Sunday, October 20, 2013

Somatic Symptom Disorder (SSD): Seriously Stupid Disorder

It's been awhile since I've posted anything, as I have been busy dealing with regular life stuff.

I was having a conversation today with someone who is plodding through the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (We'll just abbreviate to DSM). Since I refuse to spend money on a copy (Waiting for that free ICD-10), this person let me read the Somatic Symptom Disorder (SSD) section in their copy.

*face palm*

Wow, old white psychiatrist people, in what universe do you think this notion is remotely okay?

When I took Psychopathology 101 (graduate level), the class was told that in order to understand the DSM, you need to have some understanding of Freud. I would argue that you need to have both a general understanding of Freud and a general understanding of Emil Kraeplin. Kraeplin is more or less the father of biological psychiatry. In the late 1880's, he identified what are now referred to as the Bipolar Spectrum and Schizophrenia being largely genetic in origin. Unfortunately, he was a German proponent of eugenics and racial hygiene, and so the mental health field ignored him for a few decades.

Freud's primary interest was in the social etiology of mental distress. From early (childhood) social (mother and father) interactions comes a lifelong pattern of emotions and behavior. Per Freud, it was possible for physical symptoms to manifest from emotional difficulties, mainly in the case of people (cough, women, cough) who weren't allowed to express emotions in early life.

When reading the DSM, you can see when Freudian and Kraeplinian psychiatry conflict. SSD is one major conflict. The Workgroup supposedly attempted to remove stigma from "somatization" (The in-your-head term) by acknowledging people can be excessively concerned about their health but still have a medical condition that can be diagnosed. So, it's not "in their head" and often has a biological component - they just worry to the point it's pathological.

Here's the issue:

DSM people, have you been on the Internet lately? Why don't you plunk in "symptom checker" into Google and see what pops up. And when one of the many symptom checkers spits out a possible diagnosis, why don't you find an Internet forum where you can read all about people who had the same symptoms and ended up going a decade until an organ started failing and several joints became deformed, at which point a doctor said, "No, everyone was wrong about this being in your head - you have lupus."

And then you can put in something like "doctor opinions on Internet health information." You can read all about doctors who can't stand it when their patients look up information on the Internet because the Internet has so much misinformation and patients end up asking for expensive and unnecessary testing or taking weird herbal products. There might also be some ranting about fibromyalgia, which seems to come up every time doctors start complaining about patients asking for medical advice.

Wait, doctors complaining about patients looking up medical information because they could misinterpret it? Are those the same patients who were told for years that what turned out to be lupus was "in their heads"? And by the way, anything autoimmune and/or pain related gets the Freudian slap in the medical chart.

Uh huh.

Taking abnormal psychology (undergraduate) years ago, we were warned about "Medical Student Disease." It happens when students read about diagnoses and end up deciding they have one or more when there is no evidence to suggest they do. Um, if medical students (and psychology students) have an issue with reading a textbook in a class, what makes you think the lay public is going to do with information on WebMD?

Uh huh.

Now, let's assume we have someone who has a medical diagnosis, such as lupus. Remember reading about lupus during your Internet search? Lupus is scary. People die from lupus. Often. It's a nasty, nasty disease. What is a reasonable, non-pathological reaction to lupus? Probably reading up on the disease and being concerned about whether or not all medical issues are being addressed, trying to be proactive and communicate with medical providers (Which will be atleast two or three - when you have an autoimmune disorder, you often have a lot of specialists) to ensure treatment is working...oh wait, those can be symptoms of SSD if the person is spending too much time thinking about their disease and too frequently asking for medical advice.

Okay, so the diagnostic criteria for lupus are a tad nebulous. Who cares about those people with lupus? I mean, they end up getting neuropsychiatric symptoms and chronic pain, screw 'em.

How about HIV? What is a reasonable, non-pathological response to being diagnosed with HIV? At any point are you going to diagnose someone with HIV with having an excessive preoccupation with their disease?

Uh huh.

Look, I'm actually supportive of identifying the biological aspects of psych diagnoses. I'm also very supportive of more research on how the brain works and how the brain reacts in times of stress. People are biological, fleshy sorts of things in the same vein as the cat sitting next to me as I type. Stuff happens all throughout the body when watching a funny movie, playing in the snow, being laid off from work, and when living with a medical condition. But just because there are biological goings on in the body doesn't mean someone's emotional response is disordered, no matter how intense the response may seem. And just because someone has an intense emotional response doesn't mean they have problems with emotional regulation from childhood.

Getting sick is scary.

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