Can we repair the gaping hole in how we classify patients with medically unexplained symptoms (MUS)? Changes are proposed for the fifth revision of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (the DSM-5, due out in May, 2013). Unfortunately, the proposals don’t solve the problems. To see for yourself, you can review and comment here until April 20, 2010. To comment, you first need to register so you can log in with a password. Then you need to go to the Somatoform Disorders and scroll down to find the comment window.
The first proposal is for a new name for patients with MUS: Somatic Symptom Disorders (somatic means “body”). This is a significant improvement over the current term Somatoform Disorders, which is used almost exclusively by mental health practitioners and applies only to a tiny percentage of Stress Illness (1) patients. Somatic Symptom Disorders (SSD), as a phrase, will make sense to medical as well as mental health practitioners, which is essential since collaboration between these groups is needed for optimal care.
The proposed SSD category will include several mental health diagnoses. These are Somatoform Disorders, Psychological Factors Affecting Medical Condition (PFAMC), and Factitious Disorders “because the common feature of these disorders is the central place in the clinical presentation of physical symptoms and/or concern about medical illness” (from the APA web site).
SSD is a reasonable name for this varied group of conditions. If you are unfamiliar with them, Somatoform Disorder is of many years duration, begins before age 30, is more common in women, and has (over a lifetime) at least four pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one pseudoneurological symptom. PFAMC could be any of a range of psychological or medical issues and in Factitious Disorder, the patient intentionally produces symptoms of illness or feigns illness for psychological reasons rather than for environmental goals.
Unfortunately, none of these includes Stress Illness patients and the SSD term can be improved upon. More in the next post.
1. Stress Illness is my term for physical symptoms not fully explained by diagnostic tests that improve when psychosocial stresses are treated.
Tags: DSM, medical education, mental health education, Somatoform Disorder
