Discussion in 'General ME/CFS News' started by Andy, Mar 6, 2019.
This is an argument that should be repeated more often IMO:
Seems to be confusion in the medical literature about the MUPS definition. It is a very broad category whose reason for being seems to be cost-containment and what to do with the patient. The result is always: refer to psychological treatment. Woe to said patients who receive less than optimal psych treatment, or whose medical records emphasize the psychological nature (not) of their complaint.
However, the term is thrown around as a substitute for somatoform disorder which is a much more discrete psychiatric category.
So MUPS and somatization disorder are not the same thing.
The various DSM-IV somatoform disorders were replaced in DSM-5 (May 2013) with a single new category, Somatic symptom disorder, which does away with the requirement that the symptoms should be "medically unexplained" and has a far looser criteria set than DSM-IV's Somatization disorder 
The SSD diagnosis includes conditions for which no medical explanation has been found but the diagnosis can also be applied to patients with general medical diseases and conditions where the clinician perceives an exaggerated response to chronic, distressing symptoms with significant disruption of functioning, and disproportionate thoughts, feelings and behaviours regarding the symptoms.
The F45.x somatoform disorders persist in WHO's ICD-10.
For ICD-11, most of ICD-10's somatoform disorders and neurasthenia have been replaced with ICD-11's single new diagnostic category, Bodily distress disorder. ICD-11's BDD is conceptually aligned to DSM-5's Somatic symptom disorder and has very similar characterization and disorder description.
1 Mislabeling Medical Illness As Mental Disorder Allen Frances (with Suzy Chapman), Psychology Today, DSM 5 in Distress, December 8, 2012
"The clinician perceives," is a phrase that fills me with horror. What kind of physician? I'm beyond sceptical about leaving such a damaging diagnosis to the subjective judgement of a single doctor.
They can be prideful, egotistical, arrogant, devoid of empathy, and careless of pain management.
Different people have different pain thresholds. How can they judge that someone is making too much fuss or dwelling too much on their situation, when there isn't an objective measure for this type of "bodily distress"?
And what type of doctor is judging? Does the Consultant send a report to a Psychiatrist, who interviews the patient? "Chronic, distressing symptoms," as they describe, ARE, by definition, overwhelming, and dominate one's life!
It's invidious. A terrible Catch 22.
Disbelief by doctors, family and friends. To be so ill, and few, if any, taking your dreadful physical condition seriously? You feel like you're dying a terrible drawn out death...
Add in financial worries, isolation and fear of the future...
It's no wonder so many die by their own hand.
Psychiatrists fail to recognize that their own inappropriate treatments can create suicide risk in chronically ill patients.
In the 1990s, after individual antidepressants and ECT failed to improve functioning and fatigue, it was very common (for me) to be prescribed drug cocktails of up to 5 psych medications at a time. The reactions to these medication combos were at times horrific, and would probably make even healthy people contemplate suicide. But I quickly learned that if I mentioned suicidal thoughts, psychiatrists would just lecture me about the importance of taking meds as prescribed and/or order a forced 72 hour hospital lockup.
My experiences were certainly not unique.
Currently, I have no psych diagnosis. The psych misdiagnoses have been removed by my doctor. It turns out I only have decades of inappropriately managed ME/CFS.
But I will always have a deep mistrust of the psych profession (as well as the medical profession that abandoned me to psychiatry) and am very unlikely to seek help in the future, even if needed.
... but both are unproven hypothetical disorders with little objective evidence backing them. Yes, the diagnostic categories are different, but like all psychogenic claims they lack any objective reality.
MUPS at least has the token possibility that someone might consider a disorder as unexplained ... it could happen, its just not how its done in most cases.
ME has so many biomarkers and physiological findings right now that considering it unexplained is a very big stretch, and probably unethical.
This is a very dangerous thing, and a lot was made of it a few years ago, but somehow its still full steam ahead and damn the icebergs.
@Webdog ￼￼￼ and also
All subjective opinion by a doctor - someone who sees a patient for 10 minutes once in a while. How pray tell does one objectively measure "exaggerated response"? Wonder how these same doctors would react if they had a terrible physical illness.
This is one of my strongest objections to this whole framework: that the average healthy doctor has any idea what constitutes a healthy reaction to this kind of upheaval. It's normal to grieve; it's normal to focus intently on symptoms as you try to abrogate their effects or work around them; it's normal to ask yourself what you can do now, what good you are now: who you are without those activities that used to define you.
Encountered a newly diagnosed person with ME by utter coincidence the other day and she asked me that: what good am I, now? And I thought about how much chronic disease puts a person's self-concept through complete upheaval. Her doc thought "CFS" was a depressive disease and she'd been on a shiny new SSRI for a month and couldn't understand why it wasn't allowing her to be physically active again.
The misunderstandings around this disease make the psychological fallout -- which is bound to be pretty awful in the first place -- even worse.
It's a good thing she met you Jaime.
Thank you for your examples.
Awful to think of newly diagnosed pwME going through the same crap most of the rest of us have gone through. The first place people turn to is their doctor. Who, unfortunately, is still misinformed about ME.
Somatic Symptom Disorder is all encompassing. Anyone who writes on a forum about any health concern could be labeled with this disorder. Anyone who "Googles" websites on health disorders. Anyone who advocates for improvements in health care, or a specific disease, could "have" SSD. Anyone concerned about a family member's health could have SSD. Anyone who ever sees their doctor - even once, could have SSD.
Anyone developing health policy could have SSD. Scientists researching cures could have SSD.
Indeed, anyone who is a doctor, or a psychiatrist could have SSD. After all, they spend decades studying and focusing on health issues.
It is very concerning to think the SSD or BDD label can be attached due to an opinion, and only an opinion that someone is over reacting. There are no objective measures. It's always been so in this field. Based on one opinion, a person's life can become hell, if it isn't already from ME, or some other terrible organic illness.
This would be a really excellent topic for a longish article from someone who understands from an inside POV and still has the capacity to write and think. Well, I consider it important at any rate.
They say there is no one way to grieve the loss of a loved one. There are many quite normal ways to respond to being chronically ill too but all we ever get from health professionals for the most part is utter disbelief, disinterest or an 'it can't be as bad as all that' (for which IMO a normal response is ---you try being this ill for this long).
What bothers me most I think, is that most of any of the sick persons attitudes isn't all that hard to imagine as normal in the circumstance if anyone stopped to consider for a while. And it should be a normal part of doctor education. If it was a general public attitude to view the sick with compassion it probably wouldn't be as critical.
I have nothing but loathing for the BPS view as developed by this group of Ableists.
It's a good thing she liked my necklace and I liked her dog, or we never would've started talking!
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