The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill

BMJ article released today in views and reviews: How may this impact on us and ours?

The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill

BMJ 2013; 346 doi: dx.doi.org/10.1136/bmj.f1580 (Published 19 March 2013)

Lead psychiatrist for DSM-IV voices opposition to DSM-5's new ‘catch-all’ criteria in BMJ, today

"Come May, everyone with chronic medical illness or long-term pain – from cancer to coronary disease, MS to myalgia, becomes a potential candidate for a new mental health label."

Today, BMJ publishes a commentary on the DSM-5 ‘Somatic Symptom Disorder’ by Allen Frances, MD, who chaired the Task Force for DSM-IV, with contribution from Suzy Chapman, Dx Revision Watch:

Full article available without subscription, here:

bmj.com/content/346/bmj.f1580

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  • This is so interesting Nick and regrettably, so true! After three decades in social work, much of it in the medical sector, I can honestly say that this phenomenon is not new. Problematic, demanding patients often found themselves labelled as depressed/hysterical simply because their chronic pain and distress challenged beyond the knowledge and ability of medics. I have to say however, having managed services at a huge University hospital, that it was never in my experience expressed in oncology services.

    The worst examples seemed to be in the perceived 'waste basket' diagnoses such as IBS, fibromyalgia, migraine, tinnitus, chronic fatigue syndrome and unexplained abdominal pain that defied explanation. Some physicians still remain to be convinced that certain of these conditions actually exist! I know many medics would absolutely refute this but in my services, we were often left with the fall-out from...well, the fall out! I've found myself trying to convince doctors of the veracity of a patient's account in the face of mounting belief that much of the malaise had origin in attention seeking behaviour, over-reaction or social and relationship problems. And there's nothing more terrifying for people than to be in genuine medical distress and find themselves patronised or worse.

    I've had these conversations with my own GP as a general discussion. Medics know it happens but would be reluctant to admit it. But they're only human and sometimes patients push them beyond their ability to diagnose and treat. And yes of course some do have genuine psychiatric disorders but they're as valid as any physical illness.

    This extract from the article illustrates beautifully my views on this matter;

    'The late Thomas Szasz once said: “In the days of the Malleus, if the physician could find no evidence of natural illness, he was expected to find evidence of witchcraft: today, if he cannot diagnose organic illness, he is expected to diagnose mental illness.'

    And if all fails it's probably 'a trapped nerve!' Lol

    Newdawn

    (Could I request politely that my real name isn't inadvertently used on this site please as has been done on occasion as this site is more widely circulated and I'd rather not be identified at the moment due to my non CLL disclosure position). Thanks folks!

  • Interesting personal observations very well put Newdawn, which unfortunately are seen Downunder too. It is so very sad when the physical cause of long term suffering isn't able to be diagnosed, further distressing the already marginalised individual, so the 'difficult' patient gets stuck with either a mental illness label or a 'waste basket' diagnosis. Once given one of those labels, the chances of a correct diagnosis rapidly fall towards zero.

    There's also been steady trend with each DSM release to see commonly experienced emotional states becoming classified as mental illnesses. That then leads to possible treatment with mood changing drugs which don't address the root cause and can potentially cause additional problems from side effects.

    Can anyone else see a depressing future world devoid of the wide spectrum of human emotional response, with everyone drugged to the DSM designated 'normal' state?

    Neil

  • The whole idea is ...well... just NUTS! ;-)

  • That made me laugh Canada,how do you get those yellow heads ?i could have lots of fun with those,now who is nuts

  • Medscape: Experts React to DSM-5 Approval medscape.com/viewarticle/77...

    The Times: Psychologists to fight new list of mental illnesses thetimes.co.uk/tto/health/m...

    .

    American psychiatric Association DSM-5 development information website dsm5.org/Pages/Default.aspx

  • Just noticed a small article in today's newspaper about an academic study into the changing use of "mood" words. The study of over 5 million British fiction books published in the last century found that these words were 14% more common on average in books from 1900 than they were in books published in 2000.

    Is the increased use of mood altering drugs partly responsible for this reduction in words reflecting emotion in modern fiction?

    Neil

  • Neil, I'd wager that the use of sexually explicit words has increased in line with the 'mood' word reduction...seems like they skip the pre-amble now and go straight to the event!

    Thinking of the restrictions in the 1900's onwards, the long lingering look and beating heart have been replaced by expressions not to be reproduced here! (Not that I have any personal experience of such literature of course, its purely an academic observation!).

    Flowery language has been replaced with pseudo-medical expressions. People have gone from being delightfully dotty and unpredictable to possible bio-polar disorder! Fifty years ago a dedicated and fastidious housewife would have been just that. Now they'd be suspicions of

    OCD!

    Not sure if mind altering and mood suppressing drugs play a part but it's an interesting theory.

    Newdawn

  • Interesting thoughts. I did find myself almost blurting some creative language to a senior nurse on my last visit for my cardio vascular health check .

    I am quite content with life these days and have adjusted to health issues and having CLL, It was a pleasant day, I believed spring was nearly here (unlike today in this blizzard) and felt really positive as I left home.. I was somewhat surprised when the Nurse on reviewing my records noted that she has observed I am not on antidepressant medication and I felt as if she was suggesting that was wrong and I should be!!

    I left feeling cheesed off!! But glad to feel. On this occasion I didn't wish to be understood or require assistance with an aggravating physical issue, if they hadn't called me in I would have been happy in my garden planting vegetable seeds into precise patterns and ordering seedlings into neat rows ;-)

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