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The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1580 (Published 19 March 2013) Cite this as: BMJ 2013;346:f1580

Chillingly accurate prediction: The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill

This BMJ article by Allen Frances published back in March 2013, with its own substantial collection of very interesting responses, has come to attention recently.

At that time Allen Frances warned that the DSM-5 definition of somatic symptom disorder "may result in inappropriate diagnoses of mental disorder and inappropriate medical decision making". The new category extended the scope of mental disorder classification by eliminating the requirement that somatic symptoms must be “medically unexplained”. In DSM-5, the focus shifted to “excessive” responses to distressing, chronic, somatic symptoms with associated “dysfunctional thoughts, feelings, or behaviours.”

We are now very clearly seeing evidence of the applications of the DMS-5 Somatic Symptom Disorder (SSD), often still referred to as Medically Unexplained Symptoms (MUS) across the NHS system. It is utterly chilling to realise just how pertinent the 2013 prediction was - and how it is now becoming embedded in the context of 'modernising' NHS services: STPs, cost-cutting, shared care, IAPT and so on.

In recent months there have been a number of articles in the BMJ and in the BJGP on the topic, some of which I (and others) have commented on, for example: http://www.bmj.com/content/356/bmj.j268/rapid-responses.

Please may I draw particular attention to these two patient responses to a BJGP comment by Rachel Pryke ('Why are MUS conflated with heartsink?') relating to an active ongoing BJGP discussion on the topic of SSD/MUS: http://bjgp.org/content/67/659/252.1/tab-e-letters.

These current discussions are immensely important and alarming. Something is going horribly wrong when it is becoming apparent that previously healthy patients are being seriously harmed and made very unwell by medicines 'taken as prescribed' - and are then being dismissed/described as troublesome heartsink patients who display “excessive” responses to distressing, chronic, somatic symptoms with associated “dysfunctional thoughts, feelings, or behaviours.”

These patients are finding their medical records and referral letters - and even reports to MHRA - couched in phrases such as "the patient believes" and "the patient thinks". They are also being labelled with "attention seeking behaviours" and assorted "personality disorders" so as to discount and deny credibility of their very real experiences and immensely distressing functional symptoms.

There feels to be something distinctly Orwellian about this state of affairs.

Competing interests: No competing interests

13 June 2017
Marion Brown
Psychotherapist and Mediator (Independent)
none
Helensburgh