Does somatic symptom disorder really exist?

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The fifth edition of psychiatry’s official diagnostic manual, the Diagnostic and Statistical Manual (DSM-5), has gone to print with a new diagnosis included that could easily label millions of normal Americans as mentally ill.

“Somatic symptom disorder” is a new entity that the American Psychiatric Association would have us believe suddenly exists.  To merit the diagnosis a person need only report a single physical symptom that he or she finds distressing or disruptive to daily life for at least six months, along with just one of the following being true:

a) The person has disproportionate, persistent thoughts about the seriousness of their symptoms.

b) The person reports or displays a persistently high level of anxiety about his or her health or symptoms.

c) The person is devoting excessive time and energy to his or her symptoms or health concerns.

Mind you, studies by the American Psychiatric Association have already shown that 15 percent of folks with either cancer or heart disease would be diagnosed with this disorder, and 26 percent of those with irritable bowel syndrome or fibromyalgia.  What’s more, 7 percent of people who have no active medical diagnosis also could qualify.

Suddenly, being worried about your physical health in a way that a psychologist or psychiatrist or social worker considers “disproportionate” to your symptoms makes you mentally ill.  Or, devoting yourself to treating your medical illness in a way that a psychiatric nurse practitioner considers “excessive” makes you mentally ill.  Or, questioning your first and second opinions about a complicated or atyptical case of migraines or colitis or sinusitis makes you psychiatrically disordered.

Not only can this stigmatize people who are diligent about (or even devoted to) optimizing their health in the face of an illness, but it can easily dissuade many from continuing to seek optimal medical remedies for murky or hard-to-treat or misdiagnosed medical conditions.  Because, with such imprecise diagnostic guidelines, the threshold for being labeled mentally ill is very low, indeed.

Inventing this new diagnostic category does fit very well with the agenda of the pharmaceutical industry, however.  Because the millions of Americans who can now be labeled as suffering from “somatic symptom disorder,” it could be argued, will need anti-anxiety and sleep medication.

And some enterprising drug company, no doubt, will fund a study showing its new chemical reduces symptoms in those people who supposedly have this new condition.  And the Food and Drug Administration will be pressed to bless that chemical with an “indication” that it be used for “somatic symptom disorder.”

Exactly how having somatic symptom disorder differs from being obsessive-compulsive, by the way, isn’t at all clear.  Nor is it clear how a patient labeled with somatic symptom disorder should be treated by physicians charged with curing physical illnesses.  The label may well suggest to them they need not follow up on a patient’s report of physical symptoms because they must be “in his head.”

What is clear is that this new diagnosis, invented by a committee at the American Psychiatric Association (which, sadly, has proudly presided over the near-decimation of most listening arts central to psychiatry), could cost untold millions of dollars by bringing folks worried about their health into psychiatric treatment for being worried, and onto medications for being worried.

And, in those cases where their worry turns out to have been justified, and the label of mental illness turns out to have been cavalierly applied, it might just cost them their lives.