In DSM-IV, there is a category called Somatoform Disorders, the common feature of which is a preoccupation with “… physical symptoms that suggest a general medical condition …and are not fully explained by a general medical condition…”
Four of the “diagnoses” in this category will be retired in DSM-5 and will be replaced by a new “diagnosis”: somatic symptom disorder. The four superseded “diagnoses” are:
1. somatization disorder
3. pain disorder
4. undifferentiated somatoform disorder.
Here’s a brief synopsis of the four old “diagnoses.”
1. S.D: A history of at least 8 specific symptoms over a period of several years with no valid medical explanation.
2. H: A persistent fear of illness based on misinterpretation of symptoms.
3. P.D: Reported severe pain that is judged to be primarily psychological in origin and maintenance.
4. U.S.D: Similar to somatization disorder, but with fewer complaints and of shorter duration.
The common thread through all four of these “diagnosis” is that the individual is reporting pains or various other physical symptoms to a degree that is judged excessive, and in the absence, despite investigation, of any underlying physical pathology.
As mentioned earlier, the four retiring “diagnoses” will be replaced in DSM-5 by somatic symptom disorder, the essential feature of which is a disproportionate and persistent concern (lasting at least 6 months) about the medical seriousness of one’s symptoms – even if the symptoms arise from a genuine confirmed illness!
In other words, if you have cancer or diabetes or kidney failure, and your worries and concerns about your illness are – in a psychiatrist’s judgment – excessive, then you can be “diagnosed” with this “mental illness.”
By what stretch of the imagination, you might ask, can they justify such a move? I can’t do justice to their cognitive gymnastics, so I’ll let them speak for themselves.
SOMATIC SYMPTOM DISORDER
“DSM-5 better recognizes the complexity of the interface between psychiatry and medicine. Individuals with somatic symptoms plus abnormal thoughts, feelings, and behaviors may or may not have a diagnosed medical condition. The relationship between somatic symptoms and psychopathology exists along a spectrum, and the arbitrarily high symptom count required for DSM-IV somatization disorder did not accommodate this spectrum. The diagnosis of somatization disorder was essentially based on a long and complex symptom count of medically unexplained symptoms. Individuals previously diagnosed with somatization disorder will usually meet DSM-5 criteria for somatic symptom disorder, but only if they have the maladaptive thoughts, feelings, and behaviors that define the disorder, in addition to their somatic symptoms.”
MEDICALLY UNEXPLAINED SYMPTOMS
“DSM-IV criteria overemphasized the importance of an absence of a medical explanation for the somatic symptoms. Unexplained symptoms are present to various degrees, particularly in conversion disorder, but somatic symptom disorders can also accompany diagnosed medical disorders. The reliability of medically unexplained symptoms is limited, and grounding a diagnosis on the absence of an explanation is problematic and reinforces mind -body dualism. The DSM-5 classification defines disorders on the basis of positive symptoms (i.e., distressing somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to these symptoms).” APA: Highlights of Changes from DSM-IV-TR to DSM-5, p 10-11
“Comprehensive assessment of patients requires the recognition that psychiatric problems often co-occur in patients with medical problems. While DSM-IV was organized centrally around the concept of medically unexplained symptoms, DSM-5 criteria instead emphasize the degree to which a patient’s thoughts, feelings and behaviors about their somatic symptoms are disproportionate or excessive. The new narrative text for SSD notes that some patients with physical conditions such as heart disease or cancer will indeed experience disproportionate and excessive thoughts, feelings, and behaviors related to their illness, and that these individuals may qualify for a diagnosis of SSD. This in turn may enable them to access treatment for these symptoms. In this sense, SSD is like depression; it can occur in the context of a serious medical illness. It requires clinical training, experience and judgment based on guidance such as that contained in the DSM-5 text to recognize when a patient’s thoughts feelings and behaviors are indicative of a mental disorder that can benefit from focused treatment.
This change in emphasis removes the mind-body separation implied in DSM-IV and encourages clinicians to make a comprehensive assessment and use clinical judgment rather than a check list that may arbitrarily disqualify many people who are suffering with both SSD and another medical diagnosis from getting the help they need.” APA: Somatic Symptom Disorder p 2
These quotations are not very comprehensible. In fact they are more spin than substance, and can only be understood in the context of what the APA has done.
It’s a widely accepted fact that some people do indeed worry to a considerable degree about illnesses that they believe they have, even though repeated examinations by physicians produce no evidence of illness. Sometimes, of course, the doctors are wrong, but very often they are correct, and the individual is in effect worrying about a non-existent condition. For decades the APA has labeled these individuals as mentally ill. (Obviously I conceptualize the matter differently, but let’s put that issue aside for now.)
With DSM-5, the APA has increased the number of people who will be embraced by this “illness,” and they’ve done this in two ways. Firstly, by the simple expedient of relaxing the criteria for inclusion. They do this by reducing the minimum number of symptoms of which the individual is complaining (from 8 to “no minimum,” which presumably means 1!) and the duration of the complaints (from “several years” to 6 months!)
This, of course, is bad enough, but in addition they have added an entirely new group of potential victims: people who have a real illness about which they worry to a degree that a psychiatrist considers excessive! So now, by APA fiat, and the world-wide release of the long-awaited DSM-5, these individuals, in addition to cancer, diabetes, kidney failure, arthritis, or whatever real ailment they have…also have a mental illness, and can be legitimately drugged into oblivion by anyone with a prescription pad.
And remember, there’s no evidence to support this change. Like everything else in the DSM, it’s just because the APA decided.
In this light, let’s go back and look at their justification for these changes.
“The relationship between somatic symptoms and psychopathology exists along a spectrum, and the arbitrarily high symptom count required for DSM-IV somatization disorder did not accommodate this spectrum.”
For decades we mental illness “deniers” have been drawing attention to the fact that virtually every problem listed in DSM occurs on a continuum, and that the cut-offs and categorizations are arbitrary and do not reflect these continua. And for decades, the APA ignored this. But now, suddenly, it’s important. But – and this is the critical point – instead of recognizing this continuum (or spectrum, as they call it), they are simply substituting an arbitrarily low cut-off (1) for an arbitrarily high cut-off (8).
“DSM-IV criteria overemphasized the importance of an absence of a medical explanation for the somatic symptoms. Unexplained symptoms are present to various degrees, particularly in conversion disorder, but somatic symptom disorders can also accompany diagnosed medical disorders. The reliability of medically unexplained symptoms is limited, and grounding a diagnosis on the absence of an explanation is problematic and reinforces mind -body dualism.”
Why, you might ask, is the old DSM-IV requirement (that the symptoms be unexplained), which has been the defining feature of these “diagnoses” for at least four decades, now considered an over-emphasis? Because “… the reliability of medically unexplained symptoms is limited.” In other words, sometimes the medics get it wrong, and the person really does have an illness. What’s tragically funny about this is that I can’t imagine any bona fide medical specialty whose diagnostic/nosological system has poorer reliability than the DSM. But because we can’t be sure that the doctor is correct when he says the person isn’t sick, we must abandon this whole aspect of the “diagnosis.”
The other stated problem with the old system is that it “reinforces mind-body dualism.”
In other words, the old DSM-IV concept (that the person is worrying about a disease that he doesn’t really have) reinforces mind-body dualism. And lumping these individuals in with people who worry about a disease that they do really have, somehow counters this pernicious trend? The fact is that worrying about a disease, real or fictitious, has no bearing whatsoever on mind-body dualism. It’s just more APA nonsense.
But it gets even worse. They are retaining conversion disorder and pseudocyesis (false pregnancy) in DSM-5 (with their requirements of medically unexplained symptoms!) “…because it is possible to demonstrate definitively in such disorders that the symptoms are not consistent with medical pathophysiology.” And this, you see, does not reinforce mind-body dualism.
When you consider the damage that psychiatrists have done and continue to do to millions of people, with their spurious diagnosing, their routine subordination of science to spin, their disempowering of the individuals they “serve,” and their pill-for-every-problem philosophy, their present pursuit of intellectual purity with regards to mind-body dualism is a little difficult to fathom.
The APA’s justification for the changes is what con-artists call a smoke-screen. The APA’s agenda for the past 50 years has been the expansion of the diagnostic maw and the pushing of drugs onto more and more people. They do this to expand their turf and their incomes, and to maintain an ever-increasing flow of profits for their pharmaceutical allies. DSM-5 is just more of the same – only worse. Don’t be fooled by the spin. And remember, 69% of the DSM-5 task force have ties to the pharmaceutical industry. But we don’t have to worry about this, because the APA has assured us that these ties did not affect their professional judgment in any way.
The question I find myself asking almost constantly with regards to the APA is: where do they find the gall. How can they go on promoting this intellectual travesty and this reckless destruction of human life? How can they be so crassly self-serving and so indifferent to the plight of their victims?
And just as I’m beginning to think that they surely can’t get any worse, they produce somatic symptom disorder. By what perverted chain of reasoning do they consider themselves qualified to decide the appropriateness or otherwise of a person’s reaction to contracting a serious illness? Have they finally lost all sense of proportion and decency?
Please – if you’re not already doing so – speak out against DSM-5.