the appointment:

Be specific and direct: Instead of "I have digestive problems," say "I have 8 to 12 watery bowel movements per day with urgency, and this has continued for six months."

Use the phrase; "This is significantly affecting my quality of life.": Physicians are trained to respond to quality-of-life impact.

Ask directly for biopsies: "I understand the colonoscopy may look normal visually, but I'd like biopsies taken to rule out MC, which is only visible microscopically."

Request explanations: If told "everything is normal," ask "What specific conditions have been ruled out by this test?" and "What conditions haven't been ruled out yet that could cause these symptoms?"

Challenge psychological attributions: If symptoms are attributed to stress or anxiety, respond with: "I'm willing to explore that possibility, but I'd like medical causes ruled out first with appropriate testing."

Ask for documentation: "Can you note in my chart that I requested biopsies and explain why they weren't done?" This creates accountability.

If your symptoms are dismissed:

Get a second opinion: Find a gastroenterologist with specific experience in MC, ideally at an academic medical center.

Request your medical records: You have a legal right to your complete records. Review them for accuracy and to see what the physician actually documented about your visit.

File a patient complaint if appropriate: If you were genuinely dismissed without adequate evaluation, filing a formal complaint with the medical practice or hospital creates a record and may prevent future patients from similar experiences.

Consider a patient advocate: Many hospitals have patient advocates who can help navigate the system and ensure you're heard.

Don't give up: Your symptoms are real. Persistence in seeking proper diagnosis is not being difficult — it's appropriate self-advocacy.

When to escalate concerns:

Certain situations warrant more urgent action:

• You have severe symptoms (more than 10 bowel movements daily, significant weight loss, severe dehydration, blood in stool) that are being dismissed
• A colonoscopy was performed without biopsies despite your specific request for them
• You've been told multiple times "nothing is wrong" but symptoms continue to severely impair your life
• You're being prescribed medications (like fiber supplements or standard anti-diarrheals) that are making symptoms worse, but your physician won't change course
• You feel unsafe, unheard, or actively disbelieved by your current provider

In these cases, finding a new physician isn't giving up — it's recognizing that the current relationship is not serving our medical needs.

Why this recognition matters now:

The formal recognition of medical gaslighting in peer-reviewed literature represents an important shift in medicine. It signals that patient experience is being taken more seriously, that communication is being recognized as a clinical tool with measurable impact, and that systemic flaws in healthcare delivery are being acknowledged rather than denied.

But recognition alone isn't enough. Individual patients still must navigate a system that frequently fails them, and knowledge of these systemic problems doesn't immediately change how individual physicians practice or how rushed appointment schedules fail to allow for complex case evaluation.

The basic problem:

Underlying this entire discussion is a tension at the heart of modern medicine — the medical system excels at analyzing isolated, clearly defined conditions but struggles profoundly with complex, interconnected conditions that don't fit neatly into a single specialty.

MC can involve immune dysregulation, food sensitivities, medication reactions, gut-brain axis disruption, mast cell involvement, autonomic dysfunction, and systemic inflammation. When a condition spans immune, neurological, gastrointestinal, and endocrine systems simultaneously, patients often fall through the cracks between specialties.

The problem is not simply that MC is difficult to diagnose — it's actually quite straightforward once biopsies are taken. The problem is how the medical system responds when symptoms don't immediately fit familiar patterns. The typical response is dismissal, rather than investigation, with premature diagnostic closure rather than systematic evaluation, with assumptions about the patient's credibility rather than assumptions about the limitations of initial testing.

The bottom line:

This research confirms what many MC patients have long known from experience: the problem is not that some conditions are difficult to diagnose — the problem is how the medical system responds to that difficulty.

When diagnostic uncertainty leads to dismissal rather than continued investigation, when normal-appearing colonoscopy results close the diagnostic process despite ongoing severe symptoms, when patient reports are valued less than incomplete test results, patients are left without answers, without treatment, and often without support.

For MC patients, the implications are clear:

Persistent symptoms deserve persistent medical attention. Chronic diarrhea is not normal and is not something you should "just live with."

Lack of visible abnormality does not equal absence of disease. MC is defined by being invisible to the naked eye, and that's why biopsies exist.

Validation is not optional—it's a core component of appropriate medical care. Believing patients when they report symptoms is not being "nice" — it's being competent.

All of us have the right to advocate for thorough evaluation. Requesting biopsies, asking for explanations, seeking second opinions, and insisting on continued investigation when symptoms persist are not being difficult. Those are appropriate ways to advocate for our own healthcare.
Our symptoms are real. Our suffering is real. And we deserve a physician who believes us and is willing to do the diagnostic work necessary to help. If we're not getting that, it's not a failure on our part — it's a failure of the system, and we have every right to seek care elsewhere until we find a provider who takes our symptoms seriously and investigates appropriately.

Medical gaslighting in MC is not rare, it's not just our imagination, and it's increasingly being recognized as a systemic problem that requires systemic solutions. Until those solutions are widely implemented, individual patients must arm themselves with knowledge, documentation, and the confidence to advocate persistently for the care they deserve.

Reference:

1. Mustafa, N., Nima, J., Klaus, M., and Anthony, S. (2026). Medical Gaslighting in Gastroenterology: A Narrative Review from Pediatric and Adult Practice. Hepatology Advances, Retrieved from https://www.ghadvances.org/article/S2772-5723(26)00082-8/fulltext