Editorial: Is there a better term than "Medically unexplained symptoms"?
(Previously published on Co-Cure)
An Editorial to watch out for in a forthcoming issue of the Journal of Psychosomatic Research.
The In Press version is already available online (purchase required).
[Current issue is Volume 67, Issue 5, Pages A1-A4, 367-466 (November 2009)]
Journal of Psychosomatic Research
Is there a better term than "Medically unexplained symptoms"?
Copyright 2009 Published by Elsevier Inc.
References and further reading may be available for this article. To view references and further reading you must purchase this article.
Francis Creed a, Elspeth Guthrie a, Per Fink b, Peter Henningsen c, Winfried Rief d, Michael Sharpe e and Peter White f
a University of Manchester, Manchester, UK firstname.lastname@example.org
b University Hospital Aarhus, Denmark
c Technical University, Munich Germany
d University of Marburg, Germany
e University of Edinburgh, UK
f Queen Mary University of London, UK
Received 24 August 2009; revised 24 August 2009; accepted 7 September 2009. Available online 17 October 2009.
"Medically unexplained symptoms" - one advantage, but many reasons to discontinue use of the term
Criteria to judge the value of alternative terms for "medically unexplained symptoms"
Terms suggested as alternatives for "medically unexplained symptoms"
Implications for treatment
Implications for DSM-V and ICD-11
ME agenda Note:
Francis Creed is Co-Editor of the Journal of Psychosomatic Research.
Francis Creed, Per Fink, Peter Henningsen and Winfried Rief were all members of the international CISSD Project, (Principal Administrators: Action for M.E., Co-ordinator: Dr Richard Sykes, now engaged in the "London MUPSS Project" in association with the Institute of Psychiatry). Michael Sharpe was the UK Chair of the CISSD Project.
Michael Sharpe and Francis Creed have been members of the APA's DSM-V Somatic Distress Disorders Work Group since 2007.
Francis Creed (UK), Peter Henningsen (Germany) and Per Fink (Denmark) are the co-ordinators of European EACLPP MUS Work Group.
Francis Creed and Peter Henningsen were the authors of "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", January 2009. Draft white paper here:
Per Fink is a member of the Danish Working Group on Chronic Fatigue Syndrome, established in August 2008 and expected to complete its work in spring 2009.
DSM-V is anticipated to be finalised in May 2012; field trials were expected to start in October 2009. No updates or reports have been published by the APA's DSM-V Task Force or Work Groups since April 2009.
An Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV - a preliminary report
by DSM-V Work Group members, Joel Dimsdale and Francis Creed on behalf of the DSM-V Workgroup on Somatic Symptom Disorders, was published in the June 2009 issue of the Journal of Psychosomatic Research.
Full text of DSM-V WG preliminary report can be accessed here:
The International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders most recent meeting took place on 28 - 29 September. It is anticipated that a Summary Report of the meeting will be available in late November/December.
DSM-V and ICD-11 have committed as far as possible "to facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria"
with the objective that "the WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM."
For detailed information on the proposed structure of ICD-11, the Content Model and operation of iCAT, the collaborative authoring platform through which the WHO will be revising ICD-10, please scrutinise key documents on the ICD-11 Revision Google site:
Availability of EACLPP white paper
The In Press version of 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
to be published in a forthcoming issue of the Journal of Psychosomatic Research (already available online - purchase required) needs to be read in conjunction with the white paper to which I drew attention, earlier this year:
The European Association for Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) http://www.eaclpp.org/
"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:
ME agenda Note:
The document is approx 76 pages long, including tables and charts. I had considerable difficulty opening this document, in May, due to a corrupted table and note that the file on the EACLPP site remains glitchy. A copy of the document was obtained directly from the EACLPP, in May, and has been uploaded to ME agenda site. Note that there may be some revisions to the document as supplied in May but it will serve as reference if others experience difficulties opening the file from the EACLPP website.
If you would like a copy of the file as a Word.doc attachment, please email with "EACLPP MUS DOC" in the subject line and I will forward a copy to you. [600 KB]
Or download Draft white paper- prepared by Peter Henningsen and Francis Creed January 2009 from ME agenda WordPress site at: http://wp.me/p5foE-2d6
"The Editorial 'Is there a better term than "Medically unexplained symptoms"?' discusses the deliberations of the EACLPP study group:
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" . 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."
"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
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 . 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 ."
ME agenda Note:
DSM-V Task Force member, Javier Escobar, MD, who works closely with the DSM-V Somatic Distress Disorders Work Group, has alleged that "Functional Somatic Syndromes" (FSS), or "Medically Unexplained Symptoms" include a long list of medical conditions:
"Irritable bowel syndrome, Chronic fatigue syndrome, Fibromyalgia, Multiple chemical sensitivity, Nonspecific chest pain, Premenstrual disorder, Non-ulcer dyspepsia, Repetitive strain injury, Tension headache, Temporomandibular joint disorder, Atypical facial pain, Hyperventilation syndrome, Globus syndrome, Sick building syndrome, Chronic pelvic pain, Chronic whiplash syndrome, Chronic Lyme disease, Silicone breast implant effects, Candidiasis hypersensivity, Food allergy, Gulf War syndrome, Mitral valve prolapse, Hypoglycemia, Chronic low back pain, Dizziness, Interstitial cystitis, Tinnitus, Pseudoseizures, Insomnia, Systemic yeast infection, Total allergy syndrome"
 PSYCHIATRY AND MEDICAL ILLNESS
Unexplained Physical Symptoms What's a Psychiatrist to Do?
Humberto Marin, MD and Javier I. Escobar, MD
01 August 2008, Psychiatric Times. Vol. 25 No. 9