Physical Illnesses May Soon Be Labeled “Mental Disorders”

[rdmc]

I'm really not sure where to post this...maybe it should be on the limbo land board (mods feel free to move it), but it's a very interesting article in Psychology Today about possible new criteria for diagnosing a person with Somatic Symptom Disorder.

It includes a paragraph about diseases like MS which take years go diagnosis, because they make the criteria for this diagnosis 6 months of being "concerned" about an illness.

And many of us, during the diagnostic phase of this disease would have met the criteria for this new diagnosis.

http://www.psychologytoday.com/blog/...ntal-disorders

[hunterd]

and to think all this time I have been mentally ill and I do not have MS! Who would have thunk it? I am canceling my appointment with my neurologist and scheduling one with the psychologist! ( I am being very sarcastic)

[Jules A]

I'm not sure how the author knows what will be in the DSM-V as it hasn't been published yet and I find it hard to believe the criteria will be reduced to only 1 month and 1 symptom from the previous, very specific criteria:

SOMATIZATION DISORDER
A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment of functioning. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance.

4 pain symptoms: a history of pain related to at least 4 different sites or functions

2 gastrointestinal symptoms: a history of at least 2 gastrointestinal symptoms
other than pain

1 sexual symptom: a history of at least 1 sexual or reproductive symptom other
than pain

1 pseudoneurological symptom: a history of at least 1 symptom or deficit
suggesting a neurological condition not limited to pain

Either:

After appropriate investigation, each of the symptoms cannot be fully explained by a known general medical condition or the direct effects of a substance OR

When there is a related general medical condition, the physical complaints or resulting social or occupational impairment are in excess of what would be
expected from the history, physical examination, or laboratory findings.

The symptoms are not intentionally produced or feigned.

http://www.dmacc.edu/Instructors/tkw...atoformDSM.pdf

[lstrl]

That definition seems way over the top, but would it really have any effects? A bad dr who doesn't care isn't going to go all out looking for medical proof anyway, whether they have that diagnosis readily available to them or not. I would think a good dr is still going to do everything they can to find out what's wrong with a patient before deciding it's all in their head.

Would an insurance company really have the power to decline a medical test based on a patient being diagnosed with a psychiatric disorder? That sounds to me like grounds for a lawsuit if something were to happen. I really hope that wouldn't result in someone dying because of the stigma surrounding mental illness.

This article reminds me of a dr I saw a few years ago when my hand kept going numb for a short period. He assesses my arm and hand, finds nothing wrong (why would he if it's intermittent and it's not happening right now), and then proceeds to tell me he has no idea what's wrong with me. He orders no labs, no tests, and just sends me home. He would totally take advantage of the new DSM diagnosis, but then again, he never did any real work before it came around either

[HETA78]

HA! I wish this was just all in my head

[Thinkimjob]

What I find interesting is the second last paragraph Jules A quotes, (can't do copy on my lovely new mini iPad), about patients with a diagnosed condition feeling worse than their medical tests etc would explain.

I'm sure that's been me from time to time.
(Never been in limbo land. I've definitely got MS, my MRIs haven't changed for years, but I've progressed a lot. Then that's clearly apparent to a doctor.)

I think I feel every symptom more when I feel a tad depressed, then I worry, then it seems worse than maybe it actually is.

Of course, MS has a psychological impact, too. Anyhoo, food for thought.

[Jules A]

What I find interesting is the second last paragraph Jules A quotes, (can't do copy on my lovely new mini iPad), about patients with a diagnosed condition feeling worse than their medical tests etc would explain.

I'm sure that's been me from time to time.
(Never been in limbo land. I've definitely got MS, my MRIs haven't changed for years, but I've progressed a lot. Then that's clearly apparent to a doctor.)

I think I feel every symptom more when I feel a tad depressed, then I worry, then it seems worse than maybe it actually is.

Of course, MS has a psychological impact, too. Anyhoo, food for thought.

Hopefully all physicians understand that with MS symptoms don't always correspond with our MRIs so I don't think you need to worry about being tagged with somatization do.

You make an excellent point about symptoms and our mood because depression has been shown to increase pain responses, it can either decrease or increase our ability to sleep, eat...

The other thing we need to remember is that not everyone who has thinks they have MS actually has it. I'd imagine there are also a few of us, raising my hand to volunteer, with a MS diagnosis who don't have it either.

[HellsBells1]

Hopefully all physicians understand that with MS symptoms don't always correspond with our MRIs so I don't think you need to worry about being tagged with somatization do.

And this is the problem... the very scary problem. Most family doctors do not understand much about MS at all, and they certainly put way too much stock in MRI's. It is their lack of understanding that has had many an MS'er in Limbo Land for very long periods of time.

There are many of us that have already been told "It is all in your head." without the courtesy of even running a single blood-test. My old doc knew I had a stressful job, so even when I went to him with double-vision, his answer was stress! His vacation-replacement doc read a letter from the ER doc saying I should be seen by a neurologist for my sudden-onset movement disorder, immediately told me it was all in my head and simply dismissed me. He did not even know me as a patient.

That article, and the proposed additions to DSM-V, are SHOCKING!!! I hope they stop this SSD rating before it gets published.

[Jules A]

And this is the problem... the very scary problem. Most family doctors do not understand much about MS at all, and they certainly put way too much stock in MRI's. It is their lack of understanding that has had many an MS'er in Limbo Land for very long periods of time.

There are many of us that have already been told "It is all in your head." without the courtesy of even running a single blood-test. My old doc knew I had a stressful job, so even when I went to him with double-vision, his answer was stress! His vacation-replacement doc read a letter from the ER doc saying I should be seen by a neurologist for my sudden-onset movement disorder, immediately told me it was all in my head and simply dismissed me. He did not even know me as a patient.

That article, and the proposed additions to DSM-V, are SHOCKING!!! I hope they stop this SSD rating before it gets published.

It is a shame that your pcp didn't heed the ED doc's recommendation and refer you to a neurologist but if I thought I had something like MS that was going undiagnosed I would do a self-referral to a MS specialist even if I had to pay out of pocket.

My ED doc actually made the neuro appointment for me the next day when I presented with diplopia.

[swingingwillow]

I'm not going to weigh in on this topic as it is greatly upsetting to me on so many levels and don't want to get stressy from it.

I just want to say that as a limbo lander that this can impact people with more than MS and can stop people from getting the health care that they need. It's all backwards.

In Canada I can wait for a specialist's appointment for 2 to 13 months and up to a year for diagnostic testing.

I did click on the link at the bottom of the first link provided in this thread and the doctor makes a fine statement on why it should not be included in the DSMV.

Ahhhhhhhhhhhhhhhhh!

[SunshineDaydreams]

I've already had it suggested that I'm somatic - despite lesions on MRI (that amazingly do correlate to almost all of my very real symptoms), positive LP, positive Glycominds test. One neuro didn't feel I should have symptoms ....?

Then the next decided she didn't think I should either because I'm not showing Babinski reflex (which she tested with my shoes on)

If I did not need my disability, I think I would give up on doctors altogether (except my GP - love her) and go completely alternative! As it is, I believe I may be in another exacerbation and am afraid to call any of these docs - it'll end at some point (we hope).

[HellsBells1]

It is a shame that your pcp didn't heed the ED doc's recommendation and refer you to a neurologist but if I thought I had something like MS that was going undiagnosed I would do a self-referral to a MS specialist even if I had to pay out of pocket.

My ED doc actually made the neuro appointment for me the next day when I presented with diplopia.

In Canada, we cannot self-refer to specialists, and cannot pay out of pocket for doctors. We can pay for some tests (like MRI) instead of waiting a long time.

But I can tell you that I PROMPTLY changed my family doctor to another who would listen to my complaints and explore. I ended up going to another emergency room in a city 2-1/2 hours away after the doc told me it was all in my head, and then got a referral from that ER doc to the head of neurology on Vancouver Island. He did promptly refer for tests, but has since been slow in booking a follow-up appt to review results, even though 8-9 lesions were found on my MRI, and the radiology report findings were "if clinical sx are consistent with demyelinating disease, further neurological studies are recommended."

I do not personally have the results of EEG, SSEP and VEP, but am curious to see what they might also add to the MRI findings. Have never had an LP.

[Jules A]

In Canada, we cannot self-refer to specialists, and cannot pay out of pocket for doctors. We can pay for some tests (like MRI) instead of waiting a long time.

Ohhhh that is horrible. I know this sounds totally ignorant but I always thought with socialized medicine if you wanted to pay for your own care you could.

[KateA2]

Ugh, this seems like a terrible idea:

5-6 years ago I started having odd numb patches here/there...sometimes they were really painful (like frostbite or a burn) but nothing was there. At the time, a few people in my office had Shingles, and thinking perhaps I was coming down with it, I went to my PCP.

She examined me, couldn't find anything - then said

"Well, looks like a mountain out of a molehill...the next test we can do is VERY unpleasant: they'll stick you full of long needles and run electric current into your muscles...it's excruciatingly for some people, sound like something you WANT to do? So HOW bad is the pain/how numb is it now?"

So, not wanting this "scary test" I said I guess I could manage/it wasn't that bad.

Now, keep in mind this was after I'd come in with tachycardia/SVT, vertigo and urinary issues...and was still treated like a nutcase.

It wasn't until I FINALLY had a lesion show up, that they stopped treating me like a loon.

Anyway, the "scary needle test" is an EMG, and I've had two now, and they weren't bad at all...the needles are thinner than a hair. It's not fun, but totally doable. Humph!

[onlyairfare]

HellsBells1, I used to live in Bellingham, Washington and some people in lower BC would come to our city for medical care. Typically they would pay cash for some elective procedure that required a wait at home but could be done immediately in Bellingham. I am not sure about the neuros practicing there now, but it could be an option for you.

Funny thing, I used to drive up to BC to get travel vaccinations and some people I knew would head there for medications that were much less expensive in Canada than the US!

One of my cousins works in mental health and does consulting for the DSM Manual in her area of specialty. There are preliminary manuscripts that circulate for review prior to publication, so it's possible the author of the Psychology Today article has read them already. That said, I know my cousin would never reach a conclusion regarding a mental health diagnosis until there had been a proper medical work-up for the physical symptoms involved. Nor would any other diligent professional.

It seems to me that most people seek out a psychologist, or are referred to one, after their PCP and specialists have done an evaluation and not found a diagnosis (yet). I don't know if having this label or name would make any difference.