The unifying diagnostic construct of bodily distress syndrome (BDS) was confirmed in the general population, 2019, Fink et al

Discussion in 'Psychosomatic research - ME/CFS and Long Covid' started by Dolphin, Nov 19, 2019.

  1. Dolphin

    Dolphin Senior Member (Voting Rights)

    As I recall, the definition they use for CFS is pretty rubbish e.g. they just require fatigue.

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  2. Wonko

    Wonko Senior Member (Voting Rights)

    I am confused;

    by 'the general population' do they mean 'people'?

    by 'confirmed' do they mean that they have found that people have symptoms that a construct they willfully and with purpose designed to explain these symptoms that people experience in a way that they can see ways of making money from?

    Shock headline, if you define a tree as a tree shaped space a tree could occupy then there are trees everywhere.

    ETA - how can allegedly 'smart' people not see that this self referential batshit will not fly, that it says nothing, and tells us nothing. That it's only purpose is marketing.
    ladycatlover, Lidia, EzzieD and 16 others like this.
  3. Hoopoe

    Hoopoe Senior Member (Voting Rights)

    This classification system has too much ideological baggage to be useful.
    Last edited: Nov 19, 2019
  4. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

    London, UK
    Perhaps it should be:
    The unifying diagnostic construct of bodily distress syndrome (BDS) was confirmed as being the way doctors who hold to this construct diagnose people

    Or in other words people who call rock doves 'pigeons' tend to call rock doves 'pigeons'.
  5. rvallee

    rvallee Senior Member (Voting Rights)

    Imaginary category invented to encompass specific characteristics was indeed found to describe things it set out to describe. Using this logic the old construct of natural materials (earth, fire, water, air) was also shown to contain those things because there are such things out there that can be shown to fit the criteria invented to describe them.

    This is entirely tautological. Is medical science seriously so broken that tautological statements that basically amount to ego stroking are OK? This is just plain embarrassing. This construct is largely identical to every past attempt at inventing such categories and just like those would have included every single person suffering from pre-breakthrough illnesses, definitely every autoimmune disease. It's a category that doesn't distinguish anything, you can't fail science harder than this.

    However this may be purely fictitious, it has real implications because apparently no one in medical institutions seems able to reject magical psychology. It ends up affecting real people, impairing progress and causing harm and for absolutely no benefit. Beyond irresponsible. A curse on the numbnuts who actually give validation to this. The standards have been lowered so much in allowing for psychosomagical BS, might as well embrace astrology while they're at this made-up nonsense.
    ladycatlover, EzzieD, Sarah94 and 6 others like this.
  6. Sly Saint

    Sly Saint Senior Member (Voting Rights)

    But having then classified all these patients with BDS ( as he currently does with FSD) he still has no effective treatment for any of them. So the point of this exercise is....?
  7. Wonko

    Wonko Senior Member (Voting Rights)

    He is now the master of another self created fiefdom?

    As master it doesn't matter if he can use the newly created, and totally imaginary, territory, farm it, mine it, or cure patients - that sort of thing is for underlings to organise.

    It's just a territorial grab, in the hope that he can convince people there are 'natural resources' there.

    The 'fact' that it's all imaginary...that's someone else's problem.
  8. Mithriel

    Mithriel Senior Member (Voting Rights)

    I am really glad you said this. It seems so obvious, here and in FND, that if you define an illness as BDS or FND (and how does that work :) do they talk to each other?) then a few years later or if you look at a large population then you will find the same categories.

    Then they say this confirms their theories???

    I wondered if I was missing something and glad to see I am not.
  9. Amw66

    Amw66 Senior Member (Voting Rights)

    Sadly i feel that this may only feed into the confusion with BDD.
    It is far from harmless.
  10. rvallee

    rvallee Senior Member (Voting Rights)

    Awards. Recognition. Fame. Self-serving ego stroking.

    All of which are more important that literally millions of lives. People involved in these psychosomatic ideologies seem to think of us as mere statistics, not much different than lego figurines. They have built paper-thin caricatures of who we are, how we feel and think, not a big stretch to not think of us as humans, having removed all depth and complexity in order to build up their belief systems.

    It doesn't matter that he's completely wrong, accomplishing nothing and ruining lives in the process. He is respected and awarded for doing that, keeping us, "those patients", away from regular physicians. Doesn't seem like anything more than that even factors in.
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  11. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

    To demonstrate how useless non-specific diagnoses like BDS really are?
    ladycatlover, alktipping and Andy like this.
  12. Sarah94

    Sarah94 Senior Member (Voting Rights)

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  13. obeat

    obeat Senior Member (Voting Rights)

    Isn't the basic problem always the same i.e. doctors thinking that qualitative studies are as reliable as quantitative ones?

    How on earth do we stop this? It's easy to churn out this rubbish and far too easy to get it published.
    We used to have weekly journal clubs to shred research, similar to here.

    I followed some tweets from Association for the study of medical Education. Didn't fill me with confidence!
  14. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)


    This Letter to the Editor published in the June 2019 edition of World Psychiatry (Public stakeholders’ comments on ICD-11 chapters related to mental and sexual health) summarizes common themes of the submissions for the mental disorder categories that generated the greatest response via the ICD-11 Proposal Mechanism platform [1].


    A majority of submissions regarding bodily distress disorder were critical, but were often made by the same individuals (N=8).
    Criticism mainly focused on conceptualization (48%; κ=0.64) and the disorder name (43%; κ=0.91).

    Use of a diagnostic term that is closely associated with the differently conceptualized bodily distress syndrome5 was seen as problematic.
    One criticism was that the definition relies too heavily on the subjective clinical decision that patients’ attention directed towards bodily symptoms is “excessive”. A number of comments (17%; κ=0.62) expressed concern that this would lead to patients being classified as mentally disordered and preclude them from receiving appropriate biologically-oriented care. Some contributors submitted proposals for changes to the definition (30%; κ=0.89). Others opposed inclusion of the disorder altogether (26%; κ=0.88), while no submission (κ=1) expressed support for inclusion.

    The WHO decided to retain bodily distress disorder as a diagnostic category6 and addressed concerns by requiring in the CDDG the presence of additional features, such as significant functional impairment.​

    Note: “Use of a diagnostic term that is closely associated with the differently conceptualized bodily distress syndrome5 was seen as problematic.”

    Whilst it is welcomed that this specific concern has been acknowledged within this Letter to the Editor, I have drawn to the attention of the authors (which include WHO's Dr Robert Jakob, MD and Dr Geoffrey Reed) that WHO/ICD Revision has repeatedly failed to respond to my requests to provide a rationale for its re-purposing of a diagnostic term that is already strongly associated with the Fink et al (2010) Bodily distress syndrome*, despite provision of examples from the literature clearly demonstrating that these two terms have been used interchangeably by researchers and practitioners, since 2007 and that more recently, academics and researchers are publishing papers in which they have evidently confused ICD-11's BDD with the Fink et al (2010) BDS [2].

    The potential for confusion and conflation of these differently conceptualized disorder constructs was publicly acknowledged by the WHO’s Dr Geoffrey Reed, in 2015. However, there has been no discussion of the potential for confusion in any of the S3DWG working group’s progress reports and field trial evaluations. If the WHO is not willing to reconsider and remedy this problem, there is the expectation that a rationale for going forward with the Bodily distress disorder term is provided for clinical and public stakeholders.

    *Operationalized in Denmark and beyond, BDS is differently conceptualized to ICD-11’s BDD diagnostic construct: BDS has very different criteria/essential features, based on physical symptom patterns or clusters from organ systems; psychobehavioural responses to symptoms do not form part of the BDS criteria; BDS requires the symptoms to be “medically unexplained”; is inclusive of a different patient population to ICD-11’s BDD, and crucially, is considered by its authors to capture myalgic encephalomyelitis, chronic fatigue syndrome, IBS and fibromyalgia patients under a single, unifying BDS diagnosis.

    As an unprocessed proposal is currently under review with the ICD-11 CSAC and MSAC committees, I have requested that earlier submissions, which were marked as rejected in February 2019 with no adequate rationale for dismissing the concerns raised within them, are reconsidered and that the WHO responds to three specific concerns:

    a) its re-purposing of a disorder term already in use interchangeably for a differently conceptualized disorder construct;

    b) the potential difficulties of maintaining disorder construct integrity within and beyond ICD-11 and the implications for clinical utility, data reporting and statistical analysis;

    c) the requirement for adding exclusions under BDD for Concept Title 8E49 Postviral fatigue syndrome and its inclusion terms, to mitigate confusion/conflation with the Fink et al (2007, 2010) Bodily distress syndrome.


    1 Fuss J, Lemay K, Stein DJ, Briken P, Jakob R, Reed GM and Kogan CS. (2019). Public stakeholders’ comments on ICD‐11 chapters related to mental and sexual health. World Psychiatry, 18: 233-235.

    2 Chapman S. Proposal and rationale for Deletion of the Entity Bodily distress disorder. Proposal submitted via ICD-11 Beta draft Proposal Mechanism, March 02, 2017.
  15. Amw66

    Amw66 Senior Member (Voting Rights)

    Thank you
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  16. ME/CFS Skeptic

    ME/CFS Skeptic Senior Member (Voting Rights)

    It seems thad they just looked at symptoms "regardless of etiology" in a sample of the general population and how these correlate and cluster.

    I don't see what this has to do with bodily distress syndrome.
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  17. Cheshire

    Cheshire Moderator Staff Member

    But... This is nonsense. How could that mean something? They can't be serious.
    ladycatlover, Sarah94 and Andy like this.

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