A European Research Agenda for Somatic Symptom Disorders, Bodily Distress Disorders, and Functional Disorders, 2018, van der Feltz-Cornelis et al

Sly Saint

Sly Saint

Senior Member (Voting Rights)
A European Research Agenda for Somatic Symptom Disorders, Bodily Distress Disorders, and Functional Disorders: Results of an Estimate-Talk-Estimate Delphi Expert Study

May 2018

van der Feltz-Cornelis CM., Elfeddali I., Werneke U., Malt UF., Bergh OVD., Schaefert R., Kop WJ., Lobo A., Sharpe M., Söllner W., Löwe B., Allaz AF., Ancane G., Bendix M., Berney A., Blanch J., Boye B., Burton C., Cardoso G., Cathébras P., Cosci F., Dantoft TM., Enck P., Ferrari S., Fink P., Fortes S., Fritzsche K., Frostholm L., Geiser F., Gündel H., Guthrie E., Henningsen P., Hüsing P., Hyphantis T., Jenewein J., Kenedi C., Keller M., Khohlova K., Kohlmann S., Kotsis K., Lahmann C., Lemogne C., Pohontsch N., Weigel A., Rief W., Hartman TO., Nater U., Natsov II., Nedelcu L., Noll-Hussong M., Urrutia AR., Rantis K., Rosendal M., Rosmalen J., Rymaszewska J., Sandlund M., Schröder A., Shedden-Mora M., Slawomir C., Stauder A., Stoyanov D., Syngelakis M., Stelcer B., Tomas-Aragones L., Terp IM., Tkalcic M., Toussaint A., Zurowski M.

Background: Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs and pose a substantial challenge to the population and health policy of Europe. To meet this challenge, a specific research agenda is needed as one of the cornerstones of sustainable mental health research and health policy for SSD, BDD, and FD in Europe.

Aim: To identify the main challenges and research priorities concerning SSD, BDD, and FD from a European perspective.

Methods: Delphi study conducted from July 2016 until October 2017 in 3 rounds with 3 workshop meetings and 3 online surveys, involving 75 experts and 21 European countries. EURONET-SOMA and the European Association of Psychosomatic Medicine (EAPM) hosted the meetings.
Results: Eight research priorities were identified: (1) Assessment of diagnostic profiles relevant to course and treatment outcome. (2) Development and evaluation of new, effective interventions. (3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in this context. (4) Research into patients preferences for diagnosis and treatment. (5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes (6). Translational research exploring how psychological and somatic symptoms develop from somatic conditions and biological and behavioral pathogenic factors. (7) Development of new, effective interventions to personalize treatment. (8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital
and specialty mental health settings. The general public and policymakers will benefit from the development of new, effective, personalized interventions for SSD, BDD, and FD, that will be enhanced by translational research, as well as from the outcomes of research into patient involvement, GP-patient communication, consultation-liaison models and implementation.

Conclusion: Funding for this research agenda, targeting these challenges in coordinated research networks such as EURONET-SOMA and EAPM, and systematically allocating resources by policymakers to this critical area in mental and physical well-being is urgently needed to improve efficacy and impact for diagnosis and treatment of SSD, BDD, and FD across Europe."
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"The proposed ICD-11 beta draft classification of Bodily Distress Disorders (BDD) (24, 25) may differ from SSD (19).

This has led to controversy and a proposal to delete BDD from the ICD-11 beta version (26) as it seems hard to discern from Bodily Distress Syndromes (27) that captures many of functional and somatoform disorders (28) and shows similarities with the ICD-10 classification of somatoform autonomous dysfunction (29).

Similarly to functional disorders (FD), BDD mainly focuses on medically unexplained physical symptoms for its classification, rather than on their psychological conundrums (30).

In order to cover the multitude of aspects described above, in this study, we will use the combined term of Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD), as was done in an earlier study of the EURONET-SOMA network (31)."

https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00151/full

eta: see also
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5961475/
 
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And Nater U is probably the most ridiculous quack I'm aware of.

So a bunch of people who want careers from poor research into this stuff got together and decided that:

Funding for this research agenda, targeting these challenges in coordinated research networks such as EURONET-SOMA and EAPM, and systematically allocating resources by policymakers to this critical area in mental and physical well-being is urgently needed to improve efficacy and impact for diagnosis and treatment of SSD, BDD, and FD across Europe."
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Interesting.
 
These disorders are at best highly heterogenous. Guess what happens when you investigate highly heterogenous patient cohorts when the diagnosis is problematic and you don't know what you are looking for? How long will it take to advance appropriate scientific research?

Almost everyone familiar with the CFS and ME cohort debate will know the answer to this one.
 
Where did all those extra authors come from? Only these people are listed as authors on the paper at the link
Screen Shot 2018-10-29 at 12.14.02.png

There is a section at the bottom of the paper
Acknowledgments
The research is published on behalf of EAPM. Apart from the authors, the following experts agreed to be listed as participants in the survey. We thank them and the unlisted experts for their collaboration:

Anne-Françoise Allaz, Gunta Ancane, Marie Bendix, Alexandre Berney, Jordi Blanch, Birgitte Boye, Chris Burton, Graça Cardoso, Pascal Cathébras, Fiammetta Cosci, Thomas Meinert Dantoft, Paul Enck, Silvia Ferrari, Per Fink, Sandra Fortes, Kurt Fritzsche, Lisbeth Frostholm, Franziska Geiser, Harald Gündel, Else Guthrie, Peter Henningsen, Paul Hüsing, Thomas Hyphantis, Josef Jenewein, Chris Kenedi, Monika Keller, Ksenya Khohlova, Sebastian Kohlmann, Konstantinos Kotsis, Claas Lahmann, Cédric Lemogne, Nadine Pohontsch, Angelika Weigel, Winfried Rief, Tim Olde Hartman, Urs Nater, Ivo Ivanov Natsov, Laurentiu Nedelcu, Michael Noll-Hussong, Amanda Rodriguez Urrutia, Konstantinos Rantis, Marianne Rosendal, Judith Rosmalen, Joanna Rymaszewska, Michael Sandlund, Andreas Schröder, MS, Meike Shedden-Mora, Czachowski Slawomir, Adrienne Stauder, Drozdstoy Stoyanov, Markos Syngelakis, Boguslaw Stelcer, Lucia Tomas-Aragones, Inger Merete Terp, Mladenka Tkalcic, Anne Toussaint, Mateusz Zurowski.
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Not sure it's useful to list participants as authors, assuming that's where the list came from.
 
No Patient-Centric ideals blocking this cabals future as money trail followers.
 
Just to cross reference this. Some may recall that in the 1988 paper Wessely et al stated that it was preferable to view symptoms in terms of "abnormal illness (EDIT behaviour)" rather than "hysteria". They cited a paper by Pilowsky I from 1969, which so far as I can see they have not subsequently referred to. It is interesting to note the full list of potential diagnoses which Pilowsky thought covered by this description:

functional illness, functional overlay. hysteria, hysterical overlay, conversion reaction, psychophysiological reaction, somatisation reaction, hypochondriasis, invalid reaction, neurasthenia, psychogenic regional pain, "psychosomatic", psychological invalidism, malingering, Munchhausen's syndrome and organ neurosis.

Hard to see any good reason for not wishing it to be known that that is how they see ME.
 
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Trish said:
Does anyone know the difference between Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD).
I thought they were interchangeable terms for psychosomatic.
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There are many blog posts on DxRevisionWatch that go into details about the differences between them and where they overlap.

For example:

https://dxrevisionwatch.com/2018/07/21/comparison-of-ssd-bdd-bds-bss-in-classification-systems/

https://dxrevisionwatch.com/2013/06/19/bds-bdds-bss-bdd-unscrambled/

https://dxrevisionwatch.com/2012/08...y-distress-syndrome-eaclpp-lecture-june-2012/

https://dxrevisionwatch.com/2013/05...-distress-and-functional-disorders-published/
 
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Trish said:
Does anyone know the difference between Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD).
I thought they were interchangeable terms for psychosomatic.
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To repond out of order;
BDD is Per Fink's 'new' construct which he's attempting to get accepted by WHO.
SSD is the more established construct, explained by Wikipedia as "A somatic symptom disorder, formerly known as a somatoform disorder,[1][2][3] is any mental disorder which manifests as physical symptoms that suggest illness or injury, but which cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder"
FD is complicated. Wikipedia explains it as "A functional disorder is a medical condition that impairs normal functioning of bodily processes that remains largely undetected under examination, dissection or even under a microscope. At the exterior, there is no appearance of abnormality. This stands in contrast to a structural disorder (in which some part of the body can be seen to be abnormal) or a psychosomatic disorder (in which symptoms are caused by psychological or psychiatric illness). Definitions vary somewhat between fields of medicine.

Generally, the mechanism that causes a functional disorder is unknown, poorly understood, or occasionally unimportant for treatment purposes. The brain or nerves are often believed to be involved. It is common that a person with one functional disorder will have others.".

Non-psychs will refer to functional disorders and NOT mean a psych condition (i.e. in a paper from a couple of years ago, Columbia/Lipkin referred to ME being a functional disorder and absolutely did not mean it in a psych sense), whereas psychs will refer to functional disorders and WILL mean a psych condition.

So, depending on the author, yes, they can be interchangeable terms for psychosomatic.
 
Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs
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They never mention the high medical and societal cost of a misdiagnosis of one of these unedivenced diagnoses.

A good example was a German friend who had had long standing chronic fatigue and a heart condition that required surgery. Following surgery she experience severe pain whenever she bent forward. This pain was diagnosed as psychosomatic, even though it was severe enough to prevent her working and arround the same time a foster placement with her broke down catastrophically. Following numerous visits with various doctors, private visits to a healer and a period of medically prescribed psychotherapy, she eventually some eighteen months later found a doctor willing to authorised an X-ray. There was a ten inch long surgical tool left in her chest cavity from the heart surgery.

The cost of not doing that X-ray earlier must have been in the tens of thousands of euros.

It then took several years of complaints and legal battles to gain compensation, but never an apology. I must admit when I saw the X-ray I could not imagine how she had not suffered major organ trauma. Fortunately she had fought the medical advice to push through the pain. She is however left with life long distress and a very rational fear of doctors which made life even more difficult when she subsequently developed a life threatening cancer.

[edited to remove some potentially identifying details]
 
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Trish said:
Does anyone know the difference between Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD).
I thought they were interchangeable terms for psychosomatic.
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Andy said:
BDD is Per Fink's 'new' construct which he's attempting to get accepted by WHO.
SSD is the more established construct, explained by Wikipedia as "A somatic symptom disorder, formerly known as a somatoform disorder,[1][2][3] is any mental disorder which manifests as physical symptoms that suggest illness or injury, but which cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder"
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This isn't quite right. Bodily distress syndrome is Fink's construct. Bodily distress disorder is the ICD-11 term and Somatic symptom disorder the construct from DSM-V. With respect to those terms, I don't think @Dx Revision Watch would mind me cropping this table from the attached PDF she has previously made available, which summarises the differences between them.

Screenshot_20181029-162825_Xodo Docs.jpg
 

Attachments

Sly Saint said:
van der Feltz-Cornelis CM., Elfeddali I., Werneke U., Malt UF., Bergh OVD., Schaefert R., Kop WJ., Lobo A., Sharpe M., Söllner W., Löwe B., Allaz AF., Ancane G., Bendix M., Berney A., Blanch J., Boye B., Burton C., Cardoso G., Cathébras P., Cosci F., Dantoft TM., Enck P., Ferrari S., Fink P., Fortes S., Fritzsche K., Frostholm L., Geiser F., Gündel H., Guthrie E., Henningsen P., Hüsing P., Hyphantis T., Jenewein J., Kenedi C., Keller M., Khohlova K., Kohlmann S., Kotsis K., Lahmann C., Lemogne C., Pohontsch N., Weigel A., Rief W., Hartman TO., Nater U., Natsov II., Nedelcu L., Noll-Hussong M., Urrutia AR., Rantis K., Rosendal M., Rosmalen J., Rymaszewska J., Sandlund M., Schröder A., Shedden-Mora M., Slawomir C., Stauder A., Stoyanov D., Syngelakis M., Stelcer B., Tomas-Aragones L., Terp IM., Tkalcic M., Toussaint A., Zurowski M.
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There you have the entire gang. It's really scary.
 
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