The Unaware Physician's Role in Perpetuating Somatic Symptom Disorder, 2019, Morabito/Barbi/Giorgio

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https://jamanetwork.com/journals/jamapediatrics/article-abstract/2755837

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November 18, 2019
The Unaware Physician’s Role in Perpetuating Somatic Symptom Disorder
Giuliana Morabito, MD1; Egidio Barbi, MD1,2; Cozzi Giorgio, MD1
Author Affiliations
  • 1Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
  • 2University of Trieste, Trieste, Italy
JAMA Pediatr. Published online November 18, 2019. doi:https://doi.org/10.1001/jamapediatrics.2019.4381



Full Text
Somatic symptom disorder (SSD) is one of the most common complaints in adolescents1,2 and its prevalence is increasing in recent years. The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) defines SSDs as the presence of 1 or more somatic symptoms (commonly pain), that it is associated with excessive worries, and that thoughts and energies are spent dealing with them, causing a loss of opportunities in personal and social lives (eg, school absenteeism, abandonment of leisure and sports activities, and isolation from social settings).
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Evidence shows that physicians are reluctant to diagnose mental health or behavioral problems, preferring to label it as a poorly defined disorder, such as tick-borne or infectious diseases, fibromyalgia, and chronic fatigue syndrome,3-6 with a risk of unjustified and often invasive therapies. Facing a clinical problem that eludes the comfortable borders of a well-known pathology with a well-known pharmacological or surgical solution often leads to a feeling of helplessness and inadequacy in physicians. This issue is not easily addressed and deteriorates further when physicians have to deal with embittered and contentious parents. Personal and interpersonal factors, as well as societal factors, advances in modern technology, and the fear of litigation, contribute to physicians perpetuating overmedicalization.7
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such hubris " physicians overmedicalization" are these idiots going to replace all illnesses with this tripe it seems to me this is the whish of the insurance industry after corrupt courts decided mental health issues were a get out of contract card . truly horrifying way to drag medicine back to the dark ages .
 
Facing a clinical problem that eludes the comfortable borders of a well-known pathology with a well-known pharmacological or surgical solution often leads to a feeling of helplessness and inadequacy in physicians.
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What about the feelings of helplessness and inadequacy in the patients who are left to rot with no help or treatment and no way of getting better unless they are lucky enough to hit upon the solution themselves?

This issue is not easily addressed and deteriorates further when physicians have to deal with embittered and contentious parents.
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It's no surprise that patients are embittered and contentious, given how so many of them are left untreated by the medical profession.
 
Ohh, I'll play another round of Misanthropy-Bingo while my Coco cools down. Fun game. Will only use the posted excerpts though. No, this is probably not worth anyone's time.


Somatic symptom disorder (SSD) is one of the most common complaints in adolescents and its prevalence is increasing in recent years.
The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) defines SSDs as the presence of 1 or more somatic symptoms (commonly pain), that it is associated with excessive worries, and that thoughts and energies are spent dealing with them, causing a loss of opportunities in personal and social lives.
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So we are taking '1 or more symptoms', usually pain, that occupies a person's time in an annoying way. It sounds very believable that such a construct will be a common complaint in any population that is undersupplied medically since there is no need to spend a lot of energy dealing with something that is taken care of properly.

By the way, how much worrying is the right amount? How do I know? I am worried that I occasionally worry too little and then when things get really bad compensate with over-worrying. I am in constant pain that is fluctuating a lot and don't want to offend anyone by not getting this exactly right.


Evidence shows that physicians are reluctant to diagnose mental health or behavioral problems, preferring to label it as a poorly defined disorder, such as tick-borne or infectious diseases, fibromyalgia, and chronic fatigue syndrome, with a risk of unjustified and often invasive therapies.
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So we are dealing with a labeling problem and a poorly defined disorder like e.g. ICC-CFS or an infectious disease is not a preference to a disorder that is defined as '1 or more symptom that is taking up your time'.

Okay.

Moving on.


Facing a clinical problem that eludes the comfortable borders of a well-known pathology with a well-known pharmacological or surgical solution often leads to a feeling of helplessness and inadequacy in physicians.
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That is true, I believe I have seen that happen! But people with those psychological weaknesses usually deflect and project their problems on their perceived source of inadequacy, i.e. they tend to take it out on the patient, so I doubt they actively suffer too much.


This issue is not easily addressed and deteriorates further when physicians have to deal with embittered and contentious parents. Personal and interpersonal factors, as well as societal factors, advances in modern technology, and the fear of litigation, contribute to physicians perpetuating overmedicalization.
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So here we have an admittance that trying to take care of '1 or more symptoms' without clear etiology equates 'overmedicalization'. If those people thought their victims should be treated at all they would have complained about the wrong kind of medicalization, or at least made it more clear that they are talking about a very specific kind of overmedicalizing. So this is where I call 'Bingo'.

Wow. That really wasn't as much fun as I'd hoped.
 
I find this offensive and also think that the authors are perpetuating pseudoscience.

As former adolescent that had what the authors would probably consider somatic symptom disorder, I received a lot of disbelief and indifference and I think they contributed significantly to a worse outcome.

These psychiatrists seem to be unaware that the things they say affect other people's lives. If they are wrong and are spreading false information, they can cause harm. I doubt they could present any convincing evidence that somatic symptom disorder as they describe it really exists and works in the way they believe.
 
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Personal and interpersonal factors, as well as societal factors, advances in modern technology, and the fear of litigation, contribute to physicians perpetuating overmedicalization.
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No danger of creating and perpetuating overpsychologization?

This is reification gone mad. These clowns see only what they want to see. At our expense. :mad:
 
ICD-11's Bodily distress disorder (BDD) with three severity specifiers: Mild, Moderate, and Severe is closely aligned in construct, disorder description and characterization to DMS-5's Somatic symptom disorder (SSD). The WHO's Bodily distress disorder concept term has also been added to SNOMED CT.

The full disorder description text for BDD in the Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD‐11 Mental, Behavioural and Neurodevelopmental Disorders (the equivalent publication to ICD-10's "Blue Book") is not yet available and isn't expected to be released until next year, as field trials/field trial evaluations for some disorders have yet to be completed.

I have been submitting for exclusions for PVFS, (B)ME, and CFS under ICD-11's BDD since 2014.

"Somatic symptom disorder" is an index term in ICD-11 and is listed under Synonyms under 6C20 Bodily distress disorder and indexed to 6C20.Z Bodily distress disorder, unspecified.

The term "Somatic symptom disorder" was added to the U.S.'s ICD-10-CM in 2016, as an inclusion term under F45.1 Undifferentiated somatoform disorder and is a billable code.

Note that Guido den Broeder has publicly opposed the insertion of exclusions for PVFS, (B)ME, and CFS under BDD and claims to have submitted his views to WHO/ICD Revision and has said publicly that he pleased they have taken his views into consideration. To date, Guido has failed to provide evidence to support any submission to WHO/ICD Revision opposing insertion of exclusions.

Diagnostic criteria for DSM-5's SSD can be found here: http://www.workingfit.co.uk/medical...s/dsm-5-somatic-symptom-and-related-disorders
 
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James Morris-Lent said:
@Michiel Tack - is that you they've snuck into the citations?
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Yes, weird. Why don't they cite the evidence that shows that "physicians are reluctant to diagnose mental health or behavioral problems, preferring to label it as a poorly defined disorder, such as ... chronic fatigue syndrome" cause I would be interested in seeing it. I remember papers that suggest underdiagnosis of mental health problems in CFS patients, but that's different from what is being claimed here.

It seems that the authors don't have to provide references for the strong claims they make in this viewpoint.
parents’ catastrophism and hyperprotective attitudes play an important role.
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Investigatory zeal is increasingly being valued over comprehensive biopsychosocial history taking
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These factors contribute to an unjustified hypermedicalization that perpetuates this circle and evokes the risk of an unaware “Munchausen by physician” scenario
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Extract from:

Somatic Symptom Disorder could capture millions more under mental health diagnosis, Suzy Chapman for Dx Revision Watch, May 26, 2012

http://wp.me/pKrrB-29B


15% of “diagnosed illness” and 26% of “functional somatic” captured by SSD criteria

For testing reliability of C[SSD] criteria, three groups were studied for the [DSM-5] field trials:

488 healthy patients; a “diagnosed illness” group of 205 patients with cancer and malignancy (some in this group were said to have severe coronary disease) and a “functional somatic” group comprising 94 people with irritable bowel and “chronic widespread pain” (a term used synonymously with fibromyalgia).

Patients in the study were required to meet one to three cognitions: Do you often worry about the possibility that you have a serious illness? Do you have the feeling that people are not taking your illness seriously enough? Is it hard for you to forget about yourself and think about all sorts of other things?

Dr Dimsdale reports that if the response was “Yes – a lot.” then [C]SSD was coded.

15% of the cancer and malignancy group met SSD criteria when “one of the B type criteria” was required; if the threshold was increased to “two B type criteria” about 10% met criteria for dual-diagnosis of diagnosed illness + Somatic Symptom Disorder.

For the 94 irritable bowel and “chronic widespread pain” study group, about 26% were coded when one cognition was required; 13% coded with two cognitions required.

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Note that after the field trials, the DSM-5 SSD Work Group and Task Force went forward with the looser criteria - requiring only one from the "B type" criteria to meet the diagnosis rather than at least two from the "B type."

This was despite representations from stakeholder groups in the three public review and comment exercises and a personal meeting between Joel E Dimsdale, chair of the SSD Work Group, and Prof Allen Frances who had chaired the Task Force for DSM-IV.


References:

Allen Frances¹, Suzy Chapman². DSM-5 somatic symptom disorder mislabels medical illness as mental disorder. 1 Department of Psychiatry, Duke University 2 DxRevisionWatch.com Aust N Z J Psychiatry. 2013 May;47(5):483-4. doi: 10.1177/0004867413484525 http://www.ncbi.nlm.nih.gov/pubmed/23653063

In collaboration with Professor Allen Frances, chair of DSM-IV task force:

Frances A. DSM-5 Somatic Symptom Disorder. J Nerv Ment Dis. 2013 Jun;201(6):530-1. doi: 10.1097/NMD.0b013e318294827c http://www.ncbi.nlm.nih.gov/pubmed/23719325

Frances A. The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill. BMJ. 2013 Mar 18;346:f1580. doi: 10.1136/bmj.f1580 http://www.ncbi.nlm.nih.gov/pubmed/23511949

Further reading

Feature: Has the manual gone mental? Michael Gross, Current Biology, Volume 23, Issue 8, R295-R298, 22 April 2013 doi:10.1016/j.cub.2013.04.009 (includes quotes from Allen Frances and Suzy Chapman)

Allen Frances, BMJ 2013;346:f1580 BMJ Press Release

Mislabeling Medical Illness As Mental Disorder Allen Frances (with Suzy Chapman), Psychology Today, DSM 5 in Distress, December 8, 2012

Bad News: DSM 5 Refuses to Correct Somatic Symptom Disorder Allen Frances (with Suzy Chapman), Psychology Today, DSM 5 in Distress, January 16, 2013

Why Did DSM 5 Botch Somatic Symptom Disorder? Allen Frances (with Suzy Chapman), Psychology Today, Saving Normal, February 6, 2013

New Psych Disorder Could Mislabel Sick as Mentally Ill Susan Donaldson James, ABC News, February 27, 2013

Somatic Symptom Disorder could capture millions more under mental health diagnosis Suzy Chapman, Dx Revision Watch, May 26, 2012

Submission to DSM-5 SSD Work Group on third draft Suzy Chapman, Dx Revision Watch, June 2012


Somatic Symptom Disorder is discussed in Saving Normal: An Insider’s Revolt Against Out-Of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (pp. 193-6): Allen Frances, William Morrow & Company (20 May 2013).

Also in Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 (Chapter 16): Allen Frances, Guilford Press (14 June 2013).
 
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During the development process for DSM-5, the APA's Task Force undertook no field trials into the validity, reliability, safety, prevalence, acceptability etc of applying a diagnosis of SSD to children and young people.

In the U.S., kids as young as 4 have been diagnosed with SSD. At one point, Justina Pelletier was also diagnosis with "a somatic symptom disorder."


From October 2019:

https://www.lifesitenews.com/news/4...vices-moved-from-foster-care-to-family-friend

4-year-old taken from his home by Texas child services moved from foster care to family friend

...The CPS-funded psychologist had recommended Drake remain in foster care, arguing that he needed to be around healthy children due to a diagnosis of somatic symptom disorder (SSD) in which someone acts sick but is not really sick. The psychologist diagnosed Drake with SSD based on his lack of boundaries and a statement he made about “tubes” and “wheelchairs.”’

“She believes he is not sick, but is acting sick. He has learned to act sick,” Lambert told LifeSiteNews. “She focused on lack of boundaries; he would sit in your lap. Someone pointed out at the hearing that this child has been diagnosed with autism as well.”

[Extract ends]


The DSM-5's SSD diagnosis can also be applied to care givers for adults and to parents, where a parent is considered excessively concerned with a child’s symptoms.

Until the WHO publishes the finalized texts for the Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD‐11 Mental, Behavioural and Neurodevelopmental Disorders (the equivalent publication to ICD-10's "Blue Book") it is unclear whether WHO intends ICD-11's Bodily distress disorder to be applied in children and young people.

Anyway, enough from me...
 
Sean said:
No danger of creating and perpetuating overpsychologization?

This is reification gone mad. These clowns see only what they want to see. At our expense. :mad:
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I don't know what the standards are around the world, but referring to how medicine happens in Canada, there is a principle of absolute immunity for withholding care if it is judged to be inappropriate. It is the act of making a medical decision that begins accountability. Refusing to provide care, like fobbing off chronic patients to the psychological slow death bin is completely without fault and cannot be held accountable under any circumstances. Decisions can bring fault, refusal is absolutely no fault. But this only holds if you ignore what happens to patients, which seems to be the norm.

The framing of litigation is strictly from the perspective of the US, the only country where missing a diagnosis qualifies as tort. So it's interesting that this is very localized and in fact the very opposite is the norm, there is absolutely no danger of missing diagnoses and fobbing off sick people to fend for themselves as it's without fault in most jurisdictions. It's not even a valid complaint, doesn't even get recorded and instead ends up in the trash.

So it seems very self-centered and aimed at protecting physicians without any regard to consequences on patients. Frankly I'm seeing too much of this lately, complete disregard, even contempt, for whatever happens to patients. Everything is about how physicians feel and have to deal with "those patients".

Medicine seems to be following the same descent into madness as politics has done in the past few years, with fringe opinions that used to be hard to voice now commonplace, mocking those they see as fake patients almost seems like a hobby, a comedy routine. This is very dangerous and leading to disaster far beyond what is happening to us.

Patients rights are needed to fix this. This is completely unsustainable and broken. Everything by physicians for physicians, everything about us deliberately excluding and even ignoring us. Massive changes are needed and soon.
 
Michiel Tack said:
Yes, weird. Why don't they cite the evidence that shows that "physicians are reluctant to diagnose mental health or behavioral problems, preferring to label it as a poorly defined disorder, such as ... chronic fatigue syndrome" cause I would be interested in seeing it. I remember papers that suggest underdiagnosis of mental health problems in CFS patients, but that's different from what is being claimed here.
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Physicians don't diagnose those because then they could be held responsible for making spurious diagnoses without evidence. Zero surprise here, this construct has no basis in reality so obviously physicians only use it as an implied dismissal, written in notes but never made official.

Zero reason why anyone would make such a diagnosis, it is detached from reality and doesn't have any evidence whatsoever. Really weird to make a paper essentially whining about why physicians are not making an evidently nonsensical diagnosis.

Physicians routinely do that, they just don't make it official. Because they can't, there is no basis for it, no tests for it, no possible way in this universe with our current technology to make those diagnoses. Instead they are merely implied, very real in practice but leaving no trace anywhere but a few handwritten notes.

The evidence for ME is literally orders of magnitude above this nonsense so clearly evidence, or lack thereof, is not the real issue. This here is a purely ideological crusade that mirrors the same mistakes of the past. This is moral bankruptcy, these people are in the wrong line of work.
 
All the responses look quite annoying on a quick skim.
 
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