Alegria: Having 3 Physical Symptoms (Whether "Medically Unexplained" OR NOT) = Somatization (2010)!

[justinreilly]

… And that's just the start of this insane paper:
"Whether medically unexplained or not, three or more concurrent somatic symptoms predict psychopathology and service use in community populations (2010)"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905311/#!po=45.8333

Since Alegria defines CFS as Somatization, this present paper on somatization is extremely relevant.
http://forums.phoenixrising.me/inde...-a-neurasthenia-spectrum-disorder-2012.27107/

Here are the 6 big problems I found with this paper. All six statements are absolutely ludicrous:

(1) "Proposes the use of 3+ current General Physical Symptoms for designating a 'case'" of somatization;

(2) They claim their finding that "Medically Unexplained Physical Symptoms were not independently associated with psychopathology" logically leads one to their above conclusion (that 3 physical symptoms = somatization)

(3) In this study, they count a physical symptom as being definitely "medically unexplained" if the patient said their doctor didn't mention the cause;

(4) They say the fact that they found a high prevalence of physical symptoms (which were overwhelmingly 'medically explained') in the general population, "strongly supports the observation of many previous studies in the US and abroad that have shown that somatic symptoms represent a common expression of psychopathology…" (for the 'previous studies' they cite Wessely and Sharpe on CFS and the other "functional somatic syndromes" as being a single somatization disorder here; http://www.simonwessely.com/Downloads/Publications/CFS/108.pdf )

(5) Also prominently concludes that "physical symptoms are an important component of common mental disorders" dispite admitting in a much less prominent section that physical symptoms could well cause mental disorders and other alternative explanations exist for the co-occurance of physical symptoms and mental disorders;

(6) "Several investigators have suggested that it may be unnecessary to go through all the probes and procedures to rule out medical explanations given the stepwise association between somatic symptoms and common mental disorders such as anxiety and depression in primary care." In context, this statement seems to be saying that in studies of somatization, one should just assume that all physical symptoms in the general population are caused by mental disorders.

The following is all that Jennie Spotila and company had to say about this paper on Occupycfs.com:
"As we mentioned in our profile of Dr. Alegria, she has co-authored three publications potentially relevant to her views on ME/CFS. The first two (here and here) address the relationship between somatic symptoms and psychiatric disorders like depression. Only 14 symptoms were assessed in these papers, and fatigue was not one of them. The papers found that having 3 or more of the 14 symptoms was associated with depression/anxiety and mental health service use. However, one of the papers correctly noted that the data are ill suited to infer causality between the physical symptoms and mental health issues."

Since all six of the above points made by Alegria are completely nonsensical and harmful statements about somatization, this paper alone is evidence enough, never mind her worse paper stating that CFS = the psychiatric illness Neurasthenia, that it is absolutely unacceptable to have Alegria on the IoM panel.

 

[Ren]

For what it's worth, I recall there were some comments made on occupycfs.com in regard to the "three or more concurrent somatic symptoms predict psychopathology" paper... See posts by DZ: http://www.occupycfs.com/2013/12/05/iom-panelists-the-unknowns/#comments

These psychosomatic-obsessed psychs feel like stalkers. Leave us alone! We're already in a stable doctor-patient relationship. We don't want to date you!

 

[justinreilly]

Thanks Ren. Danny's points on the two papers don't really hit the heart of all the completely outlandish and beyond biased aspects on CFS and Somatization in these papers. But he did get a start at critically looking at them which was good. It seems that Jennie is still in denial about what these papers actually said, judging from her Feedback to IoM.

 

[justinreilly]

Alegria proposes, any normal person with three physical symptoms, even if they are 'medically explained' is given a psychiatric diagnosis! (at least if you take what she says at face value and that is a reasonable interpretation because she doesn't qualify or add anything on to that statement; And also bc the rest of this paper is such a train wreck of outlandish illogic, that interpretation of that statement would be right at home among the other extremes of ridiculousness in this paper).

But this is just so extreme that it's also possible, though unstated, that she thinks there should be additional criteria needed for a somatization diagnosis- I am guessing something like worrying about one's health, since she refers to Dimsdale and the DSM 5 revision process.

She says we should get away from qualitative criteria to dimensional criteria; what she means is that we should just count the number of physical symptoms and the more physical symptoms (even if medically explained!) the more likely the diagnosis of somatization.

She thinks the definition shouldn't be 'qualitative'. which is nonsensical since the essence of a disease definition is qualitative; a disease definition MUST DESCRIBE the disease, NOT merely COUNT up SYMPTOMS without more.
She takes the old unsupported notion in psychiatry that the more symptoms one has, the more likely they are the product of somaticization and pumps it up on steroids.

But then, she makes two more insane leaps of 'logic':

(1) she says that since she found in this study that having symptoms that she characterized as "medically UNexplained" didn't predict psychopathology AT ALL compared to if you had symptoms that were "medically explained", she takes this to logically imply that ANY 3 physical symptoms, even if they are medically explained mean you are somaticizing.

(2) then she cuts the rule of thumb among psychiatrists that one should have, among other criteria, at least 5 physical symptoms to qualify for somatization down to just 3 symptoms.

She justifies this by citing her results that show that one is likely to have FEWER psychological problems if one has 5 physical symptoms than 3 physical symptoms!

Obviously all of her findings in this study contradict her central theory, but she just finds a jaw-dropping way to incorporate them in stunning twists of illogic.

And then she goes even further through the looking glass with the other of the 6 head-smackers I outlined in my post which starts this thread.

Of all the papers I have read, I can't remember one that is as stunningly ludicrous as this one, and we all have read some funny ones, haven't we, on this ME medical investigation journey?! : )

 

[alex3619]

I have stated on facebook that I think the the increasing number of symptoms reflects increasing complexity of the medical disorder. Such complexity makes it hard for researchers to sort out what it going on, and delays discovery of causation for a very long period of time. So its more likely that symptoms on a disease like ME reflect its complexity, and so it means it takes a long time to generate sufficient research to get a grip on it.

The contrary stance of somatization is completely unfounded in reason and medical science. Its unproven hypothesis that people have staked their careers on.

Even so we now are on the verge of having two diagnostic tests if all goes well with current studies. One I expect we can push for next year, the other in 2015. Where does that leave psychobabble?

The really disturbing thing to me is that how can anyone who can propose these claims be considered anything other than extremely biased, irrational or delusional? Further why can't a seemingly intelligent community like the medical community see this? I understand much of why at an intellectual level, but at in intuitive level its like they are pod people or something.

 

[alex3619]

When I did a Google search on Alegria's paper, the other thread just came up number four: http://forums.phoenixrising.me/inde...-a-neurasthenia-spectrum-disorder-2012.27107/

 

[WillowJ]

that's pretty dismal

 

[August59]

It seems as if someone pulls these Christmas stunts every year. I remember back in the XMRV days when they wanted to dump 5 negative papers at one time. It's getting very old!!!!

 

[xchocoholic]

Surely there's therapy or medications available for people who think this way.