Diagnostic Overshadowing and Pain Insensitivity in a Schizophrenic Patient With Perforated Duodenal Ulcer

Some patients with schizophrenia and psychotic illnesses have reduced pain perception, and others have decreased pain expression. The diagnosis of the acute abdomen can be delayed, and its outcomes can be worse in psychiatric patients than in non-psychiatric patients. We present a case of perforated peptic ulcer (PPU) in a schizophrenic woman and discuss how the phenomenon of pain insensitivity and diagnostic overshadowing-a process in which a person with mental illness receives inadequate treatment due to a misattribution of physical symptoms to their mental illness-nearly contributed to a missed diagnosis.