As bizarre as what follows may sound, the danger is real and imminent. The American Psychiatric Association has proposed new criteria for diagnosing an umbrella disease called “Somatic Symptom Disorder” (SSD). A serious problem arises because the criteria are so broad and so vague that people who suffer from a wide variety of diseases (including diabetes, irritable bowel syndrome, cancer, coronary disease, fibromyalgia, and other illnesses) run the real risk of being misdiagnosed with SSD simply because they frequently complain or express their concerns about their health condition.
In effect, patients with a range of illnesses will be misdiagnosed with a psychiatric disorder if they meet the proposed new criteria—opening the door for inadequate and inappropriate treatment of their illness.
According to Allen Frances MD in the U.S. magazine Psychology Today,
“A person will meet the criteria for SSD by reporting just one bodily symptom that is distressing and/or disruptive to daily life and having just one of the following three reactions to it that persist for at least six months: 1) ‘disproportionate’ thoughts about the seriousness of their symptom(s); or 2) a high level of anxiety about their health; or, 3) devoting excessive time and energy to symptoms or health concerns.” (October 24 2011)
Of course, this means that anyone who is concerned about a diagnosis of, say, cancer could be deemed to have SSD if the patient is seen to be anxious about his or her health or actively researching treatment options.
Accordingly, we invite and implore you to read Ms. Suzy Chapman’s article pasted below as a summary of the situation, then consider following her recommendations to protect yourself and others:
SUMMARY BY MS. SUZY CHAPMAN
One in six people with cancer, diabetes, cardiovascular and other serious diseases risks being saddled with a psychiatric diagnosis if the patient is considered to be worrying “excessively” about their ill health or spending more time on the internet researching their symptoms than the American Psychiatric Association thinks good for them.
But many illness groups—particularly the so-called “functional somatic syndromes” —stand to be captured by these new criteria, assigned an additional mental health diagnosis or placed at risk of misdiagnosis.
As reported in Dr Frances’ commentary, in the DSM-5 field trials for [C]SSD, 15% of the “diagnosed illness” study group (cancer and coronary disease) met the criteria for SSD when just “one from the B type criteria” was required.
In the “functional somatic” arm of the field trials (irritable bowel and chronic widespread pain), 26% were coded for SSD.
The texts for DSM-5 are scheduled for completion by the end of this year, for May 2013 publication. The manual texts are still being finalized and the Somatic Symptom Disorder Work Group has been asked to reconsider its criteria and tighten them up before the text for this section is sent to the publishers.
If you share our concerns that these catch-all criteria will see thousands more patients tagged with a mental health label please forward the link for Dr. Frances’ commentary to your colleagues and contacts, and post the link on Twitter and on social media platforms.
And please demonstrate to the APA and the Somatic Symptom Disorder Work Group the level of concern amongst clinicians and allied health professionals, patients, caregivers and advocacy organizations by visiting Dr. Frances’ blog post and leaving a comment.
Dx Revision Watch
We also invite you to click on the following three links for a more thorough discussion of what we believe is an alarming and dangerous situation for all of us:
Once you understand the situation, we hope you will invite others to read our blog, go to the links above, and follow through on Ms. Chapman’s advice for response before the dangers to your well-being become the reality of medical practice not only in the U.S.A., but in Canada as well. We hope we are not too late
Thank you for reading and for any responses you decide to make,
Gloria and Jerre