Naming and renaming ‘medically unexplained symptoms’: Is the perfect the enemy of the good? 2026 Horn et al

[Andy]

An editorial published in the Journal of Psychosomatic Research, it is paywalled and doesn't display an abstract. I've posted it here as several of the references visible are to papers on ME/CFS.

Paywall

 

[Peter T]

The authors describe this as a ‘comment letter’ in their AI declaration.

 

[SNT Gatchaman]

To overcome this historical fragmentation, a new common classification was proposed under the umbrella of “Functional Somatic Disorders” (FSD). FSD were designed as an inclusive framework capable of integrating specific somatic syndromes and SSD features under shared brain-body mechanisms.

[…]

We strongly believe that establishing and maintaining a reliable terminology over time is a necessary step to ensure long-term clarity. A stable conceptual foundation benefits both practitioners and patients. First, it reinforces the perception that the disorder is legitimate and recognized, which is critical since the concept of PPS does not align with the classical biomedical model traditionally used in medicine.

[…]

Confronted with this fragmentation and the pressing urgency to treat these costly, disabling pathologies, we must ask: is the perfect the enemy of the good? Considering the effects of terminology instability, it is time to settle on FSD as a unified and pragmatic diagnostic umbrella.

 

[Sly Saint]

To overcome this historical fragmentation, a new common classification was proposed under the umbrella of “Functional Somatic Disorders” (FSD). FSD were designed as an inclusive framework capable of integrating specific somatic syndromes and SSD features under shared brain-body mechanisms.

SSD - somatic symptom disorder previously favoured by Chalder

Thread ''Medically unexplained symptoms' (MUS, PPS, SSD) : Time for NICE to review the 'evidence'?'

Nov 22, 2020

I posted this on another thread

That is the fundamental assumption at the heart of the PPS/MUS model: that all of the conditions categorised as such have a common psychosomatic origin and so can be managed in an identical manner.

exactly this; TC has said as much fairly recently although not using MUS:
"
The term 'somatic symptom disorder' which is very controversial but I really like it.
I like it because the same model can be applied irrespective of the cause of the
symptom"...

• Sly Saint

• 

 

[Peter T]

Confronted with this fragmentation and the pressing urgency to treat these costly, disabling pathologies, we must ask: is the perfect the enemy of the good? Considering the effects of terminology instability, it is time to settle on FSD as a unified and pragmatic diagnostic umbrella.

Struggling to classify and name these conditions, and having no real understanding of their pathology, so treat treat treat.

 

[Sean]

it is time to settle on FSD as a unified and pragmatic diagnostic umbrella.​

No it is not. If you do not know the underlying mechanism of a disorder, what the causal relationships are producing it, then you cannot use a terminology and classification ('functional') that clearly does presume such knowledge.

Idiopathic is the correct word to use in the face of ignorance.

The psychosomatic power grab continues on unrestrained by any actual science or concern for patients.

 

[rvallee]

We strongly believe that establishing and maintaining a reliable terminology over time is a necessary step to ensure long-term clarity. A stable conceptual foundation benefits both practitioners and patients.

There are two concepts here: terminology and conceptual foundations. There are no conceptual foundations, and terminology is distinct from that, in this case it's explicitly a marketing focus. The constant re-branding is part of the lack of actual conceptual foundations, this is well-documented in the literature, and I will not insult the intelligence of the authors by pretending that they are not fully aware of this.

We went from snake oil to concept of snake oil. Humans are so freaking weird.