1. Medically Unexplained Symptoms in DSM-5

The Bible of mental health diagnosis has a glaring omission (1).  The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, used worldwide as a reference for classifying and defining mental health disorders, was first published in 1952, listing 106 disorders in 130 pages.  The last major revision was released in 1994 (297 disorders, 886 pages), followed by a “text revision” in 2000 (365 disorders, 943 pages).  None of these volumes has a diagnostic term appropriate for more than a tiny fraction of Stress Illness patients.  (Stress Illness is my term for physical symptoms not fully explained by diagnostic tests that improve when psychosocial stresses are treated.)

This deficiency would be analogous to a medical textbook that left out heart disease, cancer or diabetes.  Stress Illness is responsible for a majority of primary care clinic visits in Western countries (2).  The absence of Stress Illness in the DSM makes the condition invisible to insurance companies, research scientists, mental health practitioners, medical clinicians, medical educators and, most importantly, patients themselves.  Fortunately, we now have a significant opportunity to correct this harmful error.

The next revision, DSM-5, is due out in May, 2013.  After years of work by hundreds of experts (the DSM-5 group), proposed changes are available for review and public comment (until April 20, 2010) by clicking here.  Unfortunately, current proposals fall short of what is needed and I will review them in the next post.

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

2. Kroenke, K & Mangelsdorff, AD. Common Symptoms in Ambulatory Care: Incidence, Evaluation, Therapy and Outcome.  Am J Med 86: 262-266, 1989.

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