By Shirley Mueller, MD

Well-known author Amy Tan had always been a keen observer of life’s subtle clues—after all, unraveling complex family sagas and hidden truths was her literary specialty. Nevertheless, nothing prepared her for the baffling mystery unfolding in her body.

It began quietly one warm July evening in 1999. Attending an outdoor wedding in Dutchess County, New York, Amy barely noticed the small bite on her shin, marked by a tiny black dot in the center of a bright red circle. Spider bite, she thought dismissively, brushing off the curious mark.

The next day, flu-like symptoms crept in—aches, fever, exhaustion. But just as quickly as they arrived, they disappeared, seemingly insignificant. She carried on, attributing lingering aches, stiff neck, and headaches to stress from her busy life.

As the days progressed, she began to feel she was falling apart. Strange symptoms surfaced—numbness in her feet, and bizarre sensations. Something was wrong.

Doctors offered explanations but no real answers. MRIs revealed mysterious lesions on her brain, attributed casually to normal aging. A CAT scan uncovered a tumor on her adrenal gland, prompting surgery that only briefly masked the underlying cause.

Amy felt trapped in a maze of misdiagnoses, each step leading deeper into confusion. Her health worsened—seizures, hallucinations, and frightening episodes of blood sugar crashes. Still, her doctors remained baffled.

What about Lyme disease?

Determined, Amy embarked on her own research. She stumbled on a condition eerily matching her symptoms—Lyme disease. Yet initial tests were negative, and doctors were skeptical.

Unwilling to surrender, she found a Lyme specialist. Rigorous testing followed, and finally, the mystery unraveled. Two positive tests confirmed what Amy had suspected: Lyme disease from that forgotten summer bite, overlooked for years.

Tan’s battle wasn’t over—the treatments were difficult, costly, and sometimes debilitating—but the clarity of knowing provided the strength she needed. Amy Tan had solved her own medical mystery.

Amy Tan’s story is one of a physical disease missed by physicians who did not recognize Lyme disease as the underlying cause. In fact, numerous physical diseases—from infections to endocrine imbalances—can masquerade convincingly as emotional problems.

Misdiagnosis may result in incorrect treatments, prolonged suffering, and, in the worst cases, deaths. This means that it is critical to differentiate true psychological conditions alone from symptoms triggered by an underlying illness. At times, the patient can aid in this investigation.

Mental health symptoms of physical diseases

Parkinson’s Disease: Known for tremors and rigidity, Parkinson’s can also hide emotional disturbances such as depression, anxiety, impulse control issues, and even psychosis, often before any movement problems appear. Ironically, medications for motor symptoms might worsen anxiety.

Coronary Artery Disease and Heart Attacks: Anxiety and depression commonly accompany heart troubles. After a heart attack, up to half of patients experience anxiety, while about one in five faces significant depression.

Pulmonary Embolism: A sudden blockage in the lung’s artery can provoke intense anxiety and fear, mimicking panic attacks. Survivors may grapple with ongoing anxiety and depression.

Seizure Disorders: A specific kind of seizure, Complex partial seizures, emanating from the brain’s temporal lobe, often look like psychiatric disorders due to their emotional, cognitive, and behavioral symptoms. Misdiagnosis can lead to severe health consequences.

Hypoglycemia (Low Blood Sugar): Low blood sugar causes confusion, anxiety, irritability, and altered consciousness, easily mistaken for psychiatric or neurological disorders.

Adrenal Disorders:

• Pheochromocytoma: This adrenal tumor releases adrenaline-like hormones, causing episodes of anxiety, rapid heartbeat, and sweating that closely resemble panic attacks.
• Cushing’s Syndrome: High cortisol levels trigger anxiety, depression, and cognitive impairment, often resolving once cortisol normalizes.
• Encephalitis: Brain inflammation, often autoimmune or infectious, can cause dramatic changes like psychosis, obsessive behaviors, or cognitive dysfunction, sometimes mistaken for severe psychiatric disorders.

Neurosyphilis: Once a common cause of psychiatric hospitalization, neurosyphilis can provoke psychosis, memory loss, and personality changes. Though treatable, recovery from psychiatric symptoms is unpredictable.

Huntington’s Disease: This inherited neurological condition typically brings depression, anxiety, hostility, and psychosis before its characteristic movement disorders appear.

Carcinoid Tumors: These gastrointestinal tumors produce serotonin, causing anxiety, abdominal pain, flushing, and diarrhea, significantly impacting patients’ emotional well-being.

B12 Deficiency: Lacking Vitamin B12 may cause depression, psychosis, ADHD-like symptoms, or obsessive-compulsive behaviors. Supplementation often dramatically reverses symptoms.

Thyroid Disorders:

• Hyperthyroidism: Excess thyroid hormones can stimulate aggression, anxiety, mania, and psychosis.
• Hypothyroidism: Deficient thyroid function can lead to severe depression, cognitive slowing, or even “myxedema madness,” a psychotic condition reversible with hormone treatment.

Hypercalcemia: Elevated calcium levels can dull thinking, provoke confusion, or lead to severe mental status changes, resolving once calcium returns to normal.

Substances: Recreational and prescription drugs—like alcohol, cocaine, ketamine, ecstasy, benzodiazepines, PCP, or even antihistamines—can mimic psychiatric symptoms, emphasizing the importance of careful screening for substance use or withdrawal.

Summary

What initially seems like purely psychological trouble may indeed have roots in physical conditions that, once identified, can often be successfully treated.

Shirley M. Mueller, M.D., is a neuroscientist board certified in neurology and psychiatry. She is also an avid collector. Combining these two disciplines, she wrote Inside the Head of a Collector: Neuropsychological Forces at Play. This article originally appeared in Psychology Today.