Transdiagnostic approach to understanding persistent physical symptoms, 2025 Chalder et al

[Sly Saint]

Summary​

Persistent physical symptoms (PPS) are associated with functional impairment, psychological distress and high healthcare costs. They often span multiple diagnostic categories, resulting in substantial challenges for patients and healthcare systems. Understanding the shared processes underlying PPS is crucial to improving outcomes. PPS are shaped by complex and interacting psychological and physiological mechanisms, which interact to perpetuate the condition. A transdiagnostic approach, which targets shared underlying processes, may offer a more efficient and effective framework for treatment compared with traditional disorder-specific interventions. This article describes the theory for a transdiagnostic approach and evidence for its effectiveness. We describe several theoretical models and approaches to understanding the underlying mechanisms of PPS, including central sensitisation, avoidance behaviours, emotion dysregulation and cognitive distortions. We describe interventions, particularly those incorporating key principles of cognitive–behavioural therapy. The proposed approach integrates these insights to inform a comprehensive treatment model.

LEARNING OBJECTIVES​

After reading this article you will be able to:

• • understand the challenges and inconsistencies in the nomenclature and classification of PPS
• • describe the shared psychological, behavioural and physiological mechanisms, such as cognitive distortions, avoidance behaviours and body clock dysregulation, that underpin PPS across disorders
• • describe and critically discuss models of understanding PPS, with a principal focus on the transdiagnostic cognitive–behavioural model, and an overview of alternative frameworks.

Persistent physical symptoms (PPS), which include but are not limited to fatigue, pain and gastrointestinal problems, are associated with functional impairment and psychological distress (Picariello Reference Picariello, Ali, Moss-Morris and Chalder2015). They encompass physical symptoms with normal test results and are also frequently associated with long-term physical health conditions. PPS are common, accounting for up to one in five presentations in primary care and around 50% in secondary care clinics (De Waal Reference De Waal, Arnold and Eekhof2004). PPS impose a significant burden on individuals, families, healthcare systems and society, affecting quality of life, relationships and economic productivity. PPS are linked to increased healthcare use, lost work and disability costs.

Transdiagnostic approach to understanding persistent physical symptoms | BJPsych Advances | Cambridge Core

Transdiagnostic approach to understanding persistent physical symptoms

www.cambridge.org

 

[Trish]

Won't they ever stop? Won't they ever learn?

 

[Sly Saint]

Won't they ever stop? Won't they ever learn?

Well at least it's always the same small group of people spouting the same unevidenced or poorly researched drivel.

 

[Utsikt]

Although persistent symptoms may be triggered by a range of physical and psychological stressors, they are often perpetuated by a reinforcing loop of heightened bodily awareness, misinterpretation of sensations, and subsequent avoidance behaviours that continue the cycle of distress and dysfunction. This process is further perpetuated by physiological factors such as autonomic dysregulation and disruptions to the body clock, as well as cognitive and emotional responses like catastrophising, which sustain symptoms.

I wonder how anyone can read this and think that yes, this is able to cause someone that is otherwise physically healthy to be completely bedridden.

 

[Turtle]

Won't they ever stop? Won't they ever learn?

Win for you Trish!
In the introduction ME/CFS is not mentioned
It is not about ME/CFS. Just about fatigue.
Same old, same old bunched together. What a revelation.
Are the authors getting paid for this?
Bring healthcare costs down by cutting out BPS.
Pw ME/CFS will immediately feel better without them.
No more harm by BPS misconceptions.

 

[Andy]

Win for you Trish!
In de introduction ME/CFS is not mentioned
It is not about ME/CFS. Just about fatigue.
Same old, same old bunched together. What a revelation.
Are the authors getting paid for this?
Bring healthcare costs down by cutting out BPS.
Pw ME/CFS will immediately feel better without them.
No more harm by BPS misconceptions.

Sorry to disappoint, they very much include ME/CFS in PPS.

Previous research indicates a notable prevalence of anxiety and depression among people with PPS such as chronic fatigue syndrome (CFS), fibromyalgia, irritable bowel syndrome (IBS) and chronic pain conditions.

 

[Turtle]

Sorry to disappoint, they very much include ME/CFS in PPS.

So strict Andy.
Not in the introduction.

 

[alktipping]

I have came to the opinion that any paper that includes Chalders name to be so poor that it is a complete waste of time to read .

 

[bobbler]

Summary​

Persistent physical symptoms (PPS) are associated with functional impairment, psychological distress and high healthcare costs. They often span multiple diagnostic categories, resulting in substantial challenges for patients and healthcare systems. Understanding the shared processes underlying PPS is crucial to improving outcomes. PPS are shaped by complex and interacting psychological and physiological mechanisms, which interact to perpetuate the condition. A transdiagnostic approach, which targets shared underlying processes, may offer a more efficient and effective framework for treatment compared with traditional disorder-specific interventions. This article describes the theory for a transdiagnostic approach and evidence for its effectiveness. We describe several theoretical models and approaches to understanding the underlying mechanisms of PPS, including central sensitisation, avoidance behaviours, emotion dysregulation and cognitive distortions. We describe interventions, particularly those incorporating key principles of cognitive–behavioural therapy. The proposed approach integrates these insights to inform a comprehensive treatment model.

LEARNING OBJECTIVES​

After reading this article you will be able to:

• • understand the challenges and inconsistencies in the nomenclature and classification of PPS
• • describe the shared psychological, behavioural and physiological mechanisms, such as cognitive distortions, avoidance behaviours and body clock dysregulation, that underpin PPS across disorders
• • describe and critically discuss models of understanding PPS, with a principal focus on the transdiagnostic cognitive–behavioural model, and an overview of alternative frameworks.

Persistent physical symptoms (PPS), which include but are not limited to fatigue, pain and gastrointestinal problems, are associated with functional impairment and psychological distress (Picariello Reference Picariello, Ali, Moss-Morris and Chalder2015). They encompass physical symptoms with normal test results and are also frequently associated with long-term physical health conditions. PPS are common, accounting for up to one in five presentations in primary care and around 50% in secondary care clinics (De Waal Reference De Waal, Arnold and Eekhof2004). PPS impose a significant burden on individuals, families, healthcare systems and society, affecting quality of life, relationships and economic productivity. PPS are linked to increased healthcare use, lost work and disability costs.

Transdiagnostic approach to understanding persistent physical symptoms | BJPsych Advances | Cambridge Core

Transdiagnostic approach to understanding persistent physical symptoms

www.cambridge.org

This is the lie that I find unforgivable:

and high healthcare costs

It's the BS excuse that to me is about sewing the whole undeserving problem patients to try and insinuate that the reason that HCP is feeling overworked and underresourced is the very people who have been given zero healthcare

And using the word 'Burden' so much just makes it clear that this is really gross, grim propaganda aiming to directly influence the attitudes of healthcare professionals towards people who are described in this with untruths. It is unconscionable.

It is also a deliberate inversion of the truth and facts regarding those being targeted by CHalder in this because these are people who have been given no care, and no healthcare and who these people have been suggested if they go near healthcare for anything should be dismissed and diverted elsewhere. For decades.

WHat has been draining the proper healthcare budget however has been grifters - and it is time we add up just how much money those in these kingdoms and the kingdoms themselves have in total been extracting whilst also not helping and who knows if they have even been seeing on the basis of whether they are counting someone turning up once and finding out something is rubbish gets put down as 'a course' even if said person did not attend for however long the course was because it was harmful, useless etc.

And I guess if you are a certain type who is doing that then they would as a tactic try and use pointing the finger elsewhere as a distraction and particularly towards the ones you don't want listened to in case the gravy train facade gets blown.

What I find so unforgivable is just thinking about how much normal healthcare would cost compared to this inflated version that seems to only justify its value based on denigration and 'undeservingness' of its targets, like it is doing everyone a favour whatever it does

 

[bobbler]

Although persistent symptoms may be triggered by a range of physical and psychological stressors, they are often perpetuated by a reinforcing loop of heightened bodily awareness, misinterpretation of sensations, and subsequent avoidance behaviours that continue the cycle of distress and dysfunction. This process is further perpetuated by physiological factors such as autonomic dysregulation and disruptions to the body clock, as well as cognitive and emotional responses like catastrophising, which sustain symptoms.

I wonder how anyone can read this and think that yes, this is able to cause someone that is otherwise physically healthy to be completely bedridden.

It is indeed time for research to start to focus on investigating and researching the type of person who would write these types of things. And why.

Because it isn't either medicine or psychology. The only psychology about it would be looking into the person behind these rumour-spreading made-up pretty unpleasant 'ideas' . Which in the tone chosen read as plain and grumpy bigotry not even this time pretending to be couched as help or giving two hoots but more like the disdainful tone and wording that you hear the type of laypersons who rant about hysterical women etc using.

In case any of us were in any doubt there were cruel to be kind good intentions or genuine misguided belief in them doing it because they want to help and feel sympathy behind this for years..

The tone and focus of this makes it to me an entirely political document/propaganda about targeting a group and why they are a problem and burden, with little of any good intention that I can see.

But then a transdiagnostic approach really in its breakdown of the word means 'don't bother diagnosing anymore anyway, waste of time because we just treat em all the same with re-education' (and no what we re-educate to isn't from any scientific basis, nor is it tested whether it makes them more happy or changes their illness just whether they will perform x behaviours or say they do on a forced survey etc).

Which to me is sort of about selling 'being seen to be dealing with' rather than anyone caring whether the what in that being done or offered being helpful and not harmful or working etc? in itself rather political like 'being seen to be doing something to deal with any other thing that is being sold as a burden or cause of everyone else's misery'?

 

[bobbler]

and if anyone is any doubt whether this is just propaganda

the underlying mechanisms of PPS, including central sensitisation, avoidance behaviours, emotion dysregulation and cognitive distortions

is as blatant as they've ever been at selling 'these people' as:

oversensitive, avoidant, over-emotinal and unable to control their emotion people who are mad and not to be believed because they have 'cognitive distortions'. Aka 'unreliable witnesses'.

From wikipedia: "A cognitive distortion is a thought that causes a person to perceive reality inaccurately due to being exaggerated or irrational."

then

Persistent physical symptoms (PPS), which include but are not limited to fatigue, pain and gastrointestinal problems, are associated with functional impairment and psychological distress (Picariello Reference Picariello, Ali, Moss-Morris and Chalder2015). They encompass physical symptoms with normal test results and are also frequently associated with long-term physical health conditions. PPS are common, accounting for up to one in five presentations in primary care and around 50% in secondary care clinics (De Waal Reference De Waal, Arnold and Eekhof2004). PPS impose a significant burden on individuals, families, healthcare systems and society, affecting quality of life, relationships and economic productivity. PPS are linked to increased healthcare use, lost work and disability costs.

what 'secondary care clinics' are they 'accounting for 50% of cost for'????

Oh.. it is apparently 1 in 5 primary care presentations now apparently is it? Why is noone insisting on better integrity with such claims that of course are used to prime, along with pushing people through flow-charts and closed options for other altneratives, 'bumping of' figures incorrectly for such things by suggesting someone in primary care is 'failing to spot' if they aren't 'getting their 1 in 5'.

These people are doing psychology all right. But it isn't on the patients. And it isn't a type that is about helping anyone's mental or physical health.