Changes to the Somatoform Disorders section of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association potentially will have greater practical impact than revisions of any other section. This will be the case if the tens of millions of patients (in the U.S. alone) with physical symptoms connected to psychosocial stresses are given an appropriate diagnostic term. To that end, I offer the following ideas to revise the Somatoform Disorders section in the next edition, the DSM-5.
Posts Tagged ‘mental health education’
4. Medically Unexplained Symptoms in DSM-5
Friday, February 26th, 20102. Medically Unexplained Symptoms in DSM-5
Wednesday, February 24th, 2010Can 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.
1. Medically Unexplained Symptoms in DSM-5
Monday, February 22nd, 2010The Bible of mental health diagnosis has a glaring omission (1). The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, used worldwide as a reference for classifying and defining mental health disorders, was first published in 1952, listing 106 disorders in 130 pages. The last major revision was released in 1994 (297 disorders, 886 pages), followed by a “text revision” in 2000 (365 disorders, 943 pages). None of these volumes has a diagnostic term appropriate for more than a tiny fraction of Stress Illness patients. (Stress Illness is my term for physical symptoms not fully explained by diagnostic tests that improve when psychosocial stresses are treated.)
3. Medically Unexplained Symptoms in DSM-5
Sunday, February 21st, 2010The next change proposed for the fifth revision of the Diagnostic and Statistical Manual of the American Psychiatric Association (the DSM-5) is the term Complex Somatic Symptom Disorder (CSSD). This is intended to include such disparate conditions as Somatization Disorder, Undifferentiated Somatoform Disorder, Hypochondriasis, Pain Disorder Associated With Both Psychological Factors and a General Medical Condition, and Pain Disorder Associated With Psychological Factors.
Empathy and the Mind-Body Problem (6)
Tuesday, January 19th, 2010At a high school track meet some years ago, one of my sons high-jumped over a bar set at 6’10” (2.08m). If I had spent my entire youth with the best high jump coach in the world I could not have come close to that. I remember telling my children that our abilities resemble Manhattan island, with some buildings reaching a great height and others much lower. (My ability in carpentry resembles a hole in the ground in that analogy.)
Empathy and the Mind-Body Problem (5)
Friday, January 15th, 2010Continuing the story of Carla’s uncontrolled vomiting, I had concluded that it was due to her fear of divine retribution for having a child outside of a marriage and then giving the child up for adoption. She feared that God would punish her by causing her unborn second child to be malformed or diseased.
Empathy and the Mind-Body Problem (4)
Thursday, January 14th, 2010Continuing the story of Carla’s uncontrolled vomiting, at that time I had much to learn about stress illness. Weeks were needed to see how the pieces fit together because, as is usually the case, Carla herself did not comprehend and could not explain what was happening. The first clue was that her illness began when she was a teenage unwed mother who gave up her son for adoption. Second, when Carla was a child, her mother lived just 20 miles away but completely ignored her, causing Carla to feel unworthy and to assume guilt for many life events. Third, she had a strong belief in a God that played a direct, active role in her daily life.
Empathy and the Mind-Body Problem (3)
Wednesday, January 13th, 2010How does empathy help me in understanding a patient’s stress illness? The diagnostic process in stress illness is like putting together a jigsaw puzzle when you: (more…)
Mental Health Professionals and Physicians (Letter)
Friday, December 4th, 2009Building referral pathways from medical to mental health professionals will be a key part of relieving stress illness. Here is an example of a letter written by a mental health professional to a medical clinician offering ideas that could help. (The references below will be discussed in more detail in a future post.)
Mental Health Professionals and Physicians (Intro)
Thursday, December 3rd, 2009Millions of people who could benefit significantly from a few visits with a mental health professional never get the chance. This is because the psychosocial stresses they are coping with manifest primarily as physical symptoms. When they go to a medical office, diagnostic tests are normal because the stress causes no visible damage to the body. Most of the time, neither the physician nor the patient knows what to do next.
