Sunday, October 25, 2009

More on "Medically Unexplained Symptoms"

From Suzy Chapman

25 October 2009

Availability of EACLPP white paper

With reference to:

the In Press version of the Editorial:

Is there a better term than "Medically unexplained symptoms"? Creed F,
Guthrie E, Fink P, Henningsen P, Rief W, Sharpe M and White P

to be published in a forthcoming issue of the Journal of Psychosomatic
Research (already available online - purchase required) needs to be read in
conjunction with the white paper to which I drew attention, in July:

The European Association for Consultation-Liaison Psychiatry and
Psychosomatics (EACLPP)

"A white paper of the EACLPP Medically Unexplained Symptoms study group:
Patients with medically unexplained symptoms and somatisation - a challenge
for European health care systems"  (  )

The White Paper can be downloaded from the EACLPP site here:

The document is approx 76 pages long, including tables and charts.  I had
considerable difficulty opening this document, in May, due to a corrupted
table and note that the file on the EACLPP site remains glitchy. A copy
of the document was obtained directly from the EACLPP, in May, and has been
uploaded to ME agenda site. Note that there may be some revisions to the
document as supplied in May but it will serve as reference if others
experience difficulties opening the file from the EACLPP website.

If you would like a copy of the file as a Word.doc attachment, please email
with "EACLPP MUS DOC" in the subject line and I will forward a copy to you
[600 KB].

Or download Draft white paper- prepared by Peter Henningsen and Francis
Creed January 2009 from ME agenda WordPress site at:

The Editorial 'Is there a better term than "Medically unexplained
symptoms"?' discusses the deliberations of the EACLPP study group:


The European Association of Consultation Liaison Psychiatry and
Psychosomatics (EACLPP) is preparing a document aimed at improving the
quality of care received by patients who have "medically unexplained
symptoms" or "somatisation" [1]. Part of this document identifies barriers
to improved care and it has become apparent that the term "medically
unexplained symptoms" is itself a barrier to improved care

...The authors of this paper met in Manchester in May 2009 to review
thoroughly this problem of terminology and make recommendations for a
better term....The deliberations of the group form the basis of this


"Our priority was to identify a term or terms that would facilitate
management - that is it would encourage joint medical
psychiatric/psychological assessment and treatment and be acceptable to
physicians, patients, psychiatrists and psychologists."


"Terms suggested as alternatives for "medically unexplained symptoms"

The group reviewed terms which are used currently or have been proposed for
the future. An extensive list was abbreviated to the following 8 terms or
categories: The terms we reviewed were:

1. Medically unexplained symptoms or medically unexplained physical
2. Functional disorder or functional somatic syndromes
3. Bodily distress syndrome/disorder or bodily stress syndrome/disorder
4. Somatic symptom disorder
5. Psychophysical / psychophysiological disorder
6. Psychosomatic disorder
7. Symptom defined illness or syndrome
8. Somatoform disorder"


"Implications for DSM-V and ICD-11

There is overlap between the discussion reported here and the discussion
currently under way towards the creation of DSM-V. Two of the authors (FC,
MS) are also members of the working group on Somatic Distress Disorders of
the American Psychiatric Association (APA), which is proposing a new
classification to replace the DSM-IV "somatoform" and related disorders. In
this working group, similar concerns about the use of the term and concept
of "medically unexplained symptoms" have been raised [12]. The current
suggestion by the DSM-V work group to use the term "Complex somatic symptom
disorder" must be seen as step in a process and not as a final proposal.
Unfortunately this term does not appear to meet many of the criteria listed


"One major problem for reforming the classification relates to the fact
that the DSM system includes only "mental" disorders whereas what we have
described above is the necessity of not trying to force these disorders
into either a "mental" or "physical" classification.
The ICD-10 system has
a similar problem as it has mental disorders separated from the rest of
medical disorders.

The solution of "interface disorders", suggested by DSM IV, is a compromise
but it is unsatisfactory as it is based on the dualistic separation of
organic and psychological disorders and prevents the integration of the
disorders with which we are concerned here. This lack of integration
affects the ICD classification also. For example functional somatic
syndromes (e.g. irritable bowel syndrome) would be classified within the
"physical" classification of ICD or Axis III in DSM (gastrointestinal
disorders) and omitted from the mental and behavioural chapter entirely


DSM-V Task Force member, Javier Escobar, MD, who works closely with the
DSM-V Somatic Distress Disorders Work Group, has alleged that "Functional
Somatic Syndromes" (FSS), or "Medically Unexplained Symptoms" include a
long list of medical conditions:

"Irritable bowel syndrome, Chronic fatigue syndrome, Fibromyalgia, Multiple
chemical sensitivity, Nonspecific chest pain, Premenstrual disorder,
Non-ulcer dyspepsia, Repetitive strain injury, Tension headache,
Temporomandibular joint disorder, Atypical facial pain, Hyperventilation
syndrome, Globus syndrome, Sick building syndrome, Chronic pelvic pain,
Chronic whiplash syndrome, Chronic Lyme disease, Silicone breast implant
effects, Candidiasis hypersensivity, Food allergy, Gulf War syndrome,
Mitral valve prolapse, Hypoglycemia, Chronic low back pain, Dizziness,
Interstitial cystitis, Tinnitus, Pseudoseizures, Insomnia, Systemic yeast
infection, Total allergy syndrome" [1]

Unexplained Physical Symptoms What's a Psychiatrist to Do?
Humberto Marin, MD and Javier I. Escobar, MD
01 August 2008, Psychiatric Times. Vol. 25 No. 9

Special Report

Suzy Chapman

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