Tuesday, July 30, 2013

ME/CFS, Fibromyalgia, IBS, MCS, and Chronic Pain Redefined as Mental Disorders

In 2010, Drs. Fink and Schröder, two Danish psychiatrists, redefined several physiological illnesses as a single mental disorder: "bodily distress syndrome." Among the illnesses which Drs. Fink and Schröder reclassified are: Neurasthenia, chronic pain, Chronic Fatigue Syndrome, Myalgic Encephalomyelitis, IBS, Syndrome X, “heart-ache," Fibromyalgia, Whiplash Associated Disorder, pain in the pelvis when pregnant, electricity-hypersensitivity, infrasound-hypersensitivity and Multiple Chemical Sensitivity (MCS). 

The unstated rationale for the reclassification is that because these conditions don't fit into a medical "cookbook," a single psychiatric diagnosis would relieve physicians of the onerous task of spending the time required (i.e. more than 10 minutes) to diagnose and treat these patients. In short, patients with "unexplained" illnesses could now be shunted off to a therapist -  therapy being less costly than extended visits, extensive testing, and expensive treatment.

The diagnosis of "bodily distress syndrome" has as much scientific validity as "possession by evil spirits." But that has not prevented Danish agencies from adopting "bodily distress syndrome" as a legitimate diagnosis. This "diagnosis" provided the grounds for removing Karina Hansen from her home in February 2013 to a psychiatric hospital, for revoking her right to legal representation, for enforcing "evidence-based care" (exercise and cognitive behavioral therapy), and for prohibiting visits from her parents. 

(Below is the abstract of the Fink and Schröder study.)

One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders

By P. Fink and A. Schröder


BACKGROUND: In order to clarify the classification of physical complaints not attributable to verifiable, conventionally defined diseases, a new diagnosis of bodily distress syndrome was introduced. The aim of this study was to test if patients diagnosed with one of six different functional somatic syndromes or a DSM-IV somatoform disorder characterized by physical symptoms were captured by the new diagnosis.

METHOD: A stratified sample of 978 consecutive patients from neurological (n=120) and medical (n=157) departments and from primary care (n=701) was examined applying post-hoc diagnoses based on the Schedules for Clinical Assessment in Neuropsychiatry diagnostic instrument. Diagnoses were assigned only to clinically relevant cases, i.e., patients with impairing illness.

RESULTS: Bodily distress syndrome included all patients with fibromyalgia (n=58); chronic fatigue syndrome (n=54) and hyperventilation syndrome (n=49); 98% of those with irritable bowel syndrome (n=43); and at least 90% of patients with noncardiac chest pain (n=129), pain syndrome (n=130), or any somatoform disorder (n=178). The overall agreement of bodily distress syndrome with any of these diagnostic categories was 95% (95% CI 93.1-96.0; kappa 0.86, P<.0001). Symptom profiles of bodily distress syndrome organ subtypes were similar to those of the corresponding functional somatic syndromes with diagnostic agreement ranging from 90% to 95%.

CONCLUSION: Bodily distress syndrome seem to cover most of the relevant "somatoform" or "functional" syndromes presenting with physical symptoms, not explained by well-recognized medical illness, thereby offering a common ground for the understanding of functional somatic symptoms. This may help unifying research efforts across medical disciplines and facilitate delivery of evidence-based care.

Source: J Psychosom Res. 2010 May;68(5):415-26. doi: 10.1016/j.jpsychores.2010.02.004. P. Fink and A. Schröder. The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8000 Aarhus, Denmark. per.fink@aarhus.rm.dk
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