Harms/Benefits of Somatic Symptom Disorder

Diagnostic Ethics: Harms/Benefits- Somatic Symptom Disorder | Psychology Today

“…a staggering forty-five percent of autoimmune disease patients report having been denied medical care because doctors mistakenly diagnosed their symptoms as somatoform.

While the title of this piece implies there are both harms and benefits, I have not been able to find any benefits of this new DSM V diagnosis.  Many health professionals are already warning about the harm it will cause – especially to people with devastating physical symptoms of an as-yet-undiagnosed illness.

There are five possible explanations whenever someone presents to a doctor with physical symptoms that have not yet been diagnosed:

  • the symptoms may be a manifestation of a medical illness that will be readily diagnosed after careful history, physical exam, and lab testing.
  • they may be a manifestation of a medical illness, but one as yet undetermined -many medical problems remain unclear for long periods of time before accurate diagnosis is made.
  • they may be a manifestation of one of the specific psychiatric disorders typically accompanied by physical symptoms (eg shortness of breath in Panic Disorder, loss of weight in Anorexia Nervosa, fatigue in major depressive disorder).
  • they may be perfectly normal– it is part of human nature for people sometimes to have nonspecific and transient physical symptoms, especially when under stress.
  • they may a manifestation of what DSM 5 calls Somatic Symptom Disorderan exaggerated worry about physical symptoms that has become severe enough to warrant being labelled as mental disorder.

This last category is clearly the most controversial, questionable, and subject to misunderstanding and misuse.

It is already far too easy and common for doctors to dismiss their patients’ concerns about physical symptoms with a spoken or unspoken ‘It’s all in your head.’ This is insulting, stigmatising, and risks missing specific medical and psychiatric conditions that need treatment.

DSM 5 will lead to three types of misdiagnosis: 1) mislabelling as mentally disordered people who really have a medical illnesses; 2) mislabelling as mentally disordered normal people who have nonspecific symptoms and health concerns; and, 3) missing a more specific and treatable psychiatric condition.

As it stands, more than a quarter of patients with chronic pain and a sixth of those with cancer will qualify for a DSM 5 SSD diagnosis. This makes no sense and has stirred appropriate outrage from patients and advocacy groups. http://m.psychologytoday.com/blog/dsm5-in-distress/201301/bad-new…

“In a 2012 paper, the ICD 11 work group offered this summary of its approach to the diagnosis of somatic symptoms: ‘The relevant diagnoses should include a combination of bothersome somatic symptoms with several other psychological features including beliefs about somatic symptoms and evidence of marked concerns about health and illness’. No one knows for sure what definition this will lead to, but it seems likely that ICD 11 will eventually opt for a broadly inclusive Bodily Distress Disorder that will closely resemble DSM 5’s Somatic Symptom Disorder.” http://www.ncbi.nlm.nih.gov/pubmed/23244611

Every time a doctor errs in using your criteria to explain physical symptoms, a patient actually in need of medical care may be denied access to it.

“There is abundant evidence that this kind of error is already causing grave problems across several different medical diagnoses. According to a survey by the American Autoimmune-Related Disease Association, a staggering forty-five percent of autoimmune disease patients report having been denied medical care because doctors mistakenly diagnosed their symptoms as somatoform.https://www.aarda.org/infocus_article.php?ID=15

rare disease patients spend at least three years suffering in search of diagnosis.

Most of them fit your guidelines for BDD during their long diagnostic delay, as they repeatedly seek relief for unexplained symptoms that do eventually turn out to have medical causes.”

the majority of rare disease patients spend at least three years suffering in search of diagnosis. If rare disease were actually rare this figure might not be so disturbing, but there are tens of millions such patients in the US. Most of them fit your guidelines for BDD during their long diagnostic delay, as they repeatedly seek relief for unexplained symptoms that do eventually tirn out to have medical causes.” http://blog.rarediseases.org/30-years-after-the-orphan-drug-act-i…

“Current diagnostic advice for general practitioners is inappropriate. The American Association of Family Physicians urges doctors to make early diagnoses of somatoform disorders in order to save time and to reduce costs. This is based on the common notion that somewhere between 25-75% of their patients’ symptoms are somatoform. Any diagnosis that could conceivably be misapplied to so many patients demands extraordinary caution in definition and application.”

Experts always want to focus increased attention on their pet topic, want to expand its boundaries, and worry much more about missed than about mislabeled patients.

From http://www.psychologytoday.com/blog/saving-normal/201312/diagnostic-ethics-harmsbenefits-somatic-symptom-disorder

6 thoughts on “Harms/Benefits of Somatic Symptom Disorder

  1. abodyofhope

    Being told it is all in our heads is infuriating and a waste of everyone’s time.
    On the other hand, in the rare case of somatoform disorder, one could be treated psychologically and become well. The pain or symptoms they are experiencing are real to them and working through it therapeutically can save them from risky tests, exploratory surgeries, years of money and medication searching for answers to a question that lies in the psyche.
    I am an advocate for chronic pain, but I also went to school for psychology. There is value in chronic pain management counseling and trained therapists would be able to differentiate between a somatic psychological disorder and a neurological pain disorder.
    I am so thankful you are writing about this important issue as so many frustrated physicians claim somatic when they can’t find an answer. Well done!

    Liked by 1 person

    1. Zyp Czyk Post author

      Thanks, bodyofhope! The mind/body connection certainly makes it much harder to figure out how to treat our pain.

      However, treating someone’s mind when the pain has a physical origin allows the suffering to continue. Sadly, that prospect doesn’t seem to bother the anti-opioid crowd. They all seem so convinced that our minds are in control, probably because they firmly believe their own minds are in control. Heck, I did too before my pain!

      Not until they find themselves in circumstances like ours, where the mind is helpless, can they be convinced of the absolute power held by our bodies.

      Holding the ultimate power over life and death, it’s pretty clear to me that the body is far more powerful than the mind.


    2. Raine Nutter

      I was diagnosed with conversion disorder (CD) by a neurologist and sent to a psychiatrist for further evaluation and confirmation, but that psych wasn’t sure it was somatoform disorder and I left his care without a diagnosis. 6 months later, I was diagnosed with hypermobile Ehlers-Danlos Syndrome (hEDS) by a geneticist and started working with a cognitive behavioral therapist (CBT), who confirmed all of my symptoms were hEDS related and completely ruled out CD. I benefited from the time working with him, but only because we knew and addressed the physical causes of my symptoms (I am now aware of what will lead to pain flares, and modify my behavior to avoid pain/injury or plan time to recover if it’s worth participating in the activity). Therapy was beneficial with the CBT, but it was very damaging emotionally to have my physical doctor write off my symptoms as completely mental in nature. If the neurologist has recommended going to psychiatry for support, and requested evaluation during therapy, that would have been okay with me. But dismissing me from his care because his tests were coming back normal was damaging to my trust and respect for doctors.

      Liked by 1 person

      1. Zyp Czyk Post author

        Wow – complete denial of your reality by a doctor, then confirmation by a psychiatrist – what a mind-bender!

        I’m glad you found this psychiatrist who verified your sanity. I once saw a therapist who said I was subconsciously creating my pain so that I’d have an excuse to take opioids to get high. What? First of all, I’ve never gotten “high” and secondly, EDS gives me plenty of pain without creating any extra in my mind.

        Later I was seen by an addiction specialist and she set the record straight: I don’t behave anything like an addict, I’m just a person with pain. She even wrote a letter to my PCP stating this!

        So for you and me both, one mental health worker verified what another doctor claimed didn’t exist. That alone is enough to damage someone’s mental health.


  2. Pingback: Chronic Somatic Disease Definition

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