The thing about diagnoses are, of course they can be misapplied. This is why you need education, training, and experience to apply them. There are criticisms to be made for every DSM diagnosis out there. But I'm behind this one, especially as a PWD.
Do anxiety or obsessive thoughts about your health require special treatments that are different from other anxiety and obsession treatments?
They may. The biggest argument for a special diagnosis is that you need a diagnosis to treat something; simply subsuming somatization or preoccupation about health under a different disorder excludes people who are having problems mentally dealing with physical health, but who do not have one of the other disorders.
To be honest, I'm in favour of this shift because it represents a shift in thinking away from biomedical, towards social and functional. The previous diagnosis put an emphasis on people being responsible for their own pain, and on how the illness is psychosomatic, not "real". It is not so much about whether you have ~a disease~; if you get psychosomatic aches, pains, or nausea, the new diagnosis says, well, okay, that happens, but it's not necessarily a problem. This is a shift away from stigmatizing a normal human event.
Instead of just being the wastebin diagnosis for unexplained pain or illness, this is actually about a mental state. It no longer means "patient is in pain, doctor has no frigging clue". Yes, there is a risk that it will be used as, "patient is complaining, doctor wants them to STFU." Absolutely. But there is actually less risk now that peoples' pain will get written off to somatic issues and ignored, because this diagnosis does not preclude a root physical cause.
Instead it's about whether or not a person with a physical complaint handles their problem in a way that unnecessarily disables them. Which is a knife-edge when you say "unnecessary"; pain-management specialists debate hugely about this. But the purpose of this diagnosis is to ask: is the person adaptively dealing with their symptoms? Are they realistically estimating the risks and benefits of what they're doing? Are they, as far as they are able, living a happy and productive life? Or are their thoughts or feelings about the illness getting in the way?
The other reason you don't want these people just lumped into mood or anxiety disorders is that you would treat them differently. If someone told me, "I can't ever go out to the mall with friends because I'm afraid a velociraptor will leap out of a store and kill me," I can act on the assumption that this velociraptor incident will probably never happen, and my client will not be harmed by me saying, "velociraptors don't exist anymore." With "I can't ever go out to the mall with friends because I'm afraid there will be dust somewhere and I will get an asthma attack," a diagnosis of Somatic Symptom disorder tells me: there IS a physical thing somewhere, but it does not need to be dealt with to this extreme. My client will be harmed by saying, "You'll never get an asthma attack, you're just imagining it."
no subject
Do anxiety or obsessive thoughts about your health require special treatments that are different from other anxiety and obsession treatments?
They may. The biggest argument for a special diagnosis is that you need a diagnosis to treat something; simply subsuming somatization or preoccupation about health under a different disorder excludes people who are having problems mentally dealing with physical health, but who do not have one of the other disorders.
To be honest, I'm in favour of this shift because it represents a shift in thinking away from biomedical, towards social and functional. The previous diagnosis put an emphasis on people being responsible for their own pain, and on how the illness is psychosomatic, not "real". It is not so much about whether you have ~a disease~; if you get psychosomatic aches, pains, or nausea, the new diagnosis says, well, okay, that happens, but it's not necessarily a problem. This is a shift away from stigmatizing a normal human event.
Instead of just being the wastebin diagnosis for unexplained pain or illness, this is actually about a mental state. It no longer means "patient is in pain, doctor has no frigging clue". Yes, there is a risk that it will be used as, "patient is complaining, doctor wants them to STFU." Absolutely. But there is actually less risk now that peoples' pain will get written off to somatic issues and ignored, because this diagnosis does not preclude a root physical cause.
Instead it's about whether or not a person with a physical complaint handles their problem in a way that unnecessarily disables them. Which is a knife-edge when you say "unnecessary"; pain-management specialists debate hugely about this. But the purpose of this diagnosis is to ask: is the person adaptively dealing with their symptoms? Are they realistically estimating the risks and benefits of what they're doing? Are they, as far as they are able, living a happy and productive life? Or are their thoughts or feelings about the illness getting in the way?
The other reason you don't want these people just lumped into mood or anxiety disorders is that you would treat them differently. If someone told me, "I can't ever go out to the mall with friends because I'm afraid a velociraptor will leap out of a store and kill me," I can act on the assumption that this velociraptor incident will probably never happen, and my client will not be harmed by me saying, "velociraptors don't exist anymore." With "I can't ever go out to the mall with friends because I'm afraid there will be dust somewhere and I will get an asthma attack," a diagnosis of Somatic Symptom disorder tells me: there IS a physical thing somewhere, but it does not need to be dealt with to this extreme. My client will be harmed by saying, "You'll never get an asthma attack, you're just imagining it."