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Hidden Disability and Stigma - Dr Mark Burgin

19/08/19. Dr. Mark Burgin BM BCh (oxon) MRCGP considers how to recognise and describe the hidden disabilities and avoid stigmatising those with medically unexplained symptoms.

Recent improvements in diagnosis have led to the identification of many children with hidden disabilities such as autism but adults have largely been excluded.

Even where adults with hidden disabilities were assessed as children they would not have received a diagnosis so believe that their problems are due to lack of application.

Those adults who recognise that they have problems that others cannot see, perhaps unsurprisingly believe that there is nothing that could be done.


A small proportion of the adults with Asperger’s are aware of their diagnosis but there is a greater number of adults who have areas of intelligence and do not fit into the spectrum.

It is relatively easy to recognise that these people are odd or different and have problems with coping with life but may not fit into a particular box.

More helpful is to characterise their difficulties with thinking using disability analysis descriptiors and examples of their impairments to characterise their restrictions.

Emotional distress

Psychiatric diagnosis is limited by the need to fit the symptoms of emotional distress into descriptions of specific illness although recently there has been widening of the criteria.

Disability analysis finds explanations for the patterns of restrictions by using the biopsychosocial model (BPSM) to identify the reasons in a neutral way.

It is easy to blame behaviour problems on the person by calling it ‘bad behaviour’ rather than considering whether an underlying disability is present.

Neurological symptoms

There is a myriad of neurological symptoms which often overlap with normal experience but can be disabling (e.g. fatigue, clumsiness, chronic pain and headaches).

There are few tests available to provide objective evidence and ‘functional’ diagnoses can undermine the patient’s confidence that they are being taken seriously.

Having a neutral description of the disabilities that the person has, rather focusing on a diagnosis which may add little, allows the court to deal with case objectively.


The BPSM can detect medical problems that have not been diagnosed, through the effects that they are having upon the person’s functioning and even suggest a likely cause.

Courts find this type of explanation more accessible and informative than a diagnosis-based approach because it can be used to predict future behaviour.

Until medical science develops tests that show the biological basis of hidden disabilities using disability analysis can confirm restrictions and reduce stigma.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website

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