Somatic Symptom Disorder

On November 28, Psychiatric Times published an article titled Psychiatric Diagnosis and Treatment of Somatizing Neuropsychiatric Disorders. The authors are Daniel T. Williams, MD, and Alla Landa PhD, both from Columbia University Psychiatry Department. The article’s lead-in states: "Although the somatizing disorders cover a vast array of symptomatic domains across many medical specialties, this article addresses the broad topic conceptually." The so-called somatizing disorders have an interesting history in psychiatry. DSM-III-R (1987) states: "The essential features of this group of disorders are physical symptoms suggesting physical disorder (hence, Somatoform) for which there are no demonstrable organic findings or known physiologic mechanisms, and for which there is positive evidence, or a strong presumption, that the symptoms are linked to psychological factors or conflicts." (p 255) ...

I guess everybody knows by now that Justina Pelletier is back with her parents after 16 months in the custody of Massachusetts Department of Children and Families. According to a Boston Globe report dated June 9, top DCF officials recently submitted papers to the court asking that Justina be returned to the custody of her parents, and a June 19 Boston Globe article confirmed that Judge Joseph Johnstone had, on June 18, issued an order to that effect. ...

The controversy surrounding Justina Pelletier and her family has expanded its scope in recent months, and has now become a general public scrutiny of Massachusetts’s Department of Children and Families. On April 29, State Governor Deval Patrick gave a press conference in which he announced the resignation of DCF Commissioner Olga Roche. I think there’s a very real risk of confusing some issues here. The sad fact is that, despite the enormous strides we have made as a society, there are still a great many children who are abused and neglected. Every state in the US has a social services department, one of whose statutory responsibilities is to investigate reports of abuse and/or neglect. The case workers who conduct the investigations are required to follow set procedures. Often they find that the allegation is unfounded, and the investigation is terminated. When they do find probable cause, they are required by law to present their findings to a judge, who scrutinizes the evidence in accordance with the normal judicial procedures. The social services department, the parents, and the child are usually represented by attorneys. ...

On April 1, 2014, Slate published an online article titled Mitochondrial Disease or Medical Child Abuse? The author is Brian Palmer. Slate is a daily, general interest web magazine, founded in 1996, that provides “analysis and commentary about politics, news, business, technology and culture,” and is a subsidiary of the Washington Post. Brian Palmer is Slate’s “chief explainer." As the title suggests, the article tries to explore the central question in Justina’s case: does she have mitochondrial disease or is she a victim of medical child abuse? The author does a good job of defining the various terms, unraveling the issues, and presenting both sides of the argument, though on balance he comes down in favor of Boston Children’s Hospital. Here are some quotes: ...

Under DSM-IV, a “diagnosis” of somatization disorder entailed a history of physical symptoms for which, despite thorough medical evaluation, no satisfactory physical etiology could be established. In DSM-5, this “diagnosis” was replaced by somatic symptom disorder. This is essentially similar to DSM-IV’s somatization disorder – with one critical difference. The newer “diagnosis” can be assigned even if there is an identifiable physical illness. The essential requirement for the new “diagnosis” – indeed the only requirement – is that the individual is excessively or disproportionately preoccupied with the symptoms. And who, one might ask, decides if a person’s preoccupation is excessive? A psychiatrist, of course, whose vast training in drugs and ECT equips him with the wisdom, empathy, and insight to make such judgments. As the eminent Dr. Biederman proclaimed in a public courtroom on February 26, 2009, a psychiatry professor is second only to God in status and ability! ...