In January, I told you that people with fibromyalgia were in danger of being labeled with a mental disorder due to a new diagnostic category––Somatic Symptom Disorder (SSD)––being added to the 5th edition of the American Psychological Association's (APA) Diagnostic and Statistical Manual of Mental Disorders, commonly known as the DSM-5.
Allen Frances, MD, who chaired the DSM-4 Task Force, pleaded with the DSM-5 Task Force to make last-minute changes, warning that, based on the results of the APA's own field trials, the DSM-5 “will mislabel 1 in 6 people with cancer and heart disease; 1 in 4 with irritable bowel and fibromyalgia...”
I'm sad to report that despite Dr. Frances' pleas as well as an onslaught of protests from other psychiatric and medical professionals, patient advocacy organizations and even patients themselves, the APA turned a deaf ear and sent the DSM-5 to print without making a single change to the SSD diagnostic criteria.
So when the DSM-5 is released in May, according to the new diagnostic criteria, a person can be diagnosed with Somatic Symptom Disorder (SSD) if for at least six months, they have had one or more symptoms that are distressing and/or disruptive to their daily life, and they have one of the following reactions:
Disproportionate thoughts about the seriousness of their symptom(s).
A high level of anxiety about their symptoms or health.
Devoting excessive time and energy to their symptoms or health concerns.
I am seriously concerned that when busy physicians are faced with the complex and often confusing array of symptoms that present with illnesses like fibromyalgia and ME/CFS (chronic fatigue syndrome), rather than continue to search for a medical diagnosis, some will simply diagnose the patient with SSD. Once that label is included in a patient's medical records, how likely do you think it is that future doctors will spend the necessary time to delve into the medical causes of that person's symptoms?
A Defense of Somatic Symptom Disorder
In an article on the Huffington Post, David J. Kupfer, MD, who chairs the current DSM-5 Task Force, attempted to defend the reasoning behind adding SSD to the new manual. Among other things, Dr. Kupfer explained that they were trying to make the diagnosis simpler and less confusing for non-psychiatrist physicians. He said, “Because individuals suffering from somatic [bodily] symptoms are primarily seen in general medical settings as opposed to psychiatric settings, the criteria in DSM-5 better define terms and reduce the number of disorders and sub-categories to make the criteria more useful to non-psychiatric-care providers.”
Personally, I don't think it is a positive thing to make it easier for general practitioners to diagnose and forever label patients with a mental disorder. Wouldn't it be better to refer them to a psychiatrist who has much more expertise in that field?
In My Opinion...
I've never been much of a conspiracy theorist, but lately I can't help but wonder what is going on in the psychiatric world. Let me explain.
Several times a week I check PubMed to see what new research has been published on fibromyalgia. Lately I've been seeing a lot of studies trying to relate FM to some type of psychological disorder––10 in just the past two weeks. Despite hundreds of studies proving that FM is physiological, not psychological, I get the feeling the psychiatric community is desperately trying to pull us back to the days when we were told “it's all in your head.”
When I look at this trend along with the new SSD diagnostic criteria, I have to ask, “What's up?” Are psychiatrists so desperate for patients that they're trying to drum up new business? I don't mean to sound flip about it. I'm genuinely concerned for the fibromyalgia community. We've made so much progress over the past 15 years; I don't want us to be dragged back to the days when we had to fight to be taken seriously.
If you are as concerned as I am about this new SSD diagnosis, I would encourage you to read Dr. Frances' three-part series in Psychology Today describing his concerns and his efforts to get the DSM-5 Task Force to make changes.
Published On: February 26, 2013