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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by firemonkey on December 9, 2012, at 6:56:24
Many readers of my previous blog listing the ten worst suggestions in DSM 5 were shocked that I failed to mention an eleventh dangerous mistake- that DSM 5 will harm people who are medically ill by mislabeling their medical problems as mental disorder. They are absolutely right. I apologize for my previous failure to attend to this danger and hope it is not now too late to influence the process.
Adding to the woes of the medically ill could be one of the biggest problems caused by DSM 5. It will do this in two ways: 1) by encouraging a quick jump to the erroneous conclusion that someone's physical symptoms are 'all in the head'; and 2) by mislabeling as mental disorders what are really just the normal emotional reactions that people understandably have in response to a medical illness.
UK health advocate, Suzy Chapman, has closely monitored every step in the development of DSM 5. Her website is the best available resource for finding just about everything you need to know about DSM 5 and ICD-11. Ms Chapman sent me a troubling email that summarizes where DSM 5 has gone wrong and the many harmful consequences that will follow. More details are available at: 'Somatic Symptom Disorder could capture millions more under mental health diagnosis' (http://wp.me/pKrrB-29B )
Ms Chapman writes, "...The DSM-5 Somatic Symptom Disorders Work Group is planning to eliminate several little used DSM-IV Somatoform Disorders and replace them instead with an extremely broad new category that is likely to be wildly overused ('Somatic Symptom Disorder' SSD).
"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.
"Unless DSM-5 changes these incredibly over inclusive criteria, it will greatly increase the rates of diagnosis of mental disorders in the medically ill whether they have established diseases (like diabetes, coronary disease or cancer) or have unexplained medical conditions that so far have presented with somatic symptoms of unclear etiology.
"The diagnosis of mental disorder will be based solely on the clinician's subjective and fallible judgment that the patient's life has become 'subsumed' with health concerns and preoccupations, or that the response to distressing somatic symptoms is 'excessive' or 'disproportionate,' or that the coping strategies to deal with the symptom are 'maladaptive'.
"These are inherently unreliable and untrustworthy judgments that will open the floodgates to the overdiagnosis of mental disorder and promote the missed diagnosis of medical disorder.
Posted by sleepygirl2 on December 9, 2012, at 13:31:16
In reply to Mislabeling Medical Illness As Mental Disorder, posted by firemonkey on December 9, 2012, at 6:56:24
Well, it certainly leaves a lot of room for mistakes.
One would hope that the diagnosis would be made with very careful and well developed clinical skill.What I would happen is that there would not be some blanket approach, either-or sort of perspective at work ( ex solely psychological vs only physical understanding of presenting signs/symptoms).
And then, what is the purpose of diagnosis?
To gear treatments? Supposedly
But, there's got to be both a medical and psychiatric approach, neither one discounting the other.
Problematic, at best.
Posted by brynb on January 29, 2013, at 14:36:05
In reply to Mislabeling Medical Illness As Mental Disorder, posted by firemonkey on December 9, 2012, at 6:56:24
Good post, fm. I've always taken issue w/ the DSM. It's archaic and too static of a system for trying to compartmentalize and categorize that which can't be.
I've been having a really hard time over the past 2/3 months w/ physical medical issues and problems and the docs are having a difficult time figuring things out. While being ill and in and out of the hospital has no doubt worsened my anxiety and depression, it's a completely separate issue.
With that, after a virus and a pompous pdoc pushed me into a med washouout after I was (medically) hospitalized, I went to the psych ER where former pdoc was on staff, and after waiting 14 hours, the attending pdoc questioned me as if I were being arrested, asking me how I was so med savvy (I told him it was because I suffered from depression since I was 14 and I read/studied everything I could), why was I so irritable (um, depression perhaps?? bipolar maybe?? my period?? waiting 14 hours to see him??), and how was it that a usually healthy woman was all of a sudden sick over the past few months. I said it worried me too, and his response was that it sounded like Munchausen's. I told him to "heal thyself" and played nice so I could get the hell out of there.
Sorry, didn't mean to make it about me, but I thought I'd share my experience that mirrors your concern. That, and to say I too am not a fan of the DSM. Not at all.
b
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