In “Physical Illnesses May Soon Be Labeled ‘Mental Disorders’” (December 27, 2012), I wrote about a disturbing development taking place in the drafting of the fifth edition of the DSM—the manual (published by the American Psychiatric Association) which is used to decide if people have a psychiatric disorder or not. Those who use the DSM to diagnose include a wide range of health care practitioners: psychiatrists and other physicians (such as primary care doctors), psychologists, social workers, occupational and rehab therapists. The list is long.
In that December piece, I described Somatic Symptom Disorder, a new mental illness that was being proposed for the new edition of the DSM. I wrote:
"People can be diagnosed with Somatic Symptom Disorder if, for at least six months, they’ve had one or more symptoms that are distressing and/or disruptive to their daily life, and if they have one [only one] of the following three reactions:
Criteria #1: disproportionate thoughts about the seriousness of their symptom(s);
Criteria #2: a high level of anxiety about their symptoms or health; or
Criteria #3: devoting excessive time and energy to their symptoms or health concerns.
Can you see how this diagnosis potentially includes everything from a stomach ache to cancer?
To repeat, this time using a hypothetical: For six months, you’ve had bad gastrointestinal symptoms that have been 'disruptive to your daily life' because you can’t be far from a bathroom. In the subjective view of a health practitioner, you’ve spent 'excessive time and energy devoted' to trying to figure out what to do about it (criteria #3). The result: you may well be diagnosed as suffering from a mental illness called Somatic Symptom Disorder."
This is absurd. (For an analysis of the dangers of being diagnosed with Somatic Symptom Disorder, please read my full piece from December 27th.)
Despite the vehement opposition of many in the health care field—including many therapists—the American Psychiatric Association (who publishes the DSM) has included Somatic Symptom Disorder in the its fifth edition—DSM-5—which will be published in May. The refusal of the APA to even broaden the criteria for coming under Somatic Symptom Disorder is not just a bitter disappointment, but a potentially dangerous mistake for reasons outlined in my previous piece.
Among the professionals who fought hard against the inclusion of this new diagnosis is Allen Frances, M.D. who was the chair of the DSM-4 Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently a professor emeritus at Duke. He has just written a comprehensive article about this development: “Bad News: DSM 5 Refuses To Correct Somatic Symptom Disorder.” In it, he says:
"Somatic Symptom Disorder is defined so over inclusively by DSM 5 that it will mislabel 1 in 6 people with cancer and heart disease; 1 in 4 with irritable bowel and fibromyalgia…For reasons that I can't begin to fathom, DSM 5 has decided to proceed on its mindless and irresponsible course. The sad result will be the mislabeling of potentially millions of people with a fake mental disorder that is unsupported by science and flies in the face of common sense."
I hope you’ll read Dr. Frances’ entire piece.
What can we do?
First, I advise against taking a “we v. them” stance. Dr. Frances is himself a psychiatrist and fought long and hard against the inclusion of Somatic Symptom Disorder in the DSM-5. And since I’ve been involved in this issue, I’ve heard from many therapists who are against the creation of this new diagnosis. In addition, blaming the therapeutic profession would be counterproductive because it will only result in our objections being disregarded. Our argument is with the DSM-5, not the therapeutic profession.
Our best hope is to get the press, insurance companies, and our elected officials involved in this issue. If Dr. Frances can show the press that thousands of people are reading and commenting on his articles and on mine, the press may be persuaded to take an interest in this issue.
Elected officials and insurance companies may take an interest if they can be made to see that a diagnosis of Somatic Symptom Disorder will lead to added Medicare, Medicaid, and health insurance costs in the form of unneeded therapy and psychotropic drugs. In addition, this misdiagnosis raises the risk that underlying physical causes of an illness will be ignored and this may lead to an illness going undiagnosed until the point when treatment will result in even more costly medical care. This will drive up health care costs for both government and insurance companies.
If you want to get involved, here's what you can do: share this article with others; contact members of the press (especially medical reporters such as Drs. Sanjay Gupta or Nancy Snyderman); and contact your elected officials. You can use email to do this. As a “sound bite” for those you contact, you could use language like this to get their attention: “Millions of people who suffer from chronic illness will soon be subject to diagnosis as mentally ill.” I’d like to see this as the title of a press release that goes to news sites everywhere.
Finally, know your rights. You have the right to see your medical records and you can even challenge a diagnosis, although Dr. Frances tells me it’s a complicated process and difficult to win. At the very least, in case the issue arises while you’re in a medical setting, have copies of any of Dr. Frances’ or my articles that you think might be helpful to show your health care practitioner.
I am deeply disappointed and concerned about this development.
UPDATE, May 4, 2013: Two weeks before the DSM-5 is due to appear, the National Institute of Mental Health (NIMH), the world's largest mental health research institute, has announced that it is withdrawing support for the DSM. According to a news release from Thomas R. Insel, M.D., Director of the NIMH, the institute will no longer fund research that relies exclusively on DSM criteria.
© 2013 Toni Bernhard
Thank you for reading my work. I'm the author of three books:
How to Live Well with Chronic Pain and Illness: A Mindful Guide (Fall 2015)
Visit www.tonibernhard.com for more information.