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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

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

The creation of the loosely defined Somatic Symptom Disorder in the DSM-5 is very concerning to me both as a researcher and a practicing clinician. Dr. Frances has spearheaded the movement against inclusion of SDD in the DSM but has unfortunately been met with a refusal to consider the impact that this new diagnosis will have on those living with chronic medical illness. The most concerning thing is there are no data to support the SDD diagnostic criteria, which is not a necessarily new phenomenon for the DSM.

As someone who has spent the last 9 years trying to advance the understanding and integration of physical and mental health, and de-stigmatize normal human reactions to illness, especially for those with "functional" conditions like Irritable Bowel Syndrome, I see this reclassification as an enormous step in the wrong direction. Rather than acknowledging that with a chronic illness comes normal feelings of worry, sadness, frustration, curiosity, anger, anxiety or depression, the DSM 5 is pathologizing these emotions.

Much of my experience is working with clients with Irritable Bowel Syndrome, a still relatively poorly-understood condition with few medical treatment options. Is the SDD committee telling me that these patients shouldn't spend more than a few hours on the internet looking for remedies or connecting with others via online support communities? People living with IBS already face considerable stigma and implication that their symptoms are "all in their head." Consider what an additional diagnosis of SDD would do to their status in both the medical and lay community. Will their symptoms be taken as seriously or will they be seen as people who blow things out of proportion and be dismissed as a problem patient by their physician? Will a diagnosis of SDD be given in haste to a person with as-yet medically unexplained symptoms, who will then be denied testing to ensure there really isn't something wrong? Will the SDD diagnosis become the diagnosis du jour for women experiencing physical complaints? The only woman on the task force for SDD was withdrawn in 2011.

Are there people who have "excessive" or "disproportionate" concerns about their health or medical diagnosis? Yes. I think of people who cut themselves off from their friends and family, who can't go to work for fear of having symptoms in public, or who cannot think of much else other than their illness. In my experience, this is not the norm but a relatively small percentage of the hundreds of people I've seen living with a chronic medical condition. Honestly, I'm not sure what giving them an SDD diagnosis would do for them, even if they met the official criteria - which wouldn't be difficult considering a person only needs to satisfy one, and is unheard of in the history of psychiatric diagnoses.

Since the DSM is due out in a few weeks, SDD will remain. It is up to those who practice psychology and psychiatry to use SDD sparingly and only in cases where it may provide true benefit and not harm. We should wait for quality research to be conducted on SDD and the impact it has on patient reported outcomes before accepting it into our diagnostic repertoire. We owe this to our patients.

Tiffany Taft, PsyD
Licensed Clinical Psychologist
ttaft@opbmed.com

Competing interests: No competing interests

25 March 2013
Tiffany H Taft
Clinical Psychologist
Oak Park Behavioral Medicine LLC
818 Harrison St. Suite 210 Oak Park IL