Thanks to the new DSM-5, your physical illness may now be labeled a mental disorder.
In 2013 the DSM-V (the manual of Mental Disorders put out by the American Psychiatric Association) added a major new diagnosis: Somatic Symptom Disorder, disregarding protests from more than 50 mental health organizations.
Allen Frances, M.D., the Chair of the previous DSM's task force (DSM-IV) also spoke out strongly against the new DSM's diagnosis of Somatic Symptom Disorder, but he was unable to get the new committee to make changes to what he considers an extremely broad and subjective diagnosis, with harmful repercussions.
Anyone with at least one physical symptom and at least one related mental condition – such as a high level of anxiety or “excessive” preoccupation with the condition – can now be diagnosed with SSD. So if you have cancer, and are “excessively anxious” about it; or you have the beginnings of lupus or multiple sclerosis and no one has yet diagnosed it; or you have diabetes and spend a great deal of time “preoccupied” with managing your blood sugar and diet, then you can be diagnosed with SSD.
Or if you have a very sick child and are anxious and preoccupied with that child’s treatment, your child and you are also eligible for the diagnosis.
What’s wrong with a physically sick person getting treatment for anxiety, too? Nothing, if the person wants it. But the problem with the diagnosis is that it can lead to doctors dismissing actual symptoms as being “somatic” – “all in the head” – and depriving the person of needed treatment for physical diseases.
Or, in the case of Justina Pelletier, the 15 year old girl diagnosed with a mitochondrial disorder by her doctors at Tufts, and somatic disorder by doctors at Children’s, it can lead to being put in a locked psychiatric ward for a year and being taken away from her parents – while deprived of any treatment for her underlying mitochondrial disorder.
Dr. Frances, Chair of DSM-4, says:
http://www.psychologytoday.com/blog/dsm5-in-distress/201212/mislabeling-medical-illness-mental-disorder
Adding to the woes of the medically ill could be one of the biggest problems caused by DSM 5. It will do this in two ways: 1) by encouraging a quick jump to the erroneous conclusion that someone's physical symptoms are 'all in the head'; and 2) by mislabeling as mental disorders what are really just the normal emotional reactions that people understandably have in response to a medical illness.
SNIP
"The DSM-5 Work Group is taking a flying leap into the unknown. There are no published research data on the likely prevalence rates, clinical characteristics or treatment of 'Somatic Symptom Disorder,' or its validity and safety as a construct. Decisions to code or not to code will hang on the arbitrary and subjective perceptions of DSM end-users who often spend very little time with the patient and lack training in psychiatry.
SNIP
In multi-system diseases like Multiple Sclerosis, Behçet’s syndrome or Systemic lupus, it can take several years before a diagnosis is arrived at. In the meantime, patients with chronic, multiple somatic symptoms who are still waiting for a diagnosis would be vulnerable to misdiagnosis as psychiatrically ill.
• DSM-5 allows for a diagnosis of 'Somatic Symptom Disorder' when a parent is considered 'excessively concerned' about a child's symptoms. Families caring for children with any chronic illness may be placed at risk of wrongful accusation of 'over-involvement' with their child's symptomatology or of encouraging 'sick role behavior.' By what means will a practitioner accurately assess an individual's response to illness within the context of the patient's personal, family and economic circumstances and reliably determine what might be considered 'excessive preoccupation' versus a positive coping strategy for that patient and family?
By Toni Bernhard, a former law professor at U Cal/Davis
http://www.psychologytoday.com/blog/turning-straw-gold/201301/your-physical-illness-may-now-be-labeled-mental-disorder
In “Physical Illnesses May Soon Be Labeled ‘Mental Disorders’” (December 27, 2012), I wrote about a disturbing development taking place in the drafting of the fifth edition of the DSM—the manual (published by the American Psychiatric Association) which is used to decide if people have a psychiatric disorder or not. Those who use the DSM to diagnose include a wide range of health care practitioners: psychiatrists and other physicians (such as primary care doctors), psychologists, social workers, occupational and rehab therapists. The list is long.
In that December piece, I described Somatic Symptom Disorder, a new mental illness that was being proposed for the new edition of the DSM. I wrote:
"People can be diagnosed with Somatic Symptom Disorder if, for at least six months, they’ve had one or more symptoms that are distressing and/or disruptive to their daily life, and if they have one (only one) of the following three reactions:
Criteria #1: disproportionate thoughts about the seriousness of their symptom(s);
Criteria #2: a high level of anxiety about their symptoms or health; or
Criteria #3: devoting excessive time and energy to their symptoms or health concerns.
Can you see how this diagnosis potentially includes everything from a stomach ache to cancer?
To repeat, this time using a hypothetical: For six months, you’ve had bad gastrointestinal symptoms that have been 'disruptive to your daily life' because you can’t be far from a bathroom. In the subjective view of a health practitioner, you’ve spent 'excessive time and energy devoted' to trying to figure out what to do about it (criteria #3). The result: you may well be diagnosed as suffering from a mental illness called Somatic Symptom Disorder."
SNIP
Our best hope is to get the press, insurance companies, and our elected officials involved in this issue. If Dr. Frances can show the press that thousands of people are reading and commenting on his articles and on mine, the press may be persuaded to take an interest in this issue.
Elected officials and insurance companies may take an interest if they can be made to see that a diagnosis of Somatic Symptom Disorder will lead to added Medicare, Medicaid, and health insurance costs in the form of unneeded therapy and psychotropic drugs. In addition, this misdiagnosis raises the risk that underlying physical causes of an illness will be ignored and this may lead to an illness going undiagnosed until the point when treatment will result in even more costly medical care. This will drive up health care costs for both government and insurance companies.
If you want to get involved, here's what you can do: share this article with others; contact members of the press (especially medical reporters such as Drs. Sanjay Gupta or Nancy Snyderman); and contact your elected officials. You can use email to do this. As a “sound bite” for those you contact, you could use language like this to get their attention: “Millions of people who suffer from chronic illness will soon be subject to diagnosis as mentally ill.” I’d like to see this as the title of a press release that goes to news sites everywhere.
Another article by Dr. Frances, the Chair of the DSM 4.
http://www.psychologytoday.com/blog/dsm5-in-distress/201301/bad-news-dsm-5-refuses-correct-somatic-symptom-disorder
We have failed and DSM 5 has failed us. For reasons that I can't begin to fathom, DSM 5 has decided to proceed on its mindless and irresponsible course. The sad result will be the mislabeling of potentially millions of people with a fake mental disorder that is unsupported by science and flies in the face of common sense.
I suggested simple wording changes in the DSM 5 definition of SSD that would have tightened it significantly and reduced confusion at the difficult boundary between medical and mental illness. Naively, I thought my suggestions were so obviously necessary that DSM 5 would find them easy to accept and impossible to refuse.
The new criteria set would have made it much clearer that the person's concern about physical symptoms had to be 'excessive', 'maladaptive', 'pervasive', 'persistent', 'intrusive', 'extremely anxiety provoking', 'disproportionate', and 'consuming enough time to cause significant disruption and impairment in daily life'.
SNIP
Suzy Chapman writes:
"Many years ago, the late Thomas Szasz said: 'In the days of the Malleus, if the physician could find no evidence of natural illness, he was expected to find evidence of witchcraft: today, if he cannot diagnose organic illness, he is expected to diagnose mental illness.' DSM 5's loosely defined Somatic Symptom Disorder is Szasz worst fear come true."
= new reply since forum marked as read
I'm sure it's not a coincidence that Justina Pelletier ended up with her somatic disorder diagnosis soon after the new disease classification was announced.
In fact, I'm enjoying a large pizza with chocolate sprinkles for dinner right now. Because to do otherwise would just be obsessive.
