Somatic Symptom Disorder and the DSM-5 Controversy
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is garnering a great deal of media attention, most of which is negative. The motivation for the book’s revisions was to improve diagnosis and clinical care. But 11 changes in the book are allegedly unsafe and scientifically unsound, according to Allen Frances, MD. His fear is that following DSM-5 will “lead to massive over-diagnosis and harmful over-medication.”
Dr. Frances further states more than 50 mental health professional associations petitioned for an outside review of DSM-5 to offer an independent judgment of its balance between risks and benefits. But the book has now gone to print and is scheduled to be released in May 2013. One of its gravest errors, according to several professionals, is its new definition of “somatic symptom disorder.”
Somatic Symptom Disorder
To merit a diagnosis of this disorder, a person must report a single physical symptom that he or she finds distressing or disruptive to daily life for at least six months, along with one of the following:
- The person has disproportionate, persistent thoughts about the seriousness of his or her symptoms.
- The person reports or displays a persistently high level of anxiety about his or her health or symptoms.
- The person is devoting excessive time and energy to his or her symptoms or health concerns.
What this boils down to is that a person with diabetes, AIDS, or other chronic disease could easily be diagnosed with somatic symptom disorder. This could, in turn, label millions of normal Americans as mentally ill. Currently, about 2.4 million people in the United States live with a mental illness.
Somatoform disorders are characterized by symptoms suggesting physical illness or injury that may not be fully explained by a general medical condition, another mental disorder, or by medication or substance side effects. The symptoms are either very distressing or result in significant disruption of an individual’s ability to function in daily life.
David J. Kupfer, MD, suggests the DSM-5 makes a significant change to diagnostic criteria by shifting the emphasis from medically-unexplained symptoms to the impact of those symptoms on a person’s thoughts, feelings, and actions. In DSM-IV, it was required that somatic symptoms be medically unexplained – that is, if symptoms could be traced to an identifiable underlying medical disorder like depressive symptoms in hypothyroidism, the diagnosis of somatoform disorder could not be made. But this exclusion did not account for patients who exhibit an unusually negative reaction to their symptoms (like excessively-high anxiety) even when they are medically-explained. Such patients may thus benefit from treatment.
But Keith Ablow, MD, argues the American Psychiatric Association has already found that 15 percent of people with either cancer or heart disease would be diagnosed with somatic symptom disorder, and 26 percent of those with irritable bowel syndrome or fibromyalgia. Moreover, 7 percent of people who have no active medical diagnosis could also qualify.
Some health care providers worry this can stigmatize people who are diligent about, or even devoted to, optimizing their health or treating illness. Many, however, will be easily dissuaded from seeking optimal medical remedies if they know that a mental illness diagnosis hangs over their heads. Further, mislabeling normal emotional reactions in response to medical ailments as mental disorders can pose enormous dangers to the American healthcare system.
The Cycle Begins
On the other hand, pharmaceutical companies are likely to stand by the DSM-5 with drugs in hand, ready to help the millions of Americans who will now be labeled as suffering from “somatic symptoms disorder.” These patients are, arguably, going to need anti-anxiety and sleep medications. Indeed they’ll probably need additional medications to relieve the symptoms associated with their first prescriptions. Thus the cycle begins.