1. Sign our petition calling on Cochrane to withdraw their review of Exercise Therapy for CFS here.
    Dismiss Notice
  2. Guest, the 'News in Brief' for the week beginning 27th November 2023 is here.
    Dismiss Notice
  3. Welcome! To read the Core Purpose and Values of our forum, click here.
    Dismiss Notice

Ethical Psychotherapeutic Management of Patients with Medically Unexplained Symptoms: The Risk of Misdiagnosis and Harm. O'Leary & Geraghty. 2020

Discussion in 'Psychosomatic research - ME/CFS and Long Covid' started by John Mac, Oct 10, 2020.

  1. John Mac

    John Mac Senior Member (Voting Rights)

    Full title:
    Ethical Psychotherapeutic Management of Patients with Medically Unexplained Symptoms: The Risk of Misdiagnosis and Harm
    Diane O'Leary and Keith Geraghty


    Edited to break into shorter paragraphs for easier reading.

    Last edited by a moderator: Oct 10, 2020
  2. Trish

    Trish Moderator Staff Member

    I wonder, is there such a thing as ethicial psychotherapeutic management of ME/CFS? Surely the answer to that is that ME/CFS should not be managed psychotherapeutically. It's possible comorbid psychological conditions could be managed psychotherapeutically, but not ME/CFS itself.

    I'm not too happy with ME/CFS being given an MUS label.

    Since I can't access and read the chapter, I can only hope it's good. Keith Geraghty does excellent work on ME/CFS, so I'll just have to trust he has done so here too.

    Edited to remove speculation about the chapter content.
    Last edited: Oct 10, 2020
  3. Andy

    Andy Committee Member

    Hampshire, UK
    With friends like these...

    To expand further, it's not the concept, of ME being medically unexplained, that I object to, as that is technically correct. But given that the term has been weaponised by the BPSers to mean psychological (whether they claim they have or not) means that I object to it being used with ME. By all means call it insufficiently researched, but not medically unexplained.
  4. Hoopoe

    Hoopoe Senior Member (Voting Rights)

    Insufficiently researched disease is a good name for "medically unexplained symptoms".

    Athough it would be naive to think that one could avoid the associated problems just with a name change. What's needed is mechanisms to identify which illnesses are poorly understood and neglected and initiatives to stimulate good research into them.
  5. Barry

    Barry Senior Member (Voting Rights)

  6. Trish

    Trish Moderator Staff Member

    I've had a very quick skim and so far am favourably impressed. I think this paragraph giving undiagnosed Lupus as the example on the dangers of CBT for undiagnosed physical conditions that are mistaken for psychological problems is good. I've broken a single paragraph into shorter sections for ease of reading:

    A pretty good description of gaslighting. ME/CFS is mentioned in this context.
  7. Barry

    Barry Senior Member (Voting Rights)

    Only skimmed the first bit so far.

    That hits the nail on the head.

    Ambiguity seems to be the hallmark of BPS psychiatry.
  8. Trish

    Trish Moderator Staff Member

    If it turns out that the NICE guideline recommends CBT for ME/CFS, I think this chapter will be an important one to quote when arguing against it.
  9. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

    I also find the statement:


    Note that the publication referred to above as "the new ICD for primary care" is the ICD-11 PHC*, which is still in development [1].

    ICD-11 PHC is a clinical guideline written in simpler language intended to assist non-mental health specialists, especially primary care practitioners and non medically trained health workers with the diagnosis and management of common mental disorders. It is also intended for use in low resource settings and low- to middle-income countries where clinical facilities/access to trained diagnosticians are scarce or non existent.

    The ICD-11 PHC is proposed to comprise 27 "common mental disorders" and contains no general medical diseases. Like the ICD-10 PHC (1996), this revised diagnostic and management guideline will not be mandatory for use by member states and the WHO intends to make the guideline available on its website as an unlicensed download.

    If ICD-11 PHC goes forward with its proposed "Bodily Stress Syndrome" category, there will be all these diagnostic constructs and criteria sets in play:

    Somatic symptom disorder (DSM-5; under BDD Synonyms list in the core ICD-11; potentially added to SNOMED CT)
    Bodily distress disorder (core ICD-11; SNOMED CT)
    Bodily Stress Syndrome (proposed for the ICD-11 PHC guideline for 27 common mental disorders)
    Bodily distress syndrome (Fink et al 2010, operationalized in Denmark and beyond)

    plus the existing ICD-10 and SNOMED CT Somatoform disorders categories and their equivalents in ICPC-2 (a primary care classification system that is available in over 30 countries and is mandatory for use in primary care in 6 EU countries, including the Netherlands).​

    I hope this clarifies that the forthcoming ICD-11 PHC is a non mandatory guideline for 27 mental disorders only and not an abridged version of all the chapters in the core ICD-11.

    *The ICD-11 PHC has not been developed on a publicly accessible platform and the draft texts for the 27 mental disorders proposed to be included are not available for public stakeholder review and comment. There is no indication when the WHO expects to finalise and release the ICD-11 PHC.

    1 Slide presentation: MUS becomes Bodily Stress Syndrome in the ICD-11 for primary care, Marianne Rosendal (2017)

    Note: The ICD-11 PHC should not be confused with the Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders that has been developed by the WHO Department of Mental Health and Substance Abuse and is the equivalent of the ICD-10 "Blue Book".

    The brief descriptive texts in Chapter 06: Mental, behavioural or neurodevelopmental disorders in the core version of ICD-11 are intended for use by coders and clerical workers as a basis for statistical reporting.

    The Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders provides expanded clinical descriptions, essential (required) features, boundaries with other disorders and normality, differential diagnoses, additional features, culture-related features and codes for all mental and behavioural disorders commonly encountered in clinical psychiatry and is intended for use by mental health professionals and for general clinical, educational and service use.
    Last edited: Oct 13, 2020
  10. NelliePledge

    NelliePledge Moderator Staff Member

    UK West Midlands
    It’s a pity that sentence isn’t clearer - would be simply remedied in my opinion by the addition of

    seen as or portrayed as quintessential MUS

    But it is very good that the underlying agenda of MUS is clearly exposed

    so definitely a positive contribution.
  11. Kalliope

    Kalliope Senior Member (Voting Rights)

    cfsandmore, rvallee, Barry and 12 others like this.
  12. chrisb

    chrisb Senior Member (Voting Rights)

    But how will you ever overcome "therapeutic nihilism" if you admit to not knowing?

Share This Page