Invest in ME Conference 12: First Class in Every Way
OverTheHills wraps up our series of articles on this year's 12th Invest in ME International Conference (IIMEC12) in London with some reflections on her experience as a patient attending the conference for the first time.
Discuss the article on the Forums.

Goldberg: Multiple somatic symptoms in primary care: A field study for ICD-11 PHC...

Discussion in 'Other Health News and Research' started by mango, Oct 11, 2016.

  1. mango

    mango Senior Member

    Multiple somatic symptoms in primary care: A field study for ICD-11 PHC, WHO's revised classification of mental disorders in primary care settings

    David P. Goldberg, D.M.a, , (Professor), Geoffrey M. Reed, Ph.D.b, c, Rebeca Robles, Ph.D.d, JulioBobes, M.D.e, Celso Iglesias, M.D.e, Sandra Fortes, M.D.f, Jair de Jesus Mari, M.D.g, Tai-ongLam, M.D.h, Fareed Minhas, M.D.i, Bushra Razzaque, M.D.i, José Ángel Garcia, M.Sc.c, d, Marianne Rosendal, M.D.j, C. Anthony Dowell, M.D.k, Linda Gask, M.D.l, Joseph K. Mbatia, M.D.m, Shekhar Saxena, M.D.b

    a Institute of Psychiatry, London, United Kingdom
    b World Health Organization, Geneva, Switzerland
    c National Autonomous University of Mexico, Mexico, DF, Mexico
    d National Institute of Psychiatry ‘Ramón de la Fuente Muñiz’, Mexico, DF, Mexico
    e University of Oviedo, CIBERSAM, Oviedo, Asturias, Spain
    f Rio de Janeiro State University, Rio de Janeiro, Brazil
    g Federal University of São Paulo, São Paulo, Brazil
    h University of Hong Kong, Hong Kong, People's Republic of China
    i Institute of Psychiatry, Rawalpindi, Pakistan
    j Research Unit for General Practice, University of Southern Denmark, Denmark
    k University of Otago, Wellington, New Zealand
    l University of Manchester, Manchester, United Kingdom
    m Sebastian Kolowa Memorial University, Lushoto, Tanzania

    Received 11 April 2016, Revised 30 September 2016, Accepted 3 October 2016, Available online 4 October 2016

    • Of those with bodily stress disorder or health anxiety, 70% had both disorders, and 79% had anxious depression, current anxiety or non-anxious depression
    • Those with somatic symptoms in multiple bodily systems are more disabled than those with symptoms in only one system
    • Anxious depression is the most common additional disorder, and is associated with the greatest disability

    A World Health Organization (WHO) field study conducted in five countries assessed proposals for Bodily Stress Syndrome (BSS) and Health Anxiety (HA) for the Primary Health Care Version of ICD-11.

    BSS requires multiple somatic symptoms not caused by known physical pathology and associated with distress or dysfunction. HA involves persistent, intrusive fears of having an illness or intense preoccupation with and misinterpretation of bodily sensations.

    This study examined how the proposed descriptions for BSS and HA corresponded to what was observed by working primary care physicians (PCPs) in participating countries, and the relationship of BSS and HA to depressive and anxiety disorders and to disability.

    PCPs referred patients judged to have BSS or HA, who were then interviewed using a standardized psychiatric interview and a standardized measure of disability.

    Of 587 patients with BSS or HA, 70.4% were identified as having both conditions. Participants had an average of 10.9 somatic symptoms. Patients who presented somatic symptoms across multiple body systems were more disabled than patients with symptoms in a single system. Most referred patients (78.9%) had co-occurring diagnoses of depression, anxiety, or both. Anxious depression was the most common co-occurring psychological disorder, associated with the greatest disability.

    Study results indicate the importance of assessing for mood and anxiety disorders among patients who present multiple somatic symptoms without identifiable physical pathology. Although highly co-occurring with each other and with mood and anxiety disorders, BSS and HA represent distinct constructs that correspond to important presentations in primary care.

    Primary care; Classification; Mental disorders; ICD; Bodily stress syndrome; Health anxiety
  2. alex3619

    alex3619 Senior Member

    Logan, Queensland, Australia
    BIBO Babble in, babble out. We should start using legal terms, like Presumed Disorders. There is no proof that something like Bodily Distress Disorder is a real thing.

    Now for Health Anxiety I wont make exactly the same claim, except to say that we should still be talking about presumed health anxiety given that patients who have issues that are not being addressed or even diagnosed might have cause to be anxious. In subsequently looking for answers they might get wrongly diagnosed with health anxiety. However there is no doubt this can be associated with severe cognitive and emotional distress.

    A label from the ICD or DSM does not prove a disorder is a real entity, just that it has a diagnostic criteria.

    Should we also be talking about Fictitious Disorder by Proxy, and asking why so many psychiatrists are doing this? Or why this would apply to many DSM and ICD labels?
  3. Woolie

    Woolie Senior Member

    Ah, @mango, you know how to make my day!

    Patients in this study were diagnosed by their GPs as having either bodily stress syndrome (BSS) or health anxiety or both. The GPs were from primary care centres located in: Brazil, Hong Kong, Mexico, Pakistan, and Spain. The got some training from the UK BPS-schooled lead author on what BSS means (pretty much, anything without a confirmed universally agreed "physical disease process").

    They then got a research assistant to run a structured interview to diagnose general anxiety, depression, etc.

    A truly amazing thing, this study.

    I thought, okay, obviously, the first thing a researcher would ask is whether the judgements these GPs made hold up to more serious scrutiny, right? Obviously, you can't compare the relation of one diagnosis to another if you used the first to determine the second. This is not the case in the GP clinic: Once you've decided the patient has no underlying physical illness, then their anxiety about their health suddenly looks completely irrational and disproportionate. So you're much more likely to diagnose health anxiety in such a case.

    But no! :jaw-drop::jaw-drop::jaw-drop:!! They pretty much just reported what the GPs said! :jaw-drop::jaw-drop::jaw-drop::bang-head::bang-head::bang-head:!!

    All they did was add in whether the GPs diagnosis of BSS was confirmed via a "computerised interview", but then they didn't do anything further with that data anyway.

    Then they did some simple analyses of the results of the Research assistant interview. You'll never guess what - people with more symptoms were more likely to be depressed or anxious! How astonishing!!

    Also not a surprise: the paper was published in the pink journal: the Journal of Psychosomatic Beliefs (er, Journal of Psychosomatic Research - sorry, my error there).
    Last edited: Oct 12, 2016
  4. trishrhymes

    trishrhymes Senior Member

    I was lying in bed last night catching up on new threads and feeling really cheered up by some good news - a Japanese metabolomic study, Dr Speight exonerated, Dr Edwards clarifying that he's just leaving the board, not leaving PR, the Norwich centre getting some funding, I'm sure there were a couple of other things I've forgotten.

    Then this monstrosity popped up. Arrrgh!

    All they've done is invented yet another new 'syndrome' to dump us in. I've lost count - MUS (medically unexplained symptoms), PPS (persistent physical symptoms), functional illness, somotaform disorder.

    And all because they're too lazy and blinded by their beliefs to bother to look at all the great biomedical evidence that's being found, and to really listen to their patients.

    mango, Joh, Luther Blissett and 5 others like this.
  5. taniaaust1

    taniaaust1 Senior Member

    Sth Australia
    Did they rule out ME/CFS for this poor patient group before putting the bodily distress disorder label onto them? With an average of 10.9 symptoms each, it sounds like ME/CFS is probably very likely. Its hard to come up with 10 symptoms which would be likely to be purely in someones mind even if they have anxiety or depression or imaginging symptoms

    umm Im trying come up with 10 or 11 symptoms a depressed person with anxiety may have.. depressed, anxiety, insomnia, headache, nausea, that's only 5 symptoms. So what other symptoms did this group have? Sounds like they've added FM or ME/CFS patients to this group they were studying for them to have that many symptoms.
    Last edited: Oct 12, 2016
    Luther Blissett likes this.
  6. anciendaze

    anciendaze Senior Member

    Forget ME/CFS temporarily. Did they even do any tests for mast cell activation? This is a physiological problem producing many symptoms and a variety of strange laboratory results. Most GPs are still unaware that it exists. The literature on it goes back about 10 years, and there are definitely patients who have recovered without psychotherapy, but with known medical interventions.
    Luther Blissett likes this.
  7. Cheshire

    Cheshire Senior Member


    Joh, Solstice, Woolie and 1 other person like this.
  8. taniaaust1

    taniaaust1 Senior Member

    Sth Australia
    what's the bet they didnt rule out OI disorders either. There'd be lots of things which didnt get ruled out.

    bodily stress disorder should be called lazy doctors syndrome (lazy doctors as they didnt bother trying hard enough to find out what is wrong with the patient)
    John Mac likes this.
  9. Woolie

    Woolie Senior Member

    No, CFS is BSS, according to this view. The minor symptoms variations between different kinds of "medically unexplained" disorders are irrelevant here.
    Valentijn, Cheshire and mango like this.

See more popular forum discussions.

Share This Page