In the last post, I proposed a revision of the Somatoform Disorders section for the next edition of the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association. The DSM-5 group has proposed changing the name from Somatoform Disorders to Somatic Symptom Disorders (SSD) but this term neglects the central role of psychological or cognitive factors. It will also cause confusion with the DSM-5 group’s other new proposal, the term Complex Somatic Symptom Disorder (CSSD). The term CSSD suggests that it is simply a complex form of SSD but that is not at all how the DSM-5 group has defined it. This is why I suggest replacing Somatoform Disorders with Psychosomatic Disorders, not as a diagnostic term (patients consider it stigmatizing) but as a name for this category that is well understood by mental health practitioners, medical clinicians and the public.
Posts Tagged ‘Somatoform Disorder’
5. Medically Unexplained Symptoms in DSM-5
Monday, March 1st, 20104. Medically Unexplained Symptoms in DSM-5
Friday, February 26th, 2010Changes 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.
2. 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.
Smith and Dwamena (2)
Friday, January 22nd, 2010Continuing our review of the Smith and Dwamena paper (1), they describe a spectrum of severity for patients with medically unexplained symptoms (MUS). The few patients who fully meet criteria for Somatoform Disorder (2) are severely ill. The rest range from mild to not quite as severe as those with Somatoform Disorder. The group with mild MUS is the largest. Their symptoms tend to be of short duration, resolve on their own, usually don’t require much medical care and aren’t associated with significant mental health issues. They can be managed with a Stress History (see earlier posts with this tag), observation over time and a minimum of diagnostic tests.
Smith and Dwamena (1)
Thursday, January 21st, 2010We have seen that diagnosis and treatment of medically unexplained symptoms (MUS) in a primary care clinic is completely inadequate (see the posts tagged Kroenke and Blindspot). Smith and Dwamena (1) agree. They point out that MUS patients comprise half or more of all outpatients and often are subjected to the risk and cost of “ill-advised lab testing and trial treatments” and seldom receive adequate treatment in primary care. (If the same could be said of, say, diabetes, there would be an international uproar and diabetes isn’t half as common as MUS.)
