Applying the Somatic Symptom Disorder Diagnosis to Individuals with Fibromyalgia: Strengths and Limitations 2024 LoBrutto et al

Abstract

Amidst broad changes to the somatic disorder diagnoses, DSM-IV pain disorder was absorbed into DSM-5’s somatic symptom disorder (SSD) as a specifier. However, clinical research testing of its use for the chronic pain population has been limited and its utility remains inconclusive. Using the exemplar of fibromyalgia, this article evaluates the validity, reliability, clinical utility, and acceptability of the SSD pain specifier. The diagnosis appears to have moderate validity but low specificity for the fibromyalgia population. The pain specifier has neither undergone sufficient field testing nor been evaluated for use by medical providers, with available data suggesting low reliability. Further research is needed to establish clinical utility via assessment of differential treatment outcomes. Concerns about social, legal, and economic consequences of classifying pain patients with a mental health diagnosis are outstanding. The current SSD criteria should be used with caution among the fibromyalgia patient population until its application for chronic pain has been further researched.

Open access, https://link.springer.com/article/10.1007/s10880-024-10005-9

 

The default state of the psychosomatic field.

 

It's like an aggressive mix of the sunk cost fallacy and the foot-in-the-door strategy. They fight to get their foot in the door, then once the systems have bought the BS they have shown themselves unable to walk back from it, to the point where they will avoid making any assessment of efficacy or outcomes, in fact will insist that it's too hard and that the vibes and feels are good enough, after all they are experts and they know better. So all they have to do is push it everywhere, then it becomes the only evidence that's needed.

This is all very similar to drug prohibition. All evidence shows that it makes all outcomes worse, that if the goal is to reduce harms, all prohibition does is increase harms, while massively funding organized crime and terrorists. But it keeps on going because large systems are inherently incapable of complexity analysis about their own performance, especially when it comes to bad policies. It makes them look bad when they admit to it, so they just never do.

Recently I asked both Gemini and ChatGPT for objective evidence of the benefits of the biopsychosocial model, and both admitted that there isn't any at all. All Gemini had is the fact that it's commonly used, and that it has promise and potential for improved well-being that may manifest in time, but even then would be hard to assess objectively or quantitatively. Which is basically the promise of the BPS ideology, but there isn't a single piece of objective evidence that it does that. And clearly it doesn't need that, all they need is to make it used, then being used becomes evidence that it should be used more. So the more it's used, the greater the evidence for its use. Basically, it's like a cancer. The more cancer cells there are, the more it grows.

It would be a fascinating insight into mass delusion, but frankly we got more than enough of those already.

 

The authors of the review study have not published any previous work indicating any clinical exposure to FM patients. They are all psychologists at a university.

They do urge caution using the somatic symptom disorder for FM patients (in the DSM-V) because of potential harm. But it is up to clinician to determine if the psychological symptoms of the patient are more than what is reasonable for their physical symptoms (and thus warrants the SSD diagnosis and also psychological treatment), they say in the review.

Another reason to lie to my doctor and say: my FM is fine. I'm not bothered much by it.

 

"Ultimately, we demonstrate that there are substantial limitations to applying DSM-5 SSD to individuals with fibromyalgia in the absence of additional specifications and research."

More like shuffling the deck chairs on the Titanic in desperation to be seen to be doing 'something'. Sometimes less is more.

Psychology will not solve Fibromyalgia. If it could I'd be doing it.

Psychologising Fibromyalgia helps no one, fails as an argument to deny in medico legal claims (especially if I'm the other expert witness), and makes those that push this tentative 'hypothesis' look like they are grasping at straws.

Who does this help other than to deny insurance claims?

And there are no objective, real life improvements seen post therapy for SSD.

Why even study this or publish the paper? No one serious uses SSD in clinical practice.