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A New Term! - "Bodily Distress Syndrome"

Discussion in 'Latest ME/CFS Research' started by Dr. Yes, Apr 26, 2010.

  1. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    ESF Exploratory Workshop - EMRC

    Resurrecting this thread, last added to in May 2010.

    In an earlier post here:

    I had flagged up the preliminary details for an ESF (European Science Foundation) Exploratory Workshop that had been referred to in a Henningsen/Creed Editorial and said I would look out for a copy of any report published.

    The DSM-5 "Somatic Symptom Disorders" Work Group, for which Francis Creed is a member, had considered but rejected the construct of "Bodily Distress Disorder" (which Per Fink has been peddling for several years) in favour of "Complex Somatic Symptom Disorder (CSSD)".

    Professor Francis Creed is co-editor of The Journal of Psychosomatic Research and a member of the DSM-5 Somatic Symptom Disorder Work Group.

    Understanding The Genetic, Physiological And Psychological Mechanisms Underlying Disabling Medically Unexplained Symptoms And Somatisation

    ESF Exploratory Workshop - EMRC

    Convened by: Peter Henningsen (DE), Francis Creed (UK)

    Location: 10-12 September 2009, Munich, Germany​

    Info on ESF:

    A report on that workshop was eventually published and the PDF is here:

    Text conversion:


    European Science Foundation

    Setting Science Agendas for Europe

    Exploratory Workshop Scheme
    Standing Committee for the European
    Medical Research Councils (EMRC)

    ESF Exploratory Workshop on

    Understanding the genetic, physiological and psychological mechanisms underlying disabling medically unexplained symptoms and somatisation

    Munich (Germany), 10-12 September 2009


    1. Executive Summary

    The workshop defined the most promising avenues of research concerning the aetiology and pathophysiology of "medically unexplained symptoms", somatisation and functional somatic syndromes (e.g. chronic fatigue and irritable bowel syndromes and chronic widespread pain).

    [Ed: Creed uses the term "Chronic widespread pain" for Fibromyalgia, which has its own ICD-10 coding.]

    The workshop focussed first on commonalities and differences between symptoms and syndromes.

    We examined similarities and difference across functional somatic syndromes and somatisation in terms of genetics, stress physiology/ immunology, the effect of childhood adversities, central processing and response to treatment.

    The workshop then examined the possibilities of future collaborative research - what the aims of such a collaboration would be and how it could be realised.

    The workshop brought together a multidisciplinary panel of researchers from several European countries to identify new avenues of research under 4 headings:

    (a) Defining the phenotype for imaging, genetic and immune studies,

    (b) Discussing ways of accumulating large population based studies and of identifying the new onset "cases" for intensive study,

    (c) Examining possible new avenues of investigation using genetic, physiologically and, possibly, studies of childhood adversities.

    (d) Discussing the possibilities/necessities for health service and other research that incorporates the socio-cultural differences concerning this field in Europe (including pathways to care and to chronic disorder).

    This aim was achieved.

    21 researchers from 7 EU countries contributed to a programme which was based on brief presentations of existing knowledge and ideas for further research.

    Each presentation was followed by a discussion, twice the length of the presentation, so that all participants contributed to all parts of the workshop.

    The workshop results illustrate the currently still rather sporadic progress that is being made towards a fuller understanding of the aetiology of the functional somatic syndromes.

    It can be seen that research across several syndromes is more likely to provide useful information than research solely within one syndrome and that research into the classification and aetiology of numerous somatic symptoms could be usefully linked to studies of these syndromes.

    The field requires also, however, a constant re-evaluation of existing ideas and theoretical concepts as these are challenged by, for example, a re-examination of mediators in psychological treatment studies of chronic fatigue.

    The newer techniques, such as novel measures of cardiac vagal tone or fMRI, need to be used in a creative way in carefully selected groups of patients where all important confounders are controlled if we are to learn which psychosocial variables are truly associated with which psychological or somatic ones.

    The rationale of the group formed in Munich is to develop such a co-ordinated series of studies.

    The chances of successful funding for such studies should improve now that the methods of research are becoming more sound and the importance of the functional somatic syndromes and somatisation as major causes of disability and high healthcare costs are being

    2. Scientific Report

    Functional somatic syndromes (e.g. chronic fatigue, irritable bowel syndrome and chronic widespread pain) have been studied primarily as individual syndromes to establish their aetiology.

    Over the last decade there has been a growing recognition that the syndromes have much in common including a female sex predominance, a close association with anxiety and depression and with stressful life events.

    Yet little research has considered the risk factors for several syndromes in the same study possibly because of the difficulty in getting research funding for several disorder simultaneously.

    Recent findings from individual functional somatic syndromes that might be generalisable to other syndromes were illustrated by findings in functional gastrointestinal disorders and chronic fatigue.

    Irritable bowel syndrome

    Francis Creed (UK) highlighted the importance of "somatisation" (numerous bodily symptoms) as an important factor which is associated with marked disability and high healthcare costs.

    Lukas Van Oudenhove (Belgium) and Adam Farmer (UK) focussed on mechanisms underlying visceral pain hypersensitivity. It was demonstrated that the nature of variations in cardiac vagal tone in response to painful stimuli, appears to be associated with level of neuroticism.

    Using meta-analysis, Judith Rosmalen (Netherlands) was able to show that lower baseline cardiac vagal activity has been established in patients with various functional somatic syndromes with no apparent differences between chronic fatigue, irritable bowel syndrome and chronic widespread pain.

    By contrast a similar approach to HPA axis activity found evidence of lower cortisol levels in chronic fatigue syndrome and, possibly, in chronic widespread pain, but not in irritable bowel syndrome.

    Chronic Fatigue

    Research in chronic fatigue syndrome using cluster analytic techniques has established several subgroups, some of which have been also arisen from genetic studies.

    Peter White (UK) emphasised the need for repetition of this work in large, population-based studies which should be across functional syndromes not within a single syndrome.

    Review and reanalysis of data from randomised controlled trials of cognitive behaviour therapy (CBT) for chronic fatigue syndrome led Hans Knoop (Netherlands) to demonstrate that the positive effect of treatment is not mediated by increased physical activity, as previously thought.

    The beneficial effect of CBT on fatigue is related primarily to changes in illness related cognitions, including a discrepancy between perception and observed level of functioning, a difference which has been correlated with fMRI findings.

    Diagnostic and classificatory issues

    Existing diagnostic classificatory systems were found to be inadequate in this area of psychiatry so Per Klausen Fink (Denmark) and Bernd Lwe (Germany) examined new diagnoses that might be used in future work.

    The proposed DSM-V diagnosis of "complex somatic symptom disorder" may have the highest validity and clinical utility because it includes psychological and behavioural criteria and incorporates a dimensional approach to measure both somatic and psychological symptom severity.

    An alternative approach is based on somatic symptoms, which includes under the new diagnosis of "Body distress disorder" patients with all relevant syndromes.

    A measure of severity is the number of bothersome somatic symptoms, independent of diagnosis.

    This was found in a large, prospective population-based study reported by Ladwig and colleagues, to be predictive of poor outcomes, even after adjustment for a wide range of confounders including chronic physical diseases.

    Genetic studies

    Genetic studies are really in their infancy in this area because of an ill-defined phenotype but investigations to date suggest that there may be a genetic basis to some aspects of functional somatic syndromes.

    Specific symptom patterns and the presence of multiple somatic symptoms both appear to have more pronounced unique environmental effects than genetic ones (Pedersen and Kato). John McBeth (UK) reported preliminary evidence of associations between number of somatic symptoms and SNPs in the serotonin and HPA axis pathway genes.

    Integration of findings

    One way forward in this area of research is to seek specificity of association between psychosocial variables and psychological or biological responses.

    Preliminary findings suggest that childhood abuse is associated with a specific cerebral response to visual stimuli indicating pain, even after controlling for depression, anxiety and numerous somatic symptoms (Tlle and Gndel, Germany) but such closely controlled studies are rare.

    It was suggested (Rief, Germany) that this greater specificity would mean building on current knowledge, for example, of the genetics of pain sensitivity or immune response rather than examining the genetic associations of specific functional somatic syndromes, and seeking similarities and differences between somatisation and depression in view of the recognised difference in HPA axis reactivity (enhanced in depression but blunted or otherwise in functional somatic syndromes).

    In this way we should accept that some aetiological factors may be relevant to all functional somatic syndromes and some may be relevant only to one but, in addition, some may only apply in subgroups of patients within syndromes.

    3. Assessment of the results, contribution to the future direction of the field, outcome

    The group recognised that a number of design features for future studies include the following:

    a) Two kinds of study design are required to measure predictors of change:

    i. longitudinal population-based studies

    ii. intervention studies

    b) In both designs, it is important to measure a variety of functional symptoms and syndromes as outcomes, not just focus on a single syndrome or symptom as in so much previous research

    c) Data analyses should, preferably, be directed towards trajectories of change (towards disease or remission), acknowledging important mediators (including psychopathology and medication use) and moderators (including DNA) and recognizing patient subgroups within the functional somatic syndromes

    d) large samples are necessary to encompass all of these features and to perform satisfactory genetic studies.

    e) functional imaging studies and studies of physiological parameters, e.g. response of the autonomic nervous system would benefit form using a common protocol at different centres and to included a wide variety of participants from different syndromes

    To this end, several sub-groups were formed:

    1. Uniform measures and diagnostic constructs sub-group makes suggestion for core set of instruments (Per Fink, Bernd Lwe, Winfried Rief)

    2. Neuroimaging subgroup co-ordinates designs across different functional somatic symptoms (Lukas van Oudenhove, Adam Farmer, Harald Gndel, Thomas Tlle, Ralph Mager)

    3. Population study sub-group collects information on existing and planned cohorts (Judith Rosmalen, Karl-Heinz Ladwig, Kenji Kato, Kari Ann Leiknes)

    4. Genetics subgroup collects facts on existing datasets (John McBeth, Wendy Thompson, Nancy Pedersen).

    As basis for further actions, the group discussed and agreed as a common aim of the group:

    to understand the common and specific aspects of diagnosis, aetiology and maintenance of Functional Somatic Syndromes (FSS)

    to develop und unify a field of research, using an integration of biological, psychological and sociocultural approaches

    this will enable us to improve prevention, detection and treatment of these syndromes

    It was agreed that there would be a further meeting on 22nd/23rd March 2010 in Munich.

    There, further steps for submitting proposals within the ESF and/ or EU FP programmes will be considered.

    Papers arising from presentations and discussions at the workshop will be published in a Special Issue (Eds. F Creed and P Henningsen) of the Journal of Psychosomatic Research approx. in May 2010.


    Thursday 10 September 2009

    Morning Arrival

    12.00 - 13.00 Lunch

    13.00 - 13.15 Welcome address
    Francis Creed (Manchester Royal Infirmary, UK) and Peter Henningsen
    (Klinikumrechts der Isar, Munich, DE) and

    13.15 - 13.45 Presentation of the European Science Foundation (ESF)
    Janos Rthelyi (ESF Standing Committee for the European Medical Research Councils - EMRC)

    13.45 - 14.00 Aims of the conference and the "one or many" debate
    Peter Henningsen (Klinikumrechts der Isar, Munich, DE) and Francis Creed (Manchester Royal Infirmary, UK)

    14.00 - 14.30 Discussion
    Session A: Aetiological research in single functional somatic

    14.30 - 14.45 Example 1: Studies in irritable bowel syndrome
    Francis Creed (Manchester Royal Infirmary, UK)

    14.45 - 15.15 Discussion

    15.15 - 15.45 Coffee / Tea Break

    15.45 - 16.00 Rethinking studies concerning the neuroimaging and
    pathophysiology of functional GI disorders and pain perception
    Lukas Van Oudenhove (University Hospital Gasthuisberg, Leuven, BE)

    Adam Farmer (Neurogastroenterology, St. Bartholomew`s Hospital, London)

    16.00 - 16.30 Discussion

    16.30 - 16.45 Example 2: Findings in Chronic fatigue syndrome

    Peter White (London School of Medicine and Dentistry, UK)

    16.45 - 17.15 Discussion

    19.30 Dinner

    Friday 11 September 2009

    09.00-09.15 What have we learned from cohort and treatment studies in CFS?

    Hans Knoop (Radboud University Nijmegen Medical Center, NL)

    09.15-09.45 Discussion

    09.45-10.00 Genetic findings in population based studies of chronic
    widespread pain

    John McBeth (Arc Epidemiology Unit, University of Manchester, UK)

    10.00-10.30 Discussion

    10.30-11.00 Coffee / Tea Break

    Session B: Identifying common ground 1: diagnosis, classification
    and common factors

    11.00-11.15 Improving diagnosis and classification: body distress syndrome
    and alternatives"

    Per Klausen Fink (The Research Clinic for Functional Disorders and
    Psychosomatics, Aarhus University Hospital, DK)

    11.15-11.45 Discussion

    11.45-12.00 Psychological processes common to the somatisation and related disorders"
    Bernd Lwe (Universittsklinikum Hamburg-Eppendorf, DE)

    12.00-12.30 Discussion

    12.30-13.45 Lunch

    Session C: Identifying common ground 2: Possible new avenues
    of investigation using population based, genetic and physiological

    13.45-14.00 Population based studies of somatic symptoms
    Karl-Heinz Ladwig (Helmholtz-Zentrum, Oberschleissheim, DE) and Francis Creed (Manchester Royal Infirmary, UK)

    14.00-14.30 Discussion

    14.30-14.45 Perspectives of functional neuroimaging studies on pain in
    functional somatic and other syndromes
    Thomas Tlle (Klinikumrechts der Isar, Munich, DE) and Harald Gndel
    (Medizinische Hochschule Hannover, DE)

    14.45-15.15 Discussion

    15.15-15.45 Coffee / tea break

    15.45-16.00 Genetic epidemiological studies of functional gastro-intestinal disorders and chronic fatigue
    Nancy Pedersen (Karolinska Institutet, Stockholm, SE) and Kenji Kato
    (International University of Health and Welfare, Kanagawa, JP)

    16.00-16.30 Discussion

    16.30-16.45 Stress physiology in relation to functional somatic syndromes in longitudinal studies
    J.G.M. Rosmalen (University Medical Center Groningen, NL)

    16.45-17.15 Discussion

    17.15-17.30 Genetic association and immunological studies in somatisation and somatic symptoms Winfried Rief (Klinische Psychology and Psychotherapie, Universitt Marburg,

    17.30-18.00 Discussion

    19.30 Dinner

    Saturday 12 September 2009

    Session D: Future research

    09.30-11.00 General discussion of future research plans and how they will be implemented - chaired by Francis Creed (Manchester Royal Infirmary, UK) and Peter Henningsen (Klinikumrechts der Isar, Munich, DE) i.e.:

    -Defining a list of research questions

    - Forming a central co-ordinating group

    - Practical steps

    11.00-11.30 Coffee / Tea Break

    11.30-13.00 General discussion of future research plans and how they will be implemented - ctd.

    13.00 Lunch

    afternoon departure

    5. Final List of Participants


    1. Francis CREED
    Manchester Royal Infirmary
    United Kingdom


    2. Peter HENNINGSEN
    Klinikum rechts der Isar der Technischen
    Universitt Mnchen

    ESF Representative:

    3. Janos Rthelyi
    Department of Psychiatry and
    Semmelweis University


    4. Hans KNOOP
    Radboud University Nijmegen Medical
    The Netherlands

    5. Per Klausen FINK
    The Research Clinic for Functional
    Disorders and Psychosomatics
    Aarhus University Hospital

    6. John MCBETH
    Arc Epidemiology Unit
    University of Manchester
    United Kingdom

    Trimbos Intituut/ Netherlands institute of
    Mental Health and Addiction
    The Netherlands

    8. J.G.M. ROSMALEN
    Interdisciplinary Center for Psychiatric
    University Medical Center Groningen
    The Netherlands

    9. Ralph MAGER
    Universitre Psychiatrische KlinikenBasel

    10. Lukas VAN OUDENHOVE
    Secretary of Liaison Psychiatry
    University Hospital Gasthuisberg

    11. Bernd LWE
    Institut und Poliklinik fr
    Psychosomatische Medizin und
    Universittsklinikum Hamburg-Eppendorf

    12. Kari Ann LEIKNES
    Institute of Basic Medical Sciences,
    Department of Behavioural Sciences in
    Faculty of Medicine
    University of Oslo

    13. Wendy THOMSON
    arc Epidemiology Unit
    School of Translational Medicine
    Epidemiology Research Group
    Stopford Building
    University of Manchester
    United Kingdom

    14. Kenji KATO
    School of Nursing and Rehabilitation
    International University of Health and
    Kanagawa 250-8588

    15. Peter D WHITE
    Barts and the London School of Medicine
    and Dentistry,
    Queen Mary University of London
    St Bartholomew's Hospital
    United Kingdom

    16. Nancy PEDERSEN
    Karolinska Institutet
    Department of Medical Epidemiology and

    17. Judith PRINS
    Radboud University Nijmegen Medical
    The Netherlands

    18. Winfried RIEF
    Klinische Psychologie und
    Universitt Marburg

    19. Harald GNDEL
    Klinische Psychiatrie und Psychotherapie
    Medizinische Hochschule Hannover

    20. Thomas TLLE
    Klinikum rechts der Isar der Technischen
    Universitt Mnchen
    Neurologische Klinik

    21. Karl-Heinz LADWIG

    6. Statistical Information on Participants


    Countries of origin

    United Kingdom 4
    Denmark 1
    Germany 6
    Belgium 1
    Netherlands 4
    Norway 1
    Japan 1
    Sweden 1
    Switzerland 1
    Total (20) - ESF representative not counted

    Age Range (if known)

    25-35 2
    35-45 10
    45-55 7
    >55 1


    Male 14
    Female 6

    [Text conversion of PDF completed]
  2. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    European Association for Consultation-Liaison Psychiatry and Psychosomatics

    Francis Creed has been working with European Association for Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) colleagues, Henningsen and Fink* on a draft white paper for the EACLLP MUS study group called: "Patients with medically unexplained symptoms and somatisation - a challenge for European health care systems"

    A copy of the working draft, for which comments could be submitted, can be
    downloaded here:

    For more on the European Association for Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) MUS Study Group see section 5 of ME agenda posting:

    Extract from draft White Paper: "Patients with medically unexplained symptoms
    and somatisation - a challenge for European health care systems"


    There is no simple way to classify MUS in medicine and many doctors, especially
    in primary care, are rather reluctant to code them at all. These facts seriously
    hamper recognition, research and treatment of MUS and somatisation and
    communication with patients and among health professionals about them.

    Classification depends on two related differentiations: classification on the
    level of either symptoms, syndromes or disorders and classification either as
    physical, mental or unspecified.

    .Classification as a single symptom is done for instance with the ICD-9 code
    780-789 "Signs, symptom and ill-defined conditions" or its equivalent in ICD-10,
    chapter XVIII (R00-R99). This classification is easy to use and respects the
    fact that, at least early in its course, it is hard to tell whether a symptom
    can be organically explained, or has a physical or mental nature. But it is
    therefore very unspecific, and it is not adequate for multiple symptoms and
    severe accompanying distress.

    .Classification as a specific functional somatic syndrome (FSS) is possible for
    those patients who have a constellation of (usually more than one) medically
    unexplained symptoms that fit with the description of this FSS. Examples are
    Irritable bowel syndrome(IBS), fibromyalgia (now called chronic widespread
    pain), chronic fatigue syndrome (CFS), temporomandibular joint pain. A large
    proportion of patients with one FSS also meet the criteria for one or more other
    FSS (see: Comorbidity); fatigue, for example, is a recognised feature of both
    chronic fatigue syndrome and fibromyalgia. This classification is used widely in
    somatic special care, where a major proportion of new patients are found to have
    a functional somatic syndrome - irritable bowel syndrome in gastroenterology,
    chronic widespread pain in rheumatology etc. One major advantage of terms like
    "FSS", "IBS", or "CFS" is that they are less stigmatising than the terms
    "somatisation" and "somatoform disorders". It is important to note, however,
    that gradation of severity and a description of psychological and behavioural
    characteristics are not part of the description of Functional somatic syndromes.

    .Classification as a somatoform disorder (SFD) within the ICD-10 chapter V (F)
    on mental disorders and the DSM-IV. In contrast to classification as FSS,
    subgroups of somatoform disorders allow some gradation according to number of
    symptoms/severity and delineation of the subgroup with predominant health
    anxiety. The SFD classifications mention psychological and behavioural
    characteristics like preoccupation with organic disease or dysfunctional illness
    behaviour, but they are not operationalized for single disorder categories. This
    classification is more difficult to use because it requires judgements about the
    fact that symptoms are medically unexplained and not part of another mental
    disorder like depression or anxiety. The term encourages a "lumping" perspective
    compared to the "splitting" tendency of FSS. It is, however, disliked by many
    patients, in some countries more than in others, because of its implication that
    the MUS are part of a mental disorder. New editions of the SFD classifications
    in ICD-11 and DSM-V are currently under way."


    Note that Fibromyalgia is referred to in this draft MUS White Paper as "now
    called chronic widespread pain" as I've mentioned in the previous post.

    Fibromyalgia is currently classified in ICD-10 under:

    M79 Other soft tissue disorders, not elsewhere classified
    M79.0 Rheumatism, unspecified

    *Henningsen and Fink were both members of the CISSD Project.
  3. eric_s

    eric_s Senior Member

    Switzerland/Spain (Valencia)
    Renaming Fibromyalgia to "Chronic Widespread Pain" reminds me of renaming M.E. to "Chronic Fatigue Syndrome"...

    If the association with XMRV is confirmed these efforts seem to be dead but if not it's scary...
    WillowJ likes this.
  4. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    Journal of Psychosomatic Research

    The Journal of Psychosomatic Research is the Official Journal of the European Association for Consultation Liaison Psychiatry and Psychosomatics and Affiliated with the International College of Pyschosomatic Medicine.

    The current issue of J Psychosoma Res is open to the public, that is no sub or pay per paper/editorial/article is required for this issue.

    You can view a list of Editors, Associate Editors and Advisers here:

    Dr James Levenson is announced as the new North American editor of the Journal of Psychosomatic Research.

    Like Creed, Levenson is a member of the DSM-5 "Somatic Symptom Disorders" Work Group.

    Michael Sharpe is an Associate Editor of J Psychosoma Res and also a member of the DSM-5 Somatic Symptom Disorders Work Group.

    Arthur Barsky is an Adviser and also a member of the DSM-5 Somatic Symptom Disorders Work Group.

    It's all very cosy.

    Simon Wessely is also listed as an Adviser to J Psychosoma Res.

    From Articles In Press:

    A pilot study of cognitive behavioral stress management effects on stress, quality of life, and symptoms in persons with chronic fatigue syndrome • FULL-LENGTH ARTICLE
    In Press Corrected Proof , Available online 18 January 2011
    Corina Lopez, Michael Antoni, Frank Penedo, Donna Weiss, Stacy Cruess, Mary-Catherine Segotas, Lynn Helder, Scott Siegel, Nancy Klimas, Mary Ann Fletcher
    Journal of Psychosomatic Research
    DOI: 10.1016/j.jpsychores.2010.11.010
    Abstract | Full Text | Full-Text PDF (129 KB)

    Metacognitions and negative emotions as predictors of symptom severity in chronic fatigue syndrome • FULL-LENGTH ARTICLE
    In Press Corrected Proof , Available online 19 November 2010
    Lorraine Maher-Edwards, Bruce A. Fernie, Gabrielle Murphy, Adrian Wells, Marcantonio M. Spada
    Journal of Psychosomatic Research
    DOI: 10.1016/j.jpsychores.2010.09.016
    Abstract | Full Text | Full-Text PDF (133 KB)


    The Report of the 2009 ESF Exploratory Workshop - EMRC mentioned that articles resulting from that Workshop were expected to be published in the May 2010 issue of the Journal of Psychosomatic Research and it was case that the May 2010 issue was devoted to Functional Somatic Syndromes.

    The paper:

    One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders
    Per Fink, Andreas Schrder pages 415-426
    Abstract | Full Text | Full-Text PDF (926 KB)

    is the paper for which this thread was started.

    Thread Ist post:

    Per Fink has been pushing his "Bodily Distress Disorder" for several years.

    Brief summary of a presentation he gave in 2008, to a UK conference. May 08.pdf

    The Irish College of Psychiatrists' Bulletin
    Vol 3, Issue 1. May 2008


    Report from the Royal College of Psychiatrists Liaison Faculty
    Anual Residential Conference 2008

    This conference is the highlight of the academic year for liaison psychiatrists in the UK and in Ireland. This year it was held in Newcastle upon Tyne over three days; 12th - 14th of March.


    Prof. Per Fink from Denmark delivered the keynote address and presented both new (from the Danish register) and previously published research which questions the validity of the current construct of 'Somatisation'. His research has found that it is more often the doctor than the patient who initiates over-investigation in somatoform conditions and suggests taking 'health-seeking behaviour' out of the diagnostic criteria. His presentation also examined the claims of several of the 'pseudonym' somatoform conditions which have been invented by various branches of medicine. He found that there were no differences in the symptoms reported by patients diagnosed with Fibromyalgia; Multiple Chemical Sensitivity; Sick Building Syndrome and Chronic Fatigue Syndrome' confirming the long-held clinical opinion that these are all the same condition: somatoform disorder. He also suggested a possible new name for the condition; 'Body Distress Disorder' which he believes may be more acceptable to patients and GPs.


    Sure it is, Prof Fink! We love it!

    Journal of Psychosomatic Research
    Volume 68, Issue 5, Pages 393-506 (May 2010)

    Functional Somatic Syndromes


    The genetic, physiological and psychological mechanisms underlying disabling medically unexplained symptoms and somatisation
    Peter Henningsen, Francis Creed
    pages 395-397
    Full Text | Full-Text PDF (97 KB)

    The way forward: A case for longitudinal population-based studies in the field of functional somatic syndromes, 01 February 2010
    Judith G.M. Rosmalen
    pages 399-401
    Full Text | Full-Text PDF (90 KB)
    Original Articles

    Towards positive diagnostic criteria: A systematic review of somatoform disorder diagnoses and suggestions for future classification, 15 March 2010
    Katharina Voigt, Annabel Nagel, Bjrn Meyer, Gernot Langs, Christoph Braukhaus, Bernd Lwe
    pages 403-414
    Abstract | Full Text | Full-Text PDF (180 KB)

    One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders
    Per Fink, Andreas Schrder
    pages 415-426
    Abstract | Full Text | Full-Text PDF (926 KB)

    Screening for multiple somatic complaints in a population-based survey: Does excessive symptom reporting capture the concept of somatic symptom disorders? Findings from the MONICA-KORA Cohort Study, 02 March 2010
    Karl Heinz Ladwig, Birgitt Marten-Mittag, Maria Elena Lacruz, Peter Henningsen, Francis Creed, for the MONICA KORA Investigators
    pages 427-437
    Abstract | Full Text | Full-Text PDF (509 KB)

    Commonalities and differences between the diagnostic groups: Current somatoform disorders, anxiety and/or depression, and musculoskeletal disorders, 22 March 2010
    Kari Ann Leiknes, Arnstein Finset, Torbjrn Moum
    pages 439-446
    Abstract | Full Text | Full-Text PDF (186 KB)

    Latent class analysis of functional somatic symptoms in a population-based sample of twins, 02 March 2010
    Kenji Kato, Patrick F. Sullivan, Nancy L. Pedersen
    pages 447-453
    Abstract | Full Text | Full-Text PDF (123 KB)

    Chronic fatigue syndrome: Is it one discrete syndrome or many? Implications for the “one vs. many” functional somatic syndromes debate, 18 March 2010
    Peter D. White
    pages 455-459
    Abstract | Full Text | Full-Text PDF (105 KB)

    Dysfunction of stress responsive systems as a risk factor for functional somatic syndromes
    Lineke M. Tak, Judith G.M. Rosmalen
    pages 461-468
    Abstract | Full Text | Full-Text PDF (262 KB)

    Genetic variation in neuroendocrine genes associates with somatic symptoms in the general population: Results from the EPIFUND study
    Kate L. Holliday, Gary J. Macfarlane, Barbara I. Nicholl, Francis Creed, Wendy Thomson, John McBeth
    pages 469-474
    Abstract | Full Text | Full-Text PDF (324 KB)

    The future of neuroscientific research in functional gastrointestinal disorders: Integration towards multidimensional (visceral) pain endophenotypes?, 01 February 2010
    Adam D. Farmer, Qasim Aziz, Jan Tack, Lukas Van Oudenhove
    pages 475-481
    Abstract | Full Text | Full-Text PDF (307 KB)

    Aftermath of sexual abuse history on adult patients suffering from chronic functional pain syndromes: An fMRI pilot study, 17 March 2010
    Michael Noll-Hussong, Alexander Otti, Leonhard Laeer, Afra Wohlschlaeger, Claus Zimmer, Claas Lahmann, Peter Henningsen, Thomas Toelle, Harald Guendel
    pages 483-487
    Abstract | Full Text | Full-Text PDF (313 KB)

    The central role of cognitive processes in the perpetuation of chronic fatigue syndrome, 17 March 2010
    Hans Knoop, Judith B. Prins, Rona Moss-Morris, Gijs Bleijenberg
    pages 489-494
    Abstract | Full Text | Full-Text PDF (116 KB)

    Psychobiological differences between depression and somatization, 18 March 2010
    Winfried Rief, Anika Hennings, Sabine Riemer, Frank Euteneuer
    pages 495-502
    Abstract | Full Text | Full-Text PDF (144 KB)

  5. SilverbladeTE

    SilverbladeTE Senior Member

    Somewhere near Glasgow, Scotland
    these are the dangerous lunatics who should be strapped to a wall! :/

    next up:
    "Irritable Nose Syndrome" all those suffering a drippy nose, coughs, teary eyes and malaise will be classed as having a mental illness, not the Common Cold! :p
  6. Valb626


    This really IS frightening. Can we sue them for slander?
  7. George

    George waitin' fer rabbits

    South Texas
    WoW, what a bunch of nutcases! So how are we coding these guys? 780-SNPP for Super Nutty Psychosomatic Psychiatrist? I think they just need the rest of the world to be cracked so they can pretend they are Normal! (big grins)
  8. biophile

    biophile Places I'd rather be.

    Yet the house of cards keeps falling

    I only skimmed through all that but I noticed this:

    One major component in their hypothesis has been refuted by their own work. So now they are focusing even more on the other cognitive components, like discrepant perception:

    The assumption about this "discrepancy" have been making the rounds in biopsychosocialist circles, except this one is looking very shaky as well. Yes, Knoop or someone else published such a study and no doubt cherry picked it for their review on "central role of cognitive processes in the perpetuation of chronic fatigue syndrome". However, there is a recent meta-analysis on cognitive functioning in CFS (Cockshell & Mathias 2010 - full text already in the PR library).

    Conclusion from abstract, "Persons with CFS demonstrate moderate to large impairments in simple and complex information processing speed and in tasks requiring working memory over a sustained period of time."

    Conclusion from full text, "In conclusion, this study provides objective evidence of cognitive deficits in persons with CFS, primarily in the domains of attention, memory and RT. In general, these deficits are consistent with those that are reported by patients. Both simple and complex information processing speed are impaired, along with working memory. The data also suggest that memory deficits may be due to the poor initial acquisition of information but more studies are needed to investigate this. The deficits in performance are around 0.51.0 S.D. below that of their healthy peers, which is likely to have an impact on day-to-day activities. In contrast, CFS does not appear to have an impact on perceptual abilities or fine motor speed; nor does it appear to affect higher order cognitive abilities, such as language, reasoning or intelligence."

    Twisk & Maes offer some explanations for the cognitive impairments (full text already in the PR library).

    As for Knoop et al's review on CBT and physical functioning, Stouten & Goudsmit re-examined data from the largest of the three trials included in the meta-analysis because the data was available in the public domain (Prins et al 2001, which was a "chronic fatigue" study), CBT had no significant effect on either somatic attributions or focusing on bodily symptoms, but had a significant effect on the sense of control (although the results in Table 1 suggest a relatively small effect).

    Remember Wessely's somewhat patronising speech about helping the somatising CFS patient to "call a halt to the loss of face" or something? Who's going to help these biopsychosocialists call a halt to the loss of face regarding their own abnormal illness beliefs, as various flavours of the cognitive behavioural model of CFS keep crumbling? This is occurring even without considering the weight of pathophysiology!
  9. Enid

    Enid Senior Member

    Another load of ....... from the psychos still fighting their corner and trying to dispose of real medicine with how to make an illness disappear.
  10. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    The Editorial: Is there a better term than “Medically unexplained symptoms”? Creed F, Guthrie E, Fink P, Henningsen P, Rief W, Sharpe M and White P (Journal of Psychosom Research: Volume 68, Issue 1, Pages 5–8 January 2010) discussed the deliberations of the EACLPP study group.

    The Editorial also included references to the DSM and ICD revision processes.

    References to DSM and ICD revision in:

    Is there a better term than “Medically unexplained symptoms”? J Psychoso Res: Volume 68, Issue 1, Pages 5–8.



    The European Association of Consultation Liaison Psychiatry and Psychosomatics (EACLPP) is preparing a [White paper of the EACLPP Medically Unexplained Symptoms study group by Peter Henningsen and Francis Creed] document aimed at improving the quality of care received by patients who have “medically unexplained symptoms” or “somatisation” [1]. Part of this document identifies barriers to improved care and it has become apparent that the term “medically unexplained symptoms” is itself a barrier to improved care…

    [Ed: Draft white paper was, and still may be, at: )

    …The authors of this paper met in Manchester in May 2009 to review thoroughly this problem of terminology and make recommendations for a better term….The deliberations of the group form the basis of this paper…


    Our priority was to identify a term or terms that would facilitate management – that is it would encourage joint medical psychiatric/psychological assessment and treatment and be acceptable to physicians, patients, psychiatrists and psychologists.

    Criteria to judge the value of alternative terms for “medically unexplained symptoms”

    Ten criteria were developed in order to judge the value of potential terms which might be used to describe the group of symptoms currently referred to as medically unexplained symptoms. Obviously, this list of criteria does not claim to be exhaustive, but we believe that it captures the most important aspects. The criteria are that the term:

    1. is acceptable to patients
    2. is acceptable and usable by doctors and other health care professionals, making it likely that they will use it in daily practice.
    3. does not reinforce unhelpful dualistic thinking.
    4. can be used readily in patients who also have pathologically established disease
    5. can be adequate as a stand alone diagnosis
    6. has a clear core theoretical concept
    7. will facilitate the possibility of multi-disciplinary (medical and psychological) treatment
    8. has similar meaning in different cultures
    9. is neutral with regard to aetiology and pathology
    10. has a satisfactory acronym.

    Terms suggested as alternatives for “medically unexplained symptoms”

    The group reviewed terms which are used currently or have been proposed for the future. An extensive list was abbreviated to the following 8 terms or categories: The terms we reviewed were:

    1. Medically unexplained symptoms or medically unexplained physical symptoms
    2. Functional disorder or functional somatic syndromes
    3. Bodily distress syndrome/disorder or bodily stress syndrome/disorder
    4. Somatic symptom disorder
    5. Psychophysical / psychophysiological disorder
    6. Psychosomatic disorder
    7. Symptom defined illness or syndrome
    8. Somatoform disorder


    Implications for DSM-V and ICD-11

    There is overlap between the discussion reported here and the discussion currently under way towards the creation of DSM-V. Two of the authors (FC, MS) are also members of the working group on Somatic Distress Disorders of the American Psychiatric Association (APA), which is proposing a new classification to replace the DSM-IV “somatoform” and related disorders. In this working group, similar concerns about the use of the term and concept of “medically unexplained symptoms” have been raised [12].

    The current suggestion by the DSM-V work group to use the term “Complex somatic symptom disorder” must be seen as step in a process and not as a final proposal. Unfortunately this term does not appear to meet many of the criteria listed above.


    One major problem for reforming the classification relates to the fact that the DSM system includes only “mental” disorders whereas what we have described above is the necessity of not trying to force these disorders into either a “mental” or “physical” classification. The ICD-10 system has a similar problem as it has mental disorders separated from the rest of medical disorders.

    The solution of “interface disorders”, suggested by DSM IV, is a compromise but it is unsatisfactory as it is based on the dualistic separation of organic and psychological disorders and prevents the integration of the disorders with which we are concerned here. This lack of integration affects the ICD classification also. For example functional somatic syndromes (e.g. irritable bowel syndrome) would be classified within the “physical” classification of ICD or Axis III in DSM (gastrointestinal disorders) and omitted from the mental and behavioural chapter entirely [13].

    [End Extract]

    Scary bunch this EACLPP study group, for which organisation the J of Psychosoma Res is its official organ, the Editors for which, Creed and Levenson, are DSM-5 SDD Work Group members.
  11. Enid

    Enid Senior Member

    There is a better term for "medically unexplained symptoms" - it's called "we don't know" (but in the light of research and pathology findings perhaps we should keep out and learn) 8 categories - looks like playing with words and they really are in the dark.
  12. eric_s

    eric_s Senior Member

    Switzerland/Spain (Valencia)
    One thing that really surprised me... what is Nancy Klimas' name doing there, in the list of authors of one study?

    I didn't mind she was an author of the HPA axis study, but now a new one that seems to be about CBT?

    I have not read the paper, but what sould we make of this?

    I can only repeat myself, it's what i believe, of course i can't know if what i'm thinking is smart or correct...
    Those people have influential positions, at least some of them, they have money, connections, knowledge, reputation. What do we have? How can we step up to them and stop them? So far we have not been able to, at least not sufficiently. It's dangerous, we've suffered from it and we have to change it.

    We need to organize more, we need TONS more money to hire the people we need and be able to do the research necessary, political and media work. The WPI is a very good example, but it's small compared to what we are up against.
    Almost everybody can do a little contribution and combined our number should be sufficient to be able to achieve a lot. We need to try to reach everybody with ME/CFS and combine our strength.
  13. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    PR Library

    A pilot study of cognitive behavioral stress management effects on stress, quality of life, and symptoms in persons with chronic fatigue syndrome • FULL-LENGTH ARTICLE

    In Press Corrected Proof , Available online 18 January 2011

    Corina Lopez, Michael Antoni, Frank Penedo, Donna Weiss, Stacy Cruess, Mary-Catherine Segotas, Lynn Helder, Scott Siegel, Nancy Klimas, Mary Ann Fletcher
    Journal of Psychosomatic Research
    DOI: 10.1016/j.jpsychores.2010.11.010
    Abstract | Full Text | Full-Text PDF (129 KB)


    Articles in Press



    FULL-TEXT PDF (129 KB)


    A pilot study of cognitive behavioral stress management effects on stress, quality of life, and symptoms in persons with chronic fatigue syndrome

    Corina Lopez, Michael Antoni, Frank Penedo, Donna Weiss, Stacy Cruess, Mary-Catherine Segotas, Lynn Helder, Scott Siegel, Nancy Klimas, Mary Ann Fletcher

    Received 21 September 2010; received in revised form 26 November 2010; accepted 29 November 2010. published online 18 January 2011.
    Corrected Proof


    The present pilot study was designed to test the effects of a 12-week group-based cognitive behavioral stress management (CBSM) intervention on stress, quality of life, and symptoms in chronic fatigue syndrome (CFS). We hypothesized that participants randomized to CBSM would report improvements in perceived stress, mood, quality of life, and CFS symptomatology from pre- to postintervention compared to those receiving a psychoeducational (PE) seminar control.

    We recruited 69 persons with a bona fide diagnosis of CFS and randomized 44 to CBSM and 25 to PE. Participants completed the Perceived Stress Scale (PSS), Profile of Mood States (POMS), Quality of Life Inventory (QOLI), and a Centers for Disease Control (CDC)-based CFS symptom checklist pre- and postintervention.

    Repeated measures analysis of variance revealed a significant GroupTime interaction for PSS, POMS–total mood disturbance (TMD), and QOLI scores, such that participants in CBSM evidenced greater improvements than those in PE. Participants in CBSM also reported decreases in severity of CFS symptoms vs. those in PE.

    Results suggest that CBSM is beneficial for managing distress, improving quality of life, and alleviating CFS symptom severity.

    Keywords: CDC symptoms, Chronic fatigue syndrome, Quality of life, Stress, Stress management

    Corresponding author. Department of Psychology, 5665 Ponce DeLeon Blvd., Coral Gables, FL 33124, USA.

    This study was funded by the National Institutes of Health (NIH) (1 U01 AI45940 and 1R01 NS055672-01).

    PII: S0022-3999(10)00447-2


    2010 Elsevier Inc. All rights reserved.
  14. eric_s

    eric_s Senior Member

    Switzerland/Spain (Valencia)
    What i don't get (among other things)...

    Even of those people who believe that sort of treatment is good, i'd guess that most don't think it can cure ME/CFS, as i'm not aware of any such studies or even significant numbers of cases, apart from people who probably never had CFS. I think they see in it something that might bring some improvement.
    So, obviously, even to them, it is not adressing the cause of ME/CFS or not in a successful way.
    So why the hell spend so much time on it and fund it (NIH, who seem very reluctant so far to fund XMRV related work)??? Are we the only people with an illness where efforts to bring some relief (for those who believe in it) are regarded as sufficient and the way to go?
    Why don't fund studies that try to find the cause and cure people? Only this is enough.
  15. Sean

    Sean Senior Member

    This is an important point. The somatising/CBT/GET behavioural model has seriously failed to deliver on its rather extravagant and premature claims and promises, it has not provided the necessary explanatory and therapeutic power to be the model of ME/CFS. There is no way around that.

    No genuinely science based model of reality can sustain itself forever on marginal and disputed results, slippery (but persuasive) rhetoric, and high level political protection. It does look to me like the behavioural model of ME/CFS has largely run its scientific race, and the overall results are not good for it, and are not likely to improve, quite the contrary.

    Unfortunately it will take some time for the ideological & administrative inertia behind it to fully unwind and the changes to flow through the scientific, medical, political, legal and economic systems. So it is of little comfort to those who are suffering unnecessarily under that behavioural model right now, and who may well do so for some time yet.
    WillowJ likes this.
  16. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    PR Library

    A pilot study of cognitive behavioral stress management effects on stress, quality of life, and symptoms in persons with chronic fatigue syndrome • FULL-LENGTH ARTICLE

    In Press Corrected Proof , Available online 18 January 2011

    Corina Lopez, Michael Antoni, Frank Penedo, Donna Weiss, Stacy Cruess, Mary-Catherine Segotas, Lynn Helder, Scott Siegel, Nancy Klimas, Mary Ann Fletcher
    Journal of Psychosomatic Research
    DOI: 10.1016/j.jpsychores.2010.11.010
    Abstract | Full Text | Full-Text PDF (129 KB)
  17. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    The European Association for Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) holds its next conference in Budapest:

    XIV Annual Scientific Meeting European Association for Consultation-Liaison
    Psychiatry and Psychosomatics (EACLPP)
    Budapest, Hungary
    June 30th - July 2nd 2011

    Link to congress

    Scientific Information

    Speakers include

    Manfred Beutel (Germany)
    Francis Creed (UK) *
    Elspeth Guthrie (UK)
    Jon Hunter (Canada)
    Mria S. Kopp (Hungary)
    Kurt Kroenke (USA)
    James Levenson (USA) *
    Paula Ravitz (Canada)
    Gary Rodin (Canada)
    Colin Shapiro (Canada)
    Fritz Stiefel (Switzerland)
    Ferenc Try (Hungary)

    Symposia topics include

    Psychodynamic psychotherapy in liaison psychiatry
    Medically unexplained symptoms
    Palliative care
    Sleep disorders
    Body image, eating disorders
    C-L in primary care
    Outcomes and quality control in the C-L setting
    Depression in medically ill patients
    Stress management
    Psychopharmacology in medically ill patients
    Gender and health
    Organ transplantation
    Other planned topics include
    Sexual problems in the medically ill
    Chronic pain
    Psychosomatic aspects of cardiovascular disease
    Chronic fatigue

    Workgroup topics

    Medically unexplained symptoms
    C-L psychiatry in primary care
    Child and adolescent C-L psychiatry
    Guidelines in C-L psychiatry
    Premeeting Courses
    Clinical epidemiology
    Psychotherapy effectiveness
    CALM therapy
    C-L psychiatry

    *Ed: DSM-5 Somatic Symptom Disorder Work Group members and co-editors of J Psychosoma Res.


    No conference abstracts or poster information yet.
  18. Marty

    Marty Senior Member

    Suzy, a biggest possible "Thank You" for your persistent efforts. You have proven beyond a shadow of a doubt that this is not an information campaign but a war of political will. Thank you, thank you, thank you for your extraordinary efforts over such a long time.
  19. biophile

    biophile Places I'd rather be.

    Thanks. You made some good points. It does appear that the cognitive behavioural model of CFS, a type of biopsychosocial model, has been exposed as largely hot air underneath a thin veneer of "science". All the previous dominant models in psychiatry have suffered collapse, although useful aspects of them live on. I think the biopsychosocial model will also face a similar collapse with useful aspects of it living on in the next dominant model.

    To understand why psychologisation of CFS has great inertia and resists change, it is important to note from a historical perspective that most of the themes directed towards CFS (such as the various ambiguous meanings of "somatisation", as well as misinterpretation / abnormal illness beliefs, lack of psyche-soma differentiation or lack of insight to distinguish between emotional symptoms and physical illness, overlapping mental problems, hypervigilance of benign symptoms / somatic preoccupations, hysteria, weak personality, excuse to be a failure in life, malingering, fashionable socially constructed illness, psychosomatic functional illness, etc) have in some form or another been routinely directed towards so-called "medically unexplained physical symptoms" over the last century or so.

    Psycho>somatic mechanisms in medicine have sort of been the equivalent of the "god of the gaps" in philosophy, conveniently invoked to fill in the gaps to what still lacks adequate explanation. As I'm sure you know, we are not just facing something new aimed at CFS that some biopsychosocialists invented or "discovered" in the 1980's that will go away easily when exposed as a flawed misunderstanding. The early association with yuppie burnout and somatised depression (despite being debunked), and the failure of medical scientists to pin down a definite cause quickly or easily, such a situation had invited or tapped into the massive pre-existing ocean of psychobabble. In other words we are facing hundreds of years of prejudices and ideological persuasions which we have inherited through guilt by association.

    A similar debate raged over neurasthenia a century ago, it became a massive wastebasket diagnosis of heterogeneity and was eventually classified as a psychiatric diagnosis and has been largely abandoned but many of the arguments made against neurasthenia back in the day have been revived towards CFS. Wessely and others believe CFS may suffer a similar fate, but we now have better medical technology so I believe the debate will be settled properly this time after a lengthy battle.

    I read an article somewhere about a computer model of social influence which suggested that many so-called influential people are merely conduits of the status quo rather than contributing or changing anything on their own. I think this is one clue as to why psychologisers have gained such influence on CFS despite the lack of scientific support, not because they have said anything original or discovered anything impressive, but because they are conduits of the status quo.

    Another clue is what others have written about "cargo cult science" and "zombie science" where dubious models, especially in the softer sciences of psychology and psychiatry, which appear scientific but are perpetuated despite lacking hard evidence, for reasons that are non-scientific such as self-interest and self-delusion.
    WillowJ likes this.
  20. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    Author deleted content.

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