Since negative bodily sensations, as subjective phenomena, can be observed by listening to the patients’ descriptions, systematic attention to the sensations means a distinct re-evaluation of our receptive attitude as the basis for a reliable diagnosis. Psychodynamics is essential in this context.
However, in practice it is sometimes very difficult to make a satisfactory classification using the currently valid International Classification of Mental and Behavioural Disorders (ICD 10-11).
The new edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will give an opportunity to reflect systematically and name the flaws of these classifications.
A guiding principle emerged, which allows to identify and bundle the points in need of amendment clearly: the diagnostic significance of the subjective bodily symptoms, the „body’s complaints“, which in my opinion are better to unterstand than all the “somatoform disorders”. The DSM-5 " Somatic Symptom Disorders" promise a certain progress, too. What is your experience resp. first impression?
has swritten a paper on this problem but the paper is in Dutch:
DSM-5: Van somatoforme stoornissen naar 'somatic symptom and related disorders'van der Feltz-Cornelis, C. M.; van Houdenhove, B.. Tijdschrift voor Psychiatrie 56.3 (2014): 182-186..
The conclusion is: The new description of somatic symptom disorder in DSM-5 represents a big step forwards, because the decision has been made to use, for classification, a positive criterion, namely maladaptive reaction to a somatic symptom, instead of the earlier negative criterion, namely that the symptoms should be medically unexplained. Before attaching the SSD label to an illness, the clinician will have to weigh up the clinical consequences of this psychiatric diagnosis.
Thank you very much for this message with your interesting conclusion. However, I'm afraid, the psychosomatic medicine is not enough (in my opinion: not at all) represented in DSM-5. In practice > 30 % of "positive" somatic symptoms and signs, according to SSD label will remain unexplained, using this classification or new ICD: There is no key to classify all psychosomatic symptoms and signs, which do not belong to the somatic symptom or somatoform disorder groups.
Perhaps these German papers are familiar to you? Zum Beispiel K. Voigt hat oft über dieses Thema geshcrieben.
[The Somatic Symptoms Experiences Questionnaire (SSEQ): a new self-report instrument for the assessment of psychological characteristics of patients with somatoform disorder]. Herzog A, Voigt K, Meyer B, Rief W, Henningsen P, Hausteiner-Wiehle C, Löwe B. Psychother Psychosom Med Psychol. 2014 Mar;64(3-4):115-21. doi: 10.1055/s-0032-1333303. Epub 2013 Jul 17. German.
Construct validity and descriptive validity of somatoform disorders in light of proposed changes for the DSM-5. Wollburg E, Voigt K, Braukhaus C, Herzog A, Löwe B. J Psychosom Res. 2013 Jan;74(1):18-24. doi: 10.1016/j.jpsychores.2012.09.015. Epub 2012 Oct 25.
Psychosom Med. 2013 Nov-Dec;75(9):800-6. doi: 10.1097/PSY.0000000000000013. Epub 2013 Oct 22.
Suicidality in primary care patients with somatoform disorders.
Wiborg JF, Gieseler D, Fabisch AB, Voigt K, Lautenbach A, Löwe B.
Predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder--comparison with DSM-IV somatoform disorders and additional criteria for consideration. Voigt K, Wollburg E, Weinmann N, Herzog A, Meyer B, Langs G, Löwe B. J Psychosom Res. 2012 Nov;73(5):345-50. doi: 10.1016/j.jpsychores.2012.08.020. Epub 2012 Sep 20.
J Psychosom Res. 2010 May;68(5):403-14. doi: 10.1016/j.jpsychores.2010.01.015. Epub 2010 Mar 12.Towards positive diagnostic criteria: a systematic review of somatoform disorder diagnoses and suggestions for future classification.
Voigt K, Nagel A, Meyer B, Langs G, Braukhaus C, Löwe B.
Psychosom Med. 2011 Nov-Dec;73(9):760-8. doi: 10.1097/PSY.0b013e318234eff6. Epub 2011 Nov 2. Evaluating new proposals for the psychiatric classification of patients with multiple somatic symptoms.
Rief W, Mewes R, Martin A, Glaesmer H, Brähler E.
Freundliche Grüße aus Finnland
Béatrice
Thank you, Beatrice, for all.
However, in ICD-10 GM 2014 you will find 3 (out of 870) pages only mentioning shortly "Psychosomatische" Symptome (p. 197, 199, 203). This is amazing but not amusing. This is the new International classification... Mit freundlichen Grüßen
Karl
Our special problem, Beatrice, is probably this:
In practice it is sometimes more difficult to make a satisfactory classification using the ICD-10 than using the previous 9th version (ICD-9). A survey of the DGPPN on the ICD-10 in autumn 2008 – in preparation for the planned ICD-11 – was a welcome opportunity for some members of the Working Group for Psychosomatics and Neurology (AGPN) to reflect systematically and name the flaws in the currently valid International Classification of Mental and Behavioural Disorders. In this process a guiding principle emerged, which allows to identify and bundle the points in need of amendment especially clearly: the diagnostic significance of the subjective bodily symptoms, the „body’s complaints“ („Körperklagen“, 10). The authors find the complex of symptoms in bodily sensations suitable for revaluing clinical phenomena underrepresented in the ICD-10, adding them to the classifications and also, in some cases, more clearly differentiating the existing categories and re-ordering them. Since negative bodily sensations, as subjective phenomena, can only be observed by listening to the patients’ descriptions, systematic attention to the sensations means a distinct re-evaluation of the doctor’s receptive attitude as the basis for a reliable diagnosis. Psychodynamics is essential in this context. The following account adheres to the “general questions” 8 to 11 in the DGPPN survey
.
Article Bodily sensations in diagnostics of psychiatry, neurology an...
It is worrisome that so much time and effort has been wasted over the years on somatic symptoms. There is no scientific evidence that somatoform disorder exists and many of the symptoms can be explained by organic causes. Even if every test known to humans is carried out on a patient, there is the possibility that an organic disease is missed. Somatoform disorder to me just means that the doctor has no idea what is happening in the body and is not prepared to carry out more specific tests to look for causes. I think it is ignorant and arrogant to think that a medical doctor can tell from a limited number of possibly non-specific tests what is happening in the body. As I stated before, there is no scientific evidence for somatisation.
Vielen Dank für die "Körperliche Empfindungen". In order to avoid thinking about der, die und das I go on in English although I love German. In the psychodynamc approach "the purpose of ego defence mechanisms is to protect the mind/self/ego from anxiety and/or social sanctions and/or to provide a refuge from a situation with which one cannot currently cope".
because I like psychodynamics I share some of my observations: I have observed that Körperklagen serves as a tool to get Mitgefühl from persons with narcissistic strikes. If you are not educated enough you can hide this by being "the best" in putting forward a lot of somatic symptoms. Then you can daily get your dose of narcissistic supply. The funny thing is that the Körperklagen disapper when a real or serious somatic condition is at hand! I have also observed an extended form of this Körperklagen in these persons, you take over your children's hardships to get empathy or sympathy - something you are not able to convey yourself. And you can keep your "false self" as "the perfect parent" intact. I have also observed these phenomenas as an interpretation of religion as a sort of "Thau shallt suffer" in order to enter the heaven or reversed "Thau shallt punish yourself" to enter the heaven. Old interpretations of suffering as the key to "happiness" the martyrdom makes you a Saint and you do not have to confront your envy, hatry, disgust, pride or whatever. Of course there are lots of unconscoius rewards from occupied parents for children's sick behavior and children discover the attention-seeking mechanism. In my study of children with leukemia I discovered that parents cannot handle children - who were almost dead- later on in a normal way with normal limits. This of course increases Körperklagen as a power tool. - Some old people are so alone and untouched so the running from dictor to doctor helps (a hug would do the same). However, since this defense is needed for the fragile ego not to break, it is of no use to disturb it too much (my private opinion). However, you can put a limit to what you are llistening to. If you tell that you are not at all interested in certain symtoms they do decrease.
Alles Gute
Béatrice
Dear Beatrice,
I have a degree in psychology and physiology and some of the concepts I learned in psychology bothered me, such as somatoform disorders. The statement "the purpose of ego defence mechanisms is to protect the mind/self/ego from anxiety and/or social sanctions and/or to provide a refuge from a situation with which one cannot currently cope" is just someone(s)' interpretation of what may go on, there is no scientific evidence for it. if we seek scientific evidence to exclude organic disease then why do we not seek hard evidence for the existence of somatic symptoms? How can one tell without examining the entire body down to the cellular level, that what is experienced is not organic? Yet our interpretation of what may be going is just subjective. Lots of rare illnesses take years to come to light yet cause symptoms that can not be explained by a few non-specific tests. Just look at Addison's disease and autoimmune diseases. Some diseases may also be self limiting that is, they cause problem for a while and then stop, such as subclinical infections and some autoimmune conditions. I can give plenty of examples.
You said you share some of your observations, and they are just that: observations without hard scientific evidence. Your interpretation. What makes you so sure that you are right?
If I am right, you are writing that parents with very sick children get a reward by becoming a martyr. Obviously you never had a very sick child. Trying to get help for anyone very sick would be out of compassion and because it is very difficult to see someone suffer. Also, the stress those parents would be under would physically affect them. As far as attention seeking behaviour is concerned: can you even fathom the pain those children would be in not to mention the fear of dying? Labelling something as attention seeking without understanding the physical nature of their pain is in my opinion irresponsible. Again, can someone show me hard scientific evidence for the existence of somatoform disorders? Perhaps there is the 1 in a million person who would seek attention but this would be very rare.
After 7 years of othodox psychoanalysis in Finland you too would learn to observe. My child was dying but saved in the eleventh min., so I know what it means and so forth. I have the necessary degrees to underline my observations. Because I am serious in my research approach I wrote: I share some of my observations (if they possibly benefit someone else). I have done research on children with haemophilia and leukemia, these were in some cases lethal conditions. Observations are valid for some persons, they are not general rules in sciences. Chronic disorders lead to different psychological aftermath. The book which backs up this statement is written by exoerts in Finnish so you can probably not read it. If you tell another persons how it feels when you give birth and the child's head penetrates the pelvic bone and you would use the metaphor that it felt like a fish smached his tail then this would not be evidence-based either. Sometimes a deeper level of understanding is needed than that stated in the books for a diagnosis.
I am glad that your daughter was saved, obviously because a doctor thought that it was not all in her head. I am worried about all the people who died or suffer unnecessarily because of an observation made wrong. I know of 20+ children in whom arthritis was missed because all the symptoms were put down to attention seeking. They were put under an extreme exercise regime in hospital and they did not improve. My daughter would had been one of these children had I not researched the literature and insisted on the right tests that showed fluid in the joints. A year long anti-inflammatories resulted in "cure" and now she is fine. Even the specialist said that he was glad I insisted on having those tests. I can not see how you can guarantee that your observations are right even if there are books on the subject. People do experience things differently and that is why some people may be more aware of physical symptoms. How can you tell from observation whether a person has a physical reason for pain? How can you tell, unless you investigate that a woman's persistent headache is not due to being on the wrong pill? Or that a year long headache is not due to having prescription glasses because the optometrist did not consider muscle cause of eyesight failure (as was the case for my daughter)? I just would like to know how one can guarantee that putting something down to somatisation will not have an adverse outcome.
In science as in life there is no absolute truth there is only a certain probability (p< ?) that a result answers in a truthful way a certain question. I do not have daughters. Good luck with your life.
Thank you. In science and life there is absolute truth and it is certain that everyone's body gives up and we all die. Results based on scientific tests by any means have a higher probability of being correct that observations.
Dear Aniko Huizer-Pajkos or Pajko,
concerning pain in a case of arthritis, you will find nociceptive signs and it is evident, that the nervous system ist n o t affected, for there is no lesion of the PNS/ZNS. So It's more difficult to diagnose cases of " mixed pain" (nociceptive spondylarthrosis + neuropathic radiculopathy) or even pure neuropathic pain (trigeminus neuralgia). In my opinion, we have to underline the importance of pain symptoms and signs, realizing objective and subjective phenomena in most cases of "low back pain", Zoster neuralgia and complex regional pain syndrome. There are no "somatoform" signs, I agree with you in this point. But how do you classify the rest of all, the big group of dissociative disorders and the so called Medical unexplained physikal symptoms (MUPS)?