Guidelines for Diagnosing Psychiatric Disorder May Overlook Physical Illnesses
(NEW YORK) -- The addition of a newly-labeled psychiatric disorder called somatic symptom disorder to the Diagnostics and Standards Manual, or DSM-5, has fueled a debate among patients and advocacy groups who fear that broader and "looser" criteria may make it easier for doctors to dismiss patients as mentally ill when in fact they have a physical illness.
Somatic (or bodily) symptom disorder or SSD is characterized by symptoms that suggest physical illness or injury that are either "very distressing" or result in disruption in a person's functioning. The symptoms are also often accompanied by "excessive and disproportionate thoughts, feelings and behaviors," according to the American Psychiatric Association.
Critics worry that patients will be misdiagnosed as mentally ill and won't get treatment, affecting mostly those with chronic and difficult to diagnose neurological disorders and multi-system diseases like ME/CFS, ones that are poorly understood and can take years to get medical answers.
"A lot of people will be written off as crocks -- it's just in their head," said Dr. Allen Frances, who was chair of the task force that created the DSM-4 and professor emeritus of psychiatry at Duke University. "They won't get the medical work-up they need. A lot of times they diagnose it as depression and anxiety and they get stigmatized."
But Dr. Joel E. Dimsdale, chair of the committee that reviewed the SSD diagnosis and professor emeritus in psychiatry at University of California, San Diego disagrees, noting that the new SSD diagnosis replaces four somatic disorders that were "confusing" and rarely used by doctors.
The goal was to simplify the diagnosis, according to Dimsdale. One older diagnosis, somatization disorder, had a checklist of 37 symptoms and was modified three times. "Doctors throw up their hands and can't even keep the stuff straight," he said.
But critics like Frances argue the new diagnosis could "mislabel" 1 in 6 people with cancer and heart disease; 1 in 4 with chronic pain and irritable bowel; and will have an astounding false positive rate of 7 percent in the general population, based on projections from the DSM-5 working groups.
"I think they have gone overboard," said Frances.
Frances is worried about people like Bridget Mildon, a 36-year-old mother of three from Salmon, Idaho, who said she was misdiagnosed with "conversion disorder," an older classification of somatic disorder, when she actually had a rare neurovascular disorder that causes transient seizures or full-blown stroke.
"It took me almost five years to get a doctor to finally reevaluate and look at my symptoms from a different perspective," Mildon said.
But Dimsdale defends the updated DSM, which he said is more "patient friendly" than the older DSM-4, which was written 20 years ago.
“I see it as a useful working guide to help doctors diagnose and treat patients. If it doesn't work, we'll fix it in the DSM-5.1 or DSM-6," said Dimsdale. "Perhaps some people fear they will be labeled or mislabeled, but my perspective is that it's important to treat people who are suffering," he said. "That's what we are about."
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