Per Fink paper
Here's Danish researcher, Per Fink, still beating his "bodily distress" horse to death:
Per Fink was 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/Newsletter May 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.
The paper, below, is published in the May edition of the Journal of Psychosomatic Research, for which Francis Creed is the co-editor.
(With acknowledgement to Kelly for highlighting this paper on Co-Cure.)
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.
