Turning physical illness into mental illness

[firecat]

The DSM-IV had several different diagnoses for people who were distressed about their health (somatoform disorders). The DSM-V will have one. That seems like it might be good, but the criteria for diagnosing people with this condition might have been broadened to the point where the diagnosis might be misapplied.

http://www.psychologytoday.com/blog/turning-straw-gold/201301/your-physical-illness-may-now-be-labeled-mental-disorder

"People can be diagnosed with Somatic Symptom Disorder if, for at least six months, they’ve had one or more symptoms that are distressing and/or disruptive to their daily life, and if they have one...of the following three reactions:

Criteria #1: disproportionate thoughts about the seriousness of their symptom(s);

Criteria #2: a high level of anxiety about their symptoms or health; or

Criteria #3: devoting excessive time and energy to their symptoms or health concerns.

Can you see how this diagnosis potentially includes everything from a stomach ache to cancer?

I'm of several minds about this.

Mind 1: I have chronic physical health issues and chronic mental health issues. When my mood disorder isn't well controlled, I absolutely fret about my health a lot more. So I think the state of mind they are describing is something real for some people.

Mind 2: But does the state of mind really need its own name and diagnosis? Can't they just include this as an aspect of mood disorders or obsessive disorders in general? Do anxiety or obsessive thoughts about your health require special treatments that are different from other anxiety and obsession treatments?

Mind 3: I'm concerned that this diagnosis will be used to deny people tests that could determine why they are having symptoms, or deny them treatments that would help them manage the symptoms of their chronic conditions. I'm concerned that it will be disproportionately applied to women and people of color.

More: http://dxrevisionwatch.com/2012/05/26/somatic-symptom-disorder-could-capture-millions-more-under-mental-health-diagnosis/

To meet requirements for Somatization Disorder (300.81) in DSM-IV, a considerably more rigorous criteria set needed to be fulfilled: a history of many medically unexplained symptoms before the age of thirty, resulting in treatment sought or psychosocial impairment. The diagnostic threshold was set high – a total of eight or more medically unexplained symptoms from four, specified symptom groups, with at least four pain and two gastrointestinal symptoms.

In DSM-5, the requirement for eight symptoms is dropped to just one.

Comments

[amethystfirefly]

Ugh. I cannot even. -sigh-

[sauscony]

Thank you for pointing this out. As a person with Crohn's who was told before my diagnosis that it was probably psychosomatic, this is particularly worrying.

[staranise]

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."

[shehasathree]

This is really scary.
I have several systemic diseases/disorders, and several of them have taken many years to diagnose and I have been told many times that my symptoms were "just stress" and in the case of food intolerances they were actually massively improved once I got the right diagnosis and management. It's hard enough to get proper treatment for complex conditions/multiple conditions as it is.

I am also particularly unimpressed with the third bit, which is a perfect example of how we can Never Win, because we're expected to self-manage and 'take control' and responsibility and do healthwork etc but obviously not Too Much.

[badgerbag]

Yeah that's pretty horrible.

[cereus]

"a history of many medically unexplained symptoms before the age of thirty"

Worries me. Because - that's just how things *are* for the many diseases/disorders we *just haven't* figured out yet. Celiac, MS, and many autoimmune disorders were in that category until fairly recently. Hell - Cholera was in that category for a while.

So I'm sure there are lots of people walking around out there with "medically unexplained symptoms".

(Edited to fix capitals)

[flarenut]

I have very mixed feelings about this. On the one hand, It's really easy to see how this will be used by some doctors to say "shut up and stop whining! Oh, and I'm not going to treat your actual physical symptoms either."

On the other, I've seen people who get caught up in their ailments and make a vocation of managing and worrying about them in ways that make it hard for them to do other things and hard to be around them. And if that can be recognized and treated (to some extent separately from the ailments themselves) there will be benefits, like those people having more time to actually live their lives.

(And I think, with others, than there is a difference here between obsessing about symptoms of illness and obsessing about other stuff -- in particular the fact that the illness is actually there.)

[eggcrack]

As if trying to find solutions to health issues that duck all definitions isn't hard enough already. Fuck this.

[sabotabby]

This is interesting; I'll definitely have to consult my friend who's a psychiatrist about it. Oh, and my psychiatrist, I guess.

Because it's definitely a thing; pre-tumor, I wasn't really all that depressed or anxious, even though I have a clinical diagnosis of depression and anxiety. But having my physical health deteriorate rapidly certainly triggered a depression, and it's good to recognize that as a thing. But I can also see the drawbacks to considering it an actual condition.

[bunnybutt.livejournal.com]

Um. I have all three of those symptoms about my symptoms, and in discussions with my PCP, I *should quite reasonably* be having all three of those symptoms about my symptoms. Additionally, some of those symptoms are, in fact, symptoms of physiological conditions for which I am under treatment (or are side effects to the treatments for physiological conditions). None of which adds up to a diagnosis (in my case) for Somatic Symptom Disorder anywhere except on paper in the DSM.

Any chance of seeing you at Pcon this year?

[sophy.livejournal.com]

Not to mention that just about anyone with undiagnosed symptoms, with a new diagnosis, and with newly worsening symptoms are just naturally going to fit those criteria for awhile.