Mislabeling Medical Illness As Mental Disorder
The eleventh DSM 5 mistake needs an eleventh hour correction
Psychology Today: DSM5 in Distress
by Allen J. Frances, M.D.
December 8, 2012
Many readers of my previous blog listing the ten worst suggestions in DSM 5 were shocked that I failed to mention an eleventh dangerous mistake – that DSM 5 will harm people who are medically ill by mislabeling their medical problems as mental disorder. They are absolutely right. I apologize for my previous failure to attend to this danger and hope it is not now too late to influence the process. Adding to the woes of the medically ill could be one of the biggest problems caused by DSM 5. It will do this in two ways:  by encouraging a quick jump to the erroneous conclusion that someone’s physical symptoms are ‘all in the head’; and  by mislabeling as mental disorders what are really just the normal emotional reactions that people understandably have in response to a medical illness. UK health advocate, Suzy Chapman, has closely monitored every step in the development of DSM 5. Her website is the best available resource for finding just about everything you need to know about DSM 5 and ICD-11. Ms Chapman sent me a troubling email that summarizes where DSM 5 has gone wrong and the many harmful consequences that will follow. More details are available at: ‘Somatic Symptom Disorder could capture millions more under mental health diagnosis‘ Ms. Chapman writes,
"…The DSM-5 Somatic Symptom Disorders Work Group is planning to eliminate several little used DSM-IV Somatoform Disorders and replace them instead with an extremely broad new category that is likely to be wildly overused ['Somatic Symptom Disorder' – SSD]. "A person will meet the criteria for SSD by reporting just one bodily symptom that is distressing and/or disruptive to daily life and having just one of the following three reactions to it that persist for at least six months:  ‘disproportionate’ thoughts about the seriousness of their symptom<s>; or  a high level of anxiety about their health; or,  devoting excessive time and energy to symptoms or health concerns.
"Unless DSM-5 changes these incredibly over inclusive criteria, it will greatly increase the rates of diagnosis of mental disorders in the medically ill – whether they have established diseases (like diabetes, coronary disease or cancer) or have unexplained medical conditions that so far have presented with somatic symptoms of unclear etiology. "The diagnosis of mental disorder will be based solely on the clinician’s subjective and fallible judgment that the patient’s life has become ‘subsumed’ with health concerns and preoccupations, or that the response to distressing somatic symptoms is ‘excessive’ or ‘disproportionate,’ or that the coping strategies to deal with the symptom are ‘maladaptive’. "These are inherently unreliable and untrustworthy judgments that will open the floodgates to the overdiagnosis of mental disorder and promote the missed diagnosis of medical disorder…Ms Chapman has provided a devastating and compelling critique. It is crucial that DSM 5 tighten its over-inclusive wording to prevent what could otherwise be the wholesale dismissal of real medical symptoms as psychiatric illness- leading to missed diagnoses, incorrect treatment, stigma, and patients understandably feeling greatly misunderstood…
I can’t figure out a reason for including this category. First, as I said, it’s not a uniform group. It contains people who are genuinely physically ill but undiagnosed, people seeking some kind of secondary gain, people whose somatic symptoms mask other more dire mental illnesses, prodromal symptoms of psychosis, etc. But further, why lump them together? The only thing I can think of is to label them so as to limit their drain on medical services, a cost-cutting HMO kind of maneuver. It’s certainly hard to imagine that such a diagnosis has an advantage for patients, and diagnosis is, after all, something one does for patients, not to them. Finally, these patients don’t report being mentally ill and rarely seek psychiatric care. I just don’t see the why of it, only the why not. With criteria as loose as those listed, I wouldn’t doubt that this might have a respectable kappa – be reliable. I would rather question it’s validity [or its wisdom].