Diagnostic overshadowing refers to a phenomenon commonly characterised by a person with pre-existing or recently diagnosed mental illness receiving inadequate attention for symptoms of physical illness, which are then misattributed as manifestations of the mental illness. There are potentially several underlying reasons for this, including diagnostic challenges in establishing a medical cause for the presenting symptoms, likely lack of expertise in medicine, stigma directed towards mental illness, a protean or polymorphic presentation not immediately relating to an established nosology, lack of a reliable evidence base in the area leading to an inability to correlate with established medical diagnoses as well as biases towards treating surface-level symptoms instead of identifying the underlying causes.1 The movie Brain on Fire is based on the real life of the New York Post journalist, Susanna Cahalan. She is the protagonist of the movie which vividly dramatises a presentation characterised by psychotic symptoms with an underlying oft-underdiagnosed autoimmune pathology. Her symptoms included subtle perceptual disturbances, fatigue, depressed mood and apparent withdrawal. Gradually, these progressed to frank paranoia and unstable mood. Thus, her presentation was quite polymorphic where symptoms could have been classified as a psychotic or mood disorder. Further striking changes appeared with the onset of seizure episodes, which pointed towards a neurological illness. However, these were disregarded following a lack of clear radiographic and electroencephalographic evidences.
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