Prevalence of Bodily Distress Syndrome and Prediction of Patient Outcomes: Cohort Study of 3762 Individuals With Persistent Pain 2026 Landmark et al

Andy

Andy

Senior Member (Voting rights)

ABSTRACT​


Background​

Persistent physical symptoms are common and often result in disability and high healthcare use. To capture how such symptoms co-occur, Bodily Distress Syndrome (BDS, also called Functional Somatic Disorders) was developed as an empirically derived construct, in contrast to consensus-based syndromes such as fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). BDS is distinct from ICD-11 Bodily Distress Disorder and reflects the multisystem symptom pattern described in the Functional Somatic Disorder framework. However, its prevalence, symptom structure and prognostic relevance in pain populations have not been mapped.

Methods​

This study included 3762 individuals referred to a tertiary pain clinic. At baseline, participants reported standardised measures of fatigue, insomnia, pain catastrophizing, psychological distress, perceived injustice, health-related quality of life and disability. After 12 months, they reported disability and perceived change. BDS severity was classified from predefined symptom cluster criteria. We examined prevalence, clinical correlates and prognostic utility.

Results​

92.5% met the criteria for moderate or severe BDS. They reported more severe physical symptoms, elevated psychological distress and reduced functioning than those not meeting the criteria. Severe BDS was more common among women, those without higher education and individuals outside the workforce. After 12 months, individuals with BDS showed less improvement in functioning and reported lower perceived treatment benefit.

Conclusion​

BDS was common in this outpatient hospital cohort and may offer a clinically useful lens for capturing multisystem complexity in specialised pain services. Incorporating BDS screening into routine assessment could help identify individuals with complex symptoms and support more mechanism-oriented treatment approaches.

Significance Statement​

Bodily Distress Syndrome (BDS) is highly prevalent in tertiary pain care and linked to more severe symptoms, psychosocial burden and poorer long-term outcomes. The findings support BDS as a clinically useful framework for identifying patients with complex symptom profiles and for guiding interdisciplinary, mechanism-oriented approaches to pain management.

Open access
 
They reported more severe physical symptoms, elevated psychological distress and reduced functioning than those not meeting the criteria.​

Which is exactly what you would see in patients with unresolved, disabling, and horrible physical symptoms.

It is circular definitional nonsense. Just arbitrary reframing.
 
Oh so now we have “perceived” injustice to add to pain “catastrophising” and their shopping list of gaslighting terminology.

Do they actually notify the patients that the questions they spend valuable time and energy answering will be used to classify them as catastrophising and injustice reported will be downplayed as only their perception. I doubt it.
 
Sean said:
They reported more severe physical symptoms, elevated psychological distress and reduced functioning than those not meeting the criteria.​

Which is exactly what you would see in patients with unresolved, disabling, and horrible physical symptoms.

It is circular definitional nonsense. Just arbitrary reframing.
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It’s nasty nasty little reversal deliberately after having incited the regime to make it clear there will be no hope of support so they won’t get worse. So destruction caused by them and more foot on the neck as they then use it to accelerate that power and imposition of harmful slander so people are trapped, not ‘them helping something caused by the mind’ (their little excuse to cover up outcomes as if that’s not the case)
 
NelliePledge said:
Oh so now we have “perceived” injustice to add to pain “catastrophising” and their shopping list of gaslighting terminology.

Do they actually notify the patients that the questions they spend valuable time and energy answering will be used to classify them as catastrophising and injustice reported will be downplayed as only their perception. I doubt it.
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As one of the main reasons and aims behind the ideology is to remove informed consent then id assume all was done to avoid that
 
The first part of the article is about how their data shows that people that have a lot of symptoms have a lot of symptoms, and that people with more symptoms now tend to have more symptoms in the future.

The second part is mostly propaganda for mind-body interventions. They don’t give any reason for why their hypotheses about the causes of the symptoms are reasonable.

It’s essentially an opinion piece disguised as a research paper.

Examples of the opinions:
Higher BDS symptom burden was associated with more severe insomnia and fatigue, elevated psychological distress, and greater functional disability. These associations were consistent across both categorical and dimensional approaches, supporting BDS as an index of clinical severity. The severity gradient suggests that BDS captures graded rather than discrete differences in multisystem symptom burden.
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This interpretation aligns with neurobiological and cognitive models linking persistent somatic distress to long-term dysregulation in autonomic, interoceptive and predictive systems (Henningsen, Gündel, et al. 2018), where maladaptive attentional and interpretive patterns may reinforce symptom perception over time.
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(…)
Even in multidisciplinary pain clinics, interventions are typically organised around pain, while other symptoms are referred elsewhere. A BDS framework may therefore support a more integrated focus on shared maintaining processes, including fear-driven expectations, avoidance, and psychological inflexibility.
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(…)
Group-based Acceptance and Commitment Therapy has shown promising effects in individuals with BDS (Kallesøe et al. 2021), but the added value of BDS lies in broadening the clinical focus beyond pain and supporting the targeted use of integrative approaches, including newer mind–body interventions relevant for nociplastic conditions. This broader focus could provide interdisciplinary pain teams with a clearer rationale for treatment planning and for prioritising interventions across disciplines.
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(…)
Finally, as with all observational designs, causal inference is limited, and it cannot be determined whether poorer outcomes among individuals meeting BDS criteria reflect severity, shared mechanisms or inadequate treatment.
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Seeing as all of the participants were from a multidisciplinary pain management clinic, I think we can be fairly certain that the poor outcomes are partially caused by inadequate treatment.
 
Utsikt said:
This is questionnaire pseudoresearch at its worst. It’s pure propaganda.

The Norwegian government is paying for this by funding the «researcher’s» salaries.
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I find it so ironic/meta that in the name of hating mslingerers people end up funding stuff that involves sponsoring stuff that words like finding cushy and easy way of making money and lazy methodology etc spring to mind with

It also reminds me of the not nice metaphor over here of suggesting that if you are the one who broke wind in company the only way to cover it up is to accuse someone else of being the culprit
 
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