Un nuovo disturbo psichiatrico 'cattura tutti' potrebbe etichettare le persone che si preoccupano per la loro salute come malati mentali. Secondo l'Associazione America di Psichiatria, editore del DSM, "alcuni pazienti con malattie come quelle cardiache o cancro sperimenterebbero pensieri, sentimenti o comportamenti legati alla loro malattia che sarebbero estremi o schiaccianti" e questi individui "potrebbero bessere soggetti a una diagnosi di SSD". Di Sharon Kirkley, Posmedia News, 25 febbraio 2013. Fonte: http://www.canada.com. Fotografia: Christopher Pike,
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New 'catch all' psychiatric disorder could label people who worry about their health as mentally ill
By Sharon Kirkey, Postmedia News February 25, 2013. http://www.canada.com
According to the American Psychiatric Association, publishers of the DSM, “some patients with illnesses like heart disease or cancer will indeed experience thoughts, feelings or behaviours related to their illness that will be extreme or overwhelming” and that these individuals “may qualify for an SSD diagnosis.”
Photograph by: Christopher Pike , Postmedia News
A controversial new mental diagnosis could label thousands of people with legitimate medical illnesses as psychiatrically sick and in need of treatment if they worry “excessively” about their symptoms, observers says.
The newest version of psychiatry’s official catalogue of mental disorders, due to be published in May, will contain a newly expanded definition of “somatic symptom disorder,” or SSD.
Under the previous edition of the Diagnostic and Statistical Manual of Mental Disorders — an influential guidebook used by doctors around the globe — somatoform disorders applied to people with medically unexplained health complaints. The diagnosis required that physical, bodily symptoms couldn’t be traced to any identifiable, underlying medical cause.
In the fifth and latest edition of the manual, known as DSM-5, that proviso has been removed.
The new diagnosis doesn’t distinguish between “medically unexplained” symptoms or symptoms related to an actual underlying medical problem.
According to the American Psychiatric Association, publishers of the DSM, “some patients with illnesses like heart disease or cancer will indeed experience thoughts, feelings or behaviours related to their illness that will be extreme or overwhelming” and that these individuals “may qualify for an SSD diagnosis.”
But observers fear the expanded definition will lead to widespread over-diagnosis and inappropriate treatment of people with medical illnesses, including the “worried well.”
“This DSM-5 overreach touches the lives of everyone who is medically ill,” says Dr. Allen Frances, a professor emeritus at Duke University who chaired the task force that wrote the previous edition of the manual, known as DSM-IV.
“The fundamental change is that they’re allowing the diagnosis if a person has just one physical symptom that they worry about (for at least six months), and they’ve eliminated the hierarchies that previously protected against over-diagnosis,” he said.
“In DSM-IV you wouldn’t pin a mental disorder label on someone with a medical illness until you had first ruled out several different important possibilities,” he said — including that the person is worried about something real.
“If a person has a medical illness that’s worrisome, they should be worried about it,” Frances said.
The American Psychiatric Association says that the new criteria will help doctors better identify people who need treatment.
Dr. David Kupfer, chair of the DSM-5 task force and a professor in the department of psychiatry at the University of Pittsburgh School of Medicine, was travelling and unavailable for a media interview. Postmedia was referred by the APA to a recent blog by Kupfer published in the Huffington Post, in which he says that the old diagnosis of somatoform disorder did not take into consideration “some patients who exhibit an unusually negative reaction to their symptoms (like excessively high anxiety) even when symptoms are medically explained.” He said the new criteria performed well when tested in the real world in actual clinical practices.
But Frances says that in a study conducted by people working on the DSM-5 “they found that one in six people with cancer or heart disease would qualify for this diagnosis. That’s millions of people.”
One in four with chronic pain, irritable bowel syndrome or fibromyalgia would also meet the criteria, he said. “Most amazingly, seven per cent of healthy people would.”
He worries that SSD could become a commonly diagnosed mental disorder with little testing, “and no analysis of the harms involved — especially stigma and incomplete medical and psychiatric workups to determine the underlying cause of the symptoms.”
Psychologist Frank Farley, an Edmonton native and a past president of the American Psychological Association, says the move risks increasing the “sickening of society” by labelling people with a serious physical illness as mentally ill as well, delivering a “double whammy” diagnosis.
“Yes, the mind and body are intimately connected,” Farley said in an email. “But let’s not create mental illnesses where hyper concern over serious physical health status is all that is going on.”
Suzy Chapman, a patient advocate in the United Kingdom, said that if a doctor thinks a patient is spending too much time on the internet researching their symptoms, “or considers that their patient’s life has become ‘dominated’ or ‘overwhelmed’ by ‘illness worries’ … they will now be at risk of a ‘bolt-on’ mental health diagnosis.”
Frances said that those advocating for the expanded definition worried that too many people were being missed.
“I think that their motives are noble,” he said.
“They just don’t understand that you can’t mislabel a very large percentage of the sick population as having a mental disorder without lots and lots of trouble being caused by it.”
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Original source article: New 'catch all' psychiatric disorder could label people who worry about their health as mentally ill