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

Dolphin

Dolphin

Senior Member (Voting Rights)
As I recall, the definition they use for CFS is pretty rubbish e.g. they just require fatigue.

https://www.sciencedirect.com/science/article/abs/pii/S0022399919306014

Journal of Psychosomatic Research
Available online 14 November 2019, 109868
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The unifying diagnostic construct of bodily distress syndrome (BDS) was confirmed in the general population
Marie WeinreichPetersena
AndreasSchrödera
TorbenJørgensenbcd
EvaØrnbøla
Thomas MeinertzDantoftb
MarieEliasenb
Betina H.Thuesenb
PerFinka
https://doi.org/10.1016/j.jpsychores.2019.109868Get rights and content

Highlights


•
The Bodily distress syndrome (BDS) construct can be used in general populations.

•
Four symptom clusters corresponding to the BDS subtypes were identified and confirmed.

•
Participants were divided into three classes of illness severity.

•
BDS constitutes a promising approach for classification of functional somatic disorders.



Abstract
Objectives
Bodily distress syndrome (BDS) has been shown to encompass a range of functional somatic syndromes (FSS) such as irritable bowel syndrome (IBS), fibromyalgia (FM), and chronic fatigue syndrome (CFS) in clinical samples. This study aimed to explore symptom clusters and test classification of individuals with illness similar to the BDS criteria in a general population sample.

Methods
A stratified subsample of 1590 individuals from the DanFunD part two cohort was included. Symptoms were assessed with the Research Interview for Functional somatic Disorders, performed by trained physicians. In 44 symptoms pooled from criteria of IBS, FM, CFS, and BDS, symptom clusters were explored with explorative factor analysis. Confirmation of symptom clusters of BDS in the previously described 25- and 30-item BDS checklists was performed with confirmatory factor analysis. Classification of individuals into illness groups was investigated with latent class analysis.

Results
Four symptom clusters (cardiopulmonary, gastrointestinal, musculoskeletal, general symptoms/fatigue) corresponding to the BDS subtypes and their corresponding FSS were identified and confirmed. A three-class model including 25 BDS items had the best fit for dividing participants into classes of illness: One class with low probability, one class with medium probability, and one class with high probability of having ≥4 symptoms in all symptom clusters.

Conclusion
The BDS concept was confirmed in the general population and constitutes a promising approach for improved FSS classification. It is highly clinical relevant being the only diagnostic construct defining the complex multi-organ type.

Keywords
Bodily distress syndrome
Factor analysis
Functional somatic disorders
Latent class analysis
Somatic symptoms

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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.
 
Bodily distress syndrome (BDS) has been shown to encompass a range of functional somatic syndromes
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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.
 
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.
 
Jonathan Edwards said:
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'.
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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.
 
Sly Saint said:
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....?
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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.
 
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!
 
Amw66 said:
Sadly i feel that this may only feed into the confusion with BDD.
It is far from harmless.
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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].

Extract:

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.


References:

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. https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20635

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.
 
Dx Revision Watch said:
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].

Extract:

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.


References:

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. https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20635

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.
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Thank you
 
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