A New Term! - "Bodily Distress Syndrome"

[Dr. Yes]

I was tempted to post this in the "Joke of the Day" thread, but it isn't that funny. It is one of the stupidest abstracts I've read in a while...

J Psychosom Res. 2010 May;68(5):415-26.
"One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders."

Fink P, Schrder A.
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8000 Aarhus, Denmark. per.fink@aarhus.rm.dk
Abstract

BACKGROUND: In order to clarify the classification of physical complaints not attributable to verifiable, conventionally defined diseases, a new diagnosis of bodily distress syndrome was introduced. The aim of this study was to test if patients diagnosed with one of six different functional somatic syndromes or a DSM-IV somatoform disorder characterized by physical symptoms were captured by the new diagnosis.

METHOD: A stratified sample of 978 consecutive patients from neurological (n=120) and medical (n=157) departments and from primary care (n=701) was examined applying post-hoc diagnoses based on the Schedules for Clinical Assessment in Neuropsychiatry diagnostic instrument. Diagnoses were assigned only to clinically relevant cases, i.e., patients with impairing illness.

RESULTS: Bodily distress syndrome included all patients with fibromyalgia (n=58); chronic fatigue syndrome (n=54) and hyperventilation syndrome (n=49); 98% of those with irritable bowel syndrome (n=43); and at least 90% of patients with noncardiac chest pain (n=129), pain syndrome (n=130), or any somatoform disorder (n=178). The overall agreement of bodily distress syndrome with any of these diagnostic categories was 95% (95% CI 93.1-96.0; kappa 0.86, P<.0001). Symptom profiles of bodily distress syndrome organ subtypes were similar to those of the corresponding functional somatic syndromes with diagnostic agreement ranging from 90% to 95%.

CONCLUSION: Bodily distress syndrome seem to cover most of the relevant "somatoform" or "functional" syndromes presenting with physical symptoms, not explained by well-recognized medical illness, thereby offering a common ground for the understanding of functional somatic symptoms. This may help unifying research efforts across medical disciplines and facilitate delivery of evidence-based care.

Copyright 2010 Elsevier Inc. All rights reserved.

Yes, somebody ^ actually published this thing and wants the rights to it.

Of course, with only this abstract, I have no idea how they defined "bodily distress syndrome". But however it was defined, it is worth noting that CFS and fibromyalgia were defined as 'somatoform' or 'functional syndromes'. And of course the basic idea of this.. this 'research paper' seems to have been to make up a disease name vague enough that anything they have already defined as medically unexplained would come under its umbrella. I guess "MUS" wasn't enough. How about... oh, never mind.

 

[Dx Revision Watch]

I've just posted on this Per Fink paper, over on the DSM thread, so I'll post the preamble here:

http://www.forums.aboutmecfs.org/showthread.php?3062-DSM5-Ticket-back-to-Reevesville/page17

Here's Danish researcher, Per Fink, still beating his "bodily distress" horse to death:

Per Fink had been a member of the CISSD Project, co-ordinated by Richard Sykes, PhD, between 2003 and 2007 which has fed into the DSM and ICD revision processes.

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 (J Psychoso Res: Volume 68, Issue 1, Pages 5-8.) discussed the deliberations of the EACLPP study group on which I have previously reported. The Editorial also included references to the DSM and ICD revision processes:

[Extract]

Introduction

The European Association of Consultation Liaison Psychiatry and Psychosomatics (EACLPP) is preparing a 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…

…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]


The European Association for Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) http://www.eaclpp.org/ published a white paper, last year,

A white paper of the EACLPP Medically Unexplained Symptoms study group Patients with medically unexplained symptoms and somatisation – a challenge for European health care systems

The White Paper can be downloaded from the EACLPP site here: http://www.eaclpp.org/working_groups.html

Per Fink is a member of the Danish Working Group on Chronic Fatigue Syndrome, established in August 2008 which was expected to complete its work in spring 2009.

In May 2008, Per Fink gave the keynote address to a conference:

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

http://www.irishpsychiatry.ie/pdf/Ne...20May 08.pdf

His presentation is reported on, on Page 8:

“[...] 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.”

 

[Dr. Yes]

(...) 10. has a satisfactory acronym.

Thanks Suzy.. the acronym BDS is just one letter short of perfection.

(Anyone who gets that joke, go directly to Church)

 

[Dx Revision Watch]

Thanks Suzy.. the acronym BDS is just one letter short of perfection.

(Anyone who gets that joke, go directly to Church)

I could dig up some more on Per Fink, but I'm kinda tied up, right now.

 

[Min]

I find it very alarming that the biomedical research continues to be ignored whilst the Wessely-school-of-thought continues to deliberately lose sight of our neuroimmune illness using ever vaguer terms.

It may be a load of BDS, but we must take this extremely seriously.

 

[Dx Revision Watch]

Further papers from the May issue of Journal of Psychosomatic Research

Note: CISSD Project member, Francis Creed, is the European Editor of the Journal of Psychosomatic Research. The CISSD Project International Chair was Michael Sharpe, MD, who is an Associate Editor of the Journal of Psychosomatic Research. CISSD Project members Arthur Barsky and William Rief are on the Advisory Board of the Journal of Psychosomatic Research (as is Prof Simon Wessely).

Cozy, yes?

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

http://www.jpsychores.com/current

Editorials

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 (104 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
Full Text | Full-Text PDF (96 KB)


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 (997 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 (227 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)


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 (124 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)


Articles in Press

Characteristics of oligosymptomatic versus polysymptomatic presentations of somatoform disorders in patients with suspected allergies
In Press Corrected Proof , Available online 20 April 2010
Constanze Hausteiner, Dorothea Huber, Susanne Bornschein, Martine Grosber, Esther Bubel, Sylvie Groben, Claas Lahmann, Bernd Lwe, Florian Eyer, Bernadette Eberlein, Johannes Ring, Heidrun Behrendt, Ulf Darsow, Peter Henningsen
Journal of Psychosomatic Research
DOI: 10.1016/j.jpsychores.2010.03.006
Abstract | Full Text | Full-Text PDF (133 KB)


The development of the irritable bowel syndrome-behavioral responses questionnaire
In Press Corrected Proof , Available online 17 March 2010
Silje E. Reme, Simon Darnley, Tom Kennedy, Trudie Chalder
Journal of Psychosomatic Research
DOI: 10.1016/j.jpsychores.2010.01.025
Abstract | Full Text | Full-Text PDF (346 KB)


Whether medically unexplained or not, three or more concurrent somatic symptoms predict psychopathology and service use in community populations
In Press Corrected Proof , Available online 17 February 2010
Javier I. Escobar, Benjamin Cook, Chi-Nan Chen, Michael A. Gara, Margarita Alegra, Alejandro Interian, Esperanza Diaz
Journal of Psychosomatic Research
DOI: 10.1016/j.jpsychores.2010.01.001
Abstract | Full Text | Full-Text PDF (129 KB)


Measuring fatigue in clinical and community settings
In Press Corrected Proof , Available online 11 December 2009
Matteo Cella, Trudie Chalder
Journal of Psychosomatic Research
DOI: 10.1016/j.jpsychores.2009.10.007
Abstract | Full Text | Full-Text PDF (135 KB)

 

[Gerwyn]

I was tempted to post this in the "Joke of the Day" thread, but it isn't that funny. It is one of the stupidest abstracts I've read in a while...


Yes, somebody ^ actually published this thing and wants the rights to it.



Of course, with only this abstract, I have no idea how they defined "bodily distress syndrome". But however it was defined, it is worth noting that CFS and fibromyalgia were defined as 'somatoform' or 'functional syndromes'. And of course the basic idea of this.. this 'research paper' seems to have been to make up a disease name vague enough that anything they have already defined as medically unexplained would come under its umbrella. I guess "MUS" wasn't enough. How about... oh, never mind.

Hi doc

they have obviously assumed that the conditions are somatoform and anyone worried about their symptoms should have this new pretty name applied to them.i would comment on the science but there is not any.They have however broken the first and every law of statistics.stats apply to objecively measued critrea not socially constructed labels.They have also assumed a normal distribution of this socially constructed term within the population diagnosed by this socially constructed term.That is quite something.it is rare that I see total statistical illiteracy.I believe that the publishers have foresaken their peer review process and it shows

cheers G

 

[txfriend]

Drown them with meaningless words

Hi doc

they have obviously assumed that the conditions are somatoform and anyone worried about their symptoms should have this new pretty name applied to them.i would comment on the science but there is not any.They have however broken the first and every law of statistics.stats apply to objecively measued critrea not socially constructed labels.They have also assumed a normal distribution of this socially constructed term within the population diagnosed by this socially constructed term.That is quite something.it is rare that I see total statistical illiteracy.I believe that the publishers have foresaken their peer review process and it shows

cheers G

If this crap is called science by any journal, they should be
reported to the appropriate medical societies in their respective
countries. I believe all these papers are deliberately being put
out now in order to confuse the issue of the causative nature
of CFS/ME and to make taxpayers angry at us because of our
need for disability payments. They are also, no doubt, fearing
for their livelihood, as physicians now refer us to shrinks even
before doing any relative or significant workup (for viral and/or
bacterial infections or immune system irregularities). It is all
words and they hope to drown us in them.

They will not be successful: science will win out this time!

 

[Dx Revision Watch]

If this crap is called science by any journal, they should be
reported to the appropriate medical societies in their respective
countries. I believe all these papers are deliberately being put
out now in order to confuse the issue of the causative nature
of CFS/ME and to make taxpayers angry at us because of our
need for disability payments. They are also, no doubt, fearing
for their livelihood, as physicians now refer us to shrinks even
before doing any relative or significant workup (for viral and/or
bacterial infections or immune system irregularities). It is all
words and they hope to drown us in them.

They will not be successful: science will win out this time!

J Psycho Res has been shovelling out papers like these for at least a couple of years - since the DSM-5 Work Groups were assembled, in 2007. Creed's journal also published in 2006, seven or eight papers by various members of the CISSD Project giving platforms for discussion of areas for which the CISSD Project workgroup had failed to reach consensus.

Creed's also published Editorials around DSM-5 proposals and a report, in 2009, co-athored with Joel Dimsdale, on behalf of the Somatic Symptom Disorders Work Group, for which Dimsdale is the Chair.

Creed also presented at a Nevada Conference, last November, along with Dimsdale, on DSM proposals (the slides for the Creed presentation and the text from the Dimsdale presentation can be accessed, here:

http://dxrevisionwatch.wordpress.co...-medicine-current-progress-and-controversies/

or Shortlink: http://wp.me/pKrrB-hc

Incidentally, the Somatic Symptom Disorders Work Group was originally called the "Somatic Distress Disorders" Work Group.

 

[Dx Revision Watch]

The papers above are from the May issue of

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

http://www.jpsychores.com/current


This is a special issue of the Journal which arises out of a workshop for which the stated aim was "achieving a better understanding of the genetic, physiological, and psychological mechanisms that underlie disabling and costly medically unexplained symptoms and somatisation".

The Workshop is understood to have been funded by the European Science Foundation, took place in Munich, in September 2009, and involved a multidisciplinary group of 21 researchers from 7 European Union countries.

 

[Angela Kennedy]

Thank you for all of these Dr Yes and Suzy. Any 'reliability' to be found in that first paper in particular is only the reliability of confirmatory bias (of psychiatrists).

Like asking 100 Nazis if jews are bad people - then taking their answers as demonstrating that jews are actually bad people. (invoking Nazis! I await a slapped wrist and an invocation of Godwin's law. Sorry about that.)

Dr yes - I'm on my way to the church now : )

 

[_Kim_]

Full text in the Library: Fink 2010 - One single diagnosis, bodily distress syndrome, succeeded to capture...

 

[Dreambirdie]

It's so stupid, it's UN-believable.

They definitely could use some yodeling therapy. Come to think of it, we could write a paper about THAT.

 

[Dreambirdie]

Hey Maarten, here's my new research paper:

"Graded Yodeling Therapy to Restore Cognitive Functioning In Bored Academics With Too-Much-Time-On-Their-Hands Syndrome." (Creating An Effectual Yodeling Treatment Plan For Smart People Gone Wrong.)

 

[biophile]

One ring to rule them all

I think we could "succeed in capturing" whatever we wanted with the right net. Only hardcore biomedical research is going to rescue us from this nightmare.

 

[Dreambirdie]

1. All humans have great problems, especially if they don't believe this.

Thanks Maarten. Now I finally understand what my problem really is.

 

[Wonko]

is it down the side of the cooker? or perhaps under the fridge?

as most stuff thats lost ends up in one of them - including quite a lot of my marbles

 

[Victoria]

If the scientific/medical community spent as much time doing something (intead of writing/talking about it), something positive might be done to help ill people get better.

(is my 2 cents worth)...................

 

[Stuart]

Psychologists/Psychiatrists have a great deal in common with investment bankers, they create a complicated mess to make/do nothing, but extract money from suckers.

 

[Dx Revision Watch]

European Science Foundation Munich Sept '09 Workshop

(The workshop referred to in the Henningsen/Creed Editorial.)

European Science Foundation

http://en.wikipedia.org/wiki/European_Science_Foundation

http://www.esf.org/

----------------------

http://www.esf.org/activities/explo...l-sciences-emrc/workshops-detail.html?ew=7832

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

Keywords
Genetic epidemiology; stress-related physiology; medically unexplained symptoms; somatisation; functional somatic syndromes

Summary
Medically unexplained symptoms form a major public health problem in all EU countries; costs include numerous hospital interventions and widespread lost productivity. Aetiological studies to date have been limited by our poor understanding of the phenotypes and endophenotypes concerned. This workshop proposes an EU-wide multidisciplinary group to design new genetic epidemiological, physiological and psychological studies which will increase our understanding of the different mechanisms which underlie these symptoms.

Preliminary programme and Provisional list of participant
(for information purposes only - this meeting is not open to the public)

Preliminary programme and List of Participants (to be released soon)

Contacts
Convenors:
Peter Henningsen
Department of Psychosomatic Medicine
Faculty of Medicine
Technische Universitt Munich
Langerstr. 3
81675 Munich
Germany
E-Mail

Francis Creed
Dept of Psychiatry
Faculty of Medicine
University of Manchester
Manchester
United Kingdom

ESF Contact:
Mrs.ValerieAllspach-KiechelE-Mail
Senior Administrator - Corporate Science Operations