Smith and Dwamena (2)

Continuing our review of the Smith and Dwamena paper (1), they describe a spectrum of severity for patients with medically unexplained symptoms (MUS).  The few patients who fully meet criteria for Somatoform Disorder (2) are severely ill.  The rest range from mild to not quite as severe as those with Somatoform Disorder.  The group with mild MUS is the largest.  Their symptoms tend to be of short duration, resolve on their own, usually don’t require much medical care and aren’t associated with significant mental health issues.  They can be managed with a Stress History (see earlier posts with this tag), observation over time and a minimum of diagnostic tests.

Patients whose MUS are moderate to severe see their medical professionals regularly and often have mental health disorders such as Depression, Anxiety or Post-Traumatic Stress.  These groups more often are disabled, often have a history of child abuse and are more likely to have drug or alcohol problems.  Because their symptoms are more significant, typically they will need a medical diagnostic evaluation to be sure an organ disease is not present.

Classifying MUS along a spectrum of severity legitimizes all patients with MUS.  Naming the spectrum encourages clinicians to take a Stress History to find the cause of the MUS.  In addition, the classification by severity supports a sensible allocation of medical care resources.

The next edition of the Diagnostic and Statistical Manual is due in a few years.  I hope to see something along these lines enshrined there.

1. Smith R and Dwamena F. Classification and Diagnosis of Patients with Medically Unexplained Symptoms.  J Gen Int Med 22:685-691. 2007.

2. Definition of Somatoform Disorder: of many years duration, begins before age 30, is more common in women, and has (over a lifetime) at least four pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one pseudoneurological symptom.

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