Exploration of DSM-IV Criteria in Primary Care Patients With Medically Unexplained Symptoms

Smith, Robert C.; Gardiner, Joseph C.; Lyles, Judith S.; Sirbu, Corina; Dwamena, Francesca C.; Hodges, Annemarie; Collins, Clare E.; Lein, Catherine; Given, Charles W.; Given, Barbara; Goddeeris, John H.

doi:10.1097/01.psy.0000149279.10978.3e

Cited by 105 publications

(70 citation statements)

References 51 publications

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“…Other articles communicate the unified nature of these symptoms by referring to them as a treatable or preventable condition (Rosendal et al, 2005;Morriss et al, 2006;Smith et al, 2006;Van der FeltzCornelis et al, 2006). And another group refers to sufferers as if they were a homogenous group (Jackson et al, 2004;Salmon et al, 2005;Bakal et al, 2006;Epstein et al, 2006;Morriss et al, 2006;Ringsberg and Krantz, 2006;Smith et al, 2006Smith et al, , 2005. This word use confirms an approach that reasons through diagnosis rather than interpretation and that contains ontological and psychiatric assumptions about that which is not readily available for medical classification.…”

Section: Resultsmentioning

confidence: 84%

“…The use of the acronym 'MUS' reifies the notion that all physical complaints without explanation can be viewed in the same way. However, it is not just a matter of nomenclature; references to medically unexplained symptoms give them diagnostic status by framing them as a problem to be approached epidemiologically (Brown, 2004;Rosendal et al, 2005;Smith et al, 2005;Spence et al, 2005;Verhaak et al, 2006). Other articles communicate the unified nature of these symptoms by referring to them as a treatable or preventable condition (Rosendal et al, 2005;Morriss et al, 2006;Smith et al, 2006;Van der FeltzCornelis et al, 2006).…”

Section: Resultsmentioning

confidence: 99%

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Medically unexplained symptoms and the disease label

Jutel

2010

Soc Theory Health

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Medically unexplained symptoms are a source of frustration for clinician and patient alike. They simultaneously test the credibility of the doctor and the patient; the former, for his or her inability to label the patient's complaint, and the latter, for the ignominy of being perceived to have a factitious symptom. This review explores the discursive construction of such symptoms in the medical literature in order to appreciate the context in which medicine understands and manages non-diagnosed complaints. It uses medically unexplained symptoms as a heuristic for understanding the role of classification in constituting medicine as a social authority. In the absence of diagnostic category, medically unexplained symptoms are recast as a discrete category of their own. However, this category implies the infallibility of the physician and the relevance of the medical model in all circumstances. It transfers responsibility for the disorder to the patient in a way that may hinder resolution, and it ignores socio-historical practices that influence when and why patients consult a physician.

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Section: Resultsmentioning

confidence: 84%

Section: Resultsmentioning

confidence: 99%

Medically unexplained symptoms and the disease label

Jutel

2010

Soc Theory Health

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“…Specifically, older women (aged 50 years or older) were less likely than older men (with similar severity of illness) to be admitted to intensive care units or receive lifesaving interventions. Research indicates that physicians are more likely to interpret men's symptoms as organic and women's as psychosocial [24,25], and female patients are assigned more nonspecific symptom diagnoses [20,26]. Women are also prescribed more psychoactive drugs than men [27,28].…”

Section: Gender Bias In Clinical Practicementioning

confidence: 99%

Gender Bias in Medicine

Hamberg

2008

Womens Health (Lond Engl)

250

146

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Gender bias has implications in the treatment of both male and female patients and it is important to take into consideration in most fields of medical research, clinical practice and education. Gender blindness and stereotyped preconceptions about men and women are identified as key causes to gender bias. However, exaggeration of observed sex and gender differences can also lead to bias. This article will examine the phenomenon of gender bias in medicine, present useful concepts and models for the understanding of bias, and outline areas of interest for further research. Research has shown that different biological processes, anatomies, conditions in daily life, environmental experiences, risk behaviors and responses to stressful events, may all contribute to variation in health and disease in men and women [1-5]. There is also evidence that women, for no apparent medical reason, are not offered the same treatment as men, a phenomenon that raises the question of gender bias. Many studies, for example, show that women are less likely than men to receive more advanced diagnostic and therapeutic interventions [6-11]. The word bias means 'prejudice' or 'distortion' and is a threatening phenomenon in all kinds of research and human activity. When we talk about gender bias in medicine we usually either mean an unintended, but systematic neglect of either women or men, stereotyped preconceptions about the health, behavior, experiences, needs, wishes and so on, of men and women, or neglect of gender issues relevant to the topic of interest. Gender bias has implications in treatment of both male and female patients and it is important to take into consideration in most fields of medical research, clinical practice and education. Gender bias is also a relevant issue in the discussion of clinical and academic advancements and careers [12]; however, that aspect is not the focus of this article. Since there is confusion in medicine about the use of the concept of gender [13], my use of the term is presented below.

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“…This category has been controversial ever since DSM-IV was released 1 and has prompted nu- merous calls from experts in the field to reconsider the category. These calls have ranged in scope from radical reformulation 2,3 to substantial revision [4][5][6][7][8][9][10][11][12][13][14] to merely modest refinement. [15][16][17][18] Characterized primarily by physical rather than psychological symptoms, most patients present in medical rather than mental health settings, and a somatoform diagnosis confronts the clinician with the often-difficult decision of whether to attach a psychiatric label to a person with somatic complaints.…”

Section: T He American Psychiatric Association's Diagnostic and Statimentioning

confidence: 99%

“…For example, the prevalence of somatization disorder in primary care is 1% or less, whereas the prevalence of patients with clinically relevant MUS is 10%-15% or greater. [49][50][51][52][53][54][55] For this reason, some researchers have abandoned Somatization Disorder in favor of more practical definitions. 56,57 At the same time, the "default" diagnosis of Undifferentiated Somatization Disorder (USD) is too broad and is neither well-validated nor widely-used.…”

Section: Recommendationsmentioning

confidence: 99%