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Coyne: Stalking a Cheshire cat (Abridged Somatization Disorder)

jimells

Senior Member
Messages
2,009
Location
northern Maine
Dr Coyne's new essay isn't on ME, but it covers a very-much related topic: psychobabble research, and how bad it is. He discusses how a group of researchers (maybe not the "Wessely School", but certainly fellow travellers) have manipulated the publication process in order to obfuscate what their research on CBT for alleged psychosomatic illness actually shows.

I'm sure most folks here are familiar with terms like "psychosomatic", "psychogenic", 'somatoform", "functional" disorders, and "somatization". But how about "Abridged Somatization Disorder"? Never heard of it? Well neither has anyone else - there are only two Pubmed abstracts that use that phrase in the title, and a handful of other abstracts that use a variation.

According to their definition, everyone (that means you too, dear reader) has "abridged" somatoform disorder if they have a single symptom that "cannot be fully explained by a known general medical condition or the direct effects of a substance". If you are wondering why it was necessary to invent this "disease", here is the explanation straight from the horse's mouth (or backside, you decide):

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083257/
Rasmussen et al said:
Coping style in primary care adult patients with abridged somatoform disorders

The unabridged, criterion‐based definition of somatisation disorder (Table 1), ... is rare in primary care because the lifetime prevalence rate ranges from 0.2% to 2% for women and less than 0.2% for men.

In contrast, patients with abridged somatoform disorders have substantially fewer medically unexplained symptoms; nevertheless, they have comparable functional impairment,30 use of healthcare services31 and psychiatric comorbidity,32 and they commonly present in primary care (prevalence rate ranges from 10% to 22%).30

Did you see the magician's trick? There aren't enough "psychosomatic" patients to show the disease actually exists, according to the published DSM criteria, let alone try to study it. What's a poor psychobabbler to do? Fortunately our hapless researchers know all about the Fukuda "CFS" definition and how easy it is to make the patient cohort as big as you want just by making a little "adjustment' to the criteria.

Dr Coyne explains how this sleight-of-hand guarantees that the study will show CBT "cures" this common disorder that no one has ever heard of:

Dr Coyne said:
Accepted diagnostic criteria do not yield many cases and so they shifted to “abridged.” The problem is that if they use such a broad and prevalent category, they will get a mildly symptomatic sample that is highly responsive to nonspecific interventions like reassurance, attention, and a rising expectations. They set themselves up for a very placebo responsive sample.

This isn't Science - it's Science Fiction
 

medfeb

Senior Member
Messages
491
Great post, @jimelis, and great article by Coyne. Thanks for posting. Parallels the approach used with Oxford and CFS in general. Come up with a disease theory, define your definition to include patients who might meet that theory and then use that to "prove" your theory.

What's disturbing is that DSM-5 has effectively picked up this vague diagnostic criteria in the new category Somatic Symptom Disorder (SSD).

DSM-5 says SSD is "characterized by somatic symptoms that are either very distressing or result in significant disruption of functioning, as well as excessive and disproportionate thoughts, feelings and behaviors regarding those symptoms." Only one symptom is required, there is no defined threshold for "excessive and disproportionate" and patients with medical diseases can also be diagnosed with SSD, not just those with medically unexplained diseases. Ugh
 

soti

Senior Member
Messages
109
Oddly, the category has different criteria when applied to men and women: men require four unexplained medical symptoms, whereas women require six.

Just. Wow.

I mean, it's almost as if they're admitting that women aren't studied as well so are more likely to have "unexplained symptoms"... in which case they're admitting that whether you have an "unexplained symptom" has something to do with the quality and/or quantity of research... but only for a maximum of two symptoms, if you're a woman (and none if you're a man). :bang-head:
 

jimells

Senior Member
Messages
2,009
Location
northern Maine
What's disturbing is that DSM-5 has effectively picked up this vague diagnostic criteria in the new category Somatic Symptom Disorder (SSD).

This is very interesting. The study I quoted is from 2010, so it references DSM 4, which required more symptoms for somatisation disorder. Apparently "abridged" and "unabridged" have both been replaced with the new category, and now everybody in the world has this disease, so we're gonna need a lot more CBT!

I have seen this sort of "make it up as you go along" criteria in a bunch of CDC studies for "CFS":

http://www.ncbi.nlm.nih.gov/pubmed/19414619
Psychiatric comorbidity in persons with chronic fatigue syndrome identified from the Georgia population.

OBJECTIVE:
To compare the prevalence of psychiatric disorders in persons with chronic fatigue syndrome (CFS) identified from the general population and a chronically ill group of people presenting with subsyndromic CFS-like illness ("insufficient symptoms or fatigue" (ISF))

In this case they are using "ISF" as a contrived comparison group to "prove" that "CFS" patients have more psychiatric comorbidity than "the general population" even though "the general population" is clearly not the comparison group :jaw-drop:

In spite of all I've learned about the politics around our illness, I still fail to truly understand how researchers can get away with making shit up, over and over.
 

SilverbladeTE

Senior Member
Messages
3,043
Location
Somewhere near Glasgow, Scotland
This is very interesting. The study I quoted is from 2010, so it references DSM 4, which required more symptoms for somatisation disorder. Apparently "abridged" and "unabridged" have both been replaced with the new category, and now everybody in the world has this disease, so we're gonna need a lot more CBT!

I have seen this sort of "make it up as you go along" criteria in a bunch of CDC studies for "CFS":

http://www.ncbi.nlm.nih.gov/pubmed/19414619


In this case they are using "ISF" as a contrived comparison group to "prove" that "CFS" patients have more psychiatric comorbidity than "the general population" even though "the general population" is clearly not the comparison group :jaw-drop:

In spite of all I've learned about the politics around our illness, I still fail to truly understand how researchers can get away with making shit up, over and over.


view the British Establishment....
that's it in a nutshell:
inbred (literally) incestuous (socially/mentally, cliques of asshats who went to the same universities etc), bunches of arseholes who have vested interests in preventing anything upsetting their applecart, including "facts"