The BDS checklist as measure of illness severity: a cross-sectional cohort study...., 2020, Fink et al

Andy

Andy

Retired committee member
Full title: The BDS checklist as measure of illness severity: a cross-sectional cohort study in the Danish general population, primary care and specialised setting
Objective The bodily distress syndrome (BDS) checklist has proven to be useful in the diagnostic categorisation and as screening tool for functional somatic disorders (FSD). This study aims to investigate whether the BDS checklist total sum score (0–100) can be used as a measure of physical symptom burden and FSD illness severity.

Design Cross-sectional.

Setting Danish general population, primary care and specialised clinical setting.

Participants A general population cohort (n=9656), a primary care cohort (n=2480) and a cohort of patients with multiorgan BDS from specialised clinical setting (n=492).

Outcome measures All data were self-reported. Physical symptoms were measured with the 25-item BDS checklist. Overall self-perceived health was measured with one item from the 36-item Short-Form Health Survey (SF-36). Physical functioning was measured with an aggregate score of four items from the SF-36/SF-12 scales ‘physical functioning’, ‘bodily pain’ and ‘vitality’. Emotional distress was measured with the mental distress subscale (SCL-8) from the Danish version of the Hopkins Symptom Checklist-90. Illness worry was measured with the six-item Whiteley Index.

Results For all cohorts, bifactor models established that despite some multidimensionality the total sum score of the BDS checklist adequately reflected physical symptom burden and illness severity. The BDS checklist had acceptable convergent validity with measures of overall health (r=0.25–0.58), physical functioning (r=0.22–0.58), emotional distress (r=0.47–0.62) and illness worry (r=0.36–0.55). Acceptability was good with a low number of missing responses to items (<3%). Internal consistency was high (α ≥0.879). BDS score means varied and reflected symptom burden across cohorts (13.03–46.15). We provide normative data for the Danish general population.

Conclusions The BDS checklist total sum score can be used as a measure of symptom burden and FSD illness severity across settings. These findings establish the usefulness of the BDS checklist in clinics and in research, both as a diagnostic screening tool and as an instrument to assess illness severity.
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Open access, https://bmjopen.bmj.com/content/10/12/e042880
 
I meant that more literally @Andy

ie does anyone know what the checklist actually is - ie a link to it, or know what is on it?
 
Presumably the compilers of this check list believe they have selected items that distinguish between psychological conditions and biomedical conditions, and indeed it is theoretically possible that this might on average when looking at complete heterogeneous populations be true for some people, however this does not take into account that the various symptoms listed are also symptoms of specific biomedical conditions. So even if there are people for whom this is an adequate measure of their psychological symptoms, we have no way of distinguishing them from people for whom it is a measure of biomedical symptoms.

Given there is no objective way to identify patients with BDS this is totally a boot strap operation with the researchers beliefs/prejudices being used to confirm their own beliefs/prejudices. It would be more meaningful to compare people with different psychiatric and biomedical diagnoses and comparable levels of disease burdens to see if the check list is measuring anything psychological or is simply measuring rational reporting of actual physical symptoms, but even then there is the quandary that it could simultaneously be measuring both with no way of knowing when it is measuring the psychological and when the biomedical.
 
Andy said:
View attachment 12804
From page 8 of https://sci-hub.se/10.1016/j.jpsychores.2015.03.006
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This may as well be a questionnaire about acute or long covid, or ME. I'm sure the Long Covid folks will love it just as much as we do.

I'll always be amazed at the singular mediocrity behind the thinking that too many symptoms of illness must, MUST, suggest no actual illness. No other field of expertise could get away with thinking this absurd, literally a rejection of Occam's razor in favor of Rube Goldberg's blunt mace of bluntness, the bluntiest, least sharp object in the known universe.
 
So when you add symptom 4 the first 3 stop existing and become imaginary.

Edited to add

Oliver Sachs said that 3 migraines a week were physical but more than that was psychological.

What that really means is that physicians can't distinguish real from psychological since migraines 1 to 3 must be psychologically induced as well or is it just number 4?

There is very little logic. Maybe if they said that psychological problems can cause the physical disease that might just about be acceptable but they do not. They make a pronouncement, they treat the psychology, refusing any further physical investigations and if you don't get better it is your fault for not trying or being entrenched in your behaviour.
 
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Mithriel said:
So when you add symptom 4 the first 3 stop existing and become imaginary.

Edited to add

Oliver Sachs said that 3 migraines a week were physical but more than that was psychological.

What that really means is that physicians can't distinguish real from psychological since migraines 1 to 3 must be psychologically induced as well or is it just number 4?

There is very little logic. Maybe if they said that psychological problems can cause the physical disease that might just about be acceptable but they do not. They make a pronouncement, they treat the psychology, refusing any further physical investigations and if you don't get better it is your fault for not trying or being entrenched in your behaviour.
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3 symptoms good. 4 symptoms baaaaad.
 
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