Why doc­tors will no longer be able to dis­miss your symp­toms as all in the mind

Daily Mail - - Good Health - By ROGER DOB­SON

For pa­tients who have no ob­vi­ous phys­i­cal cause for their symp­toms, try­ing to get a di­ag­no­sis or ef­fec­tive treat­ment can be a night­mare. It’s a com­mon prob­lem: in as many as one in five cases, doc­tors find no ex­pla­na­tion for a pa­tient’s symp­toms or for their sever­ity. Though the symp­toms are real, pa­tients can end up be­ing told it’s all in their mind.

This will ring all too true for many with con­di­tions such as chronic fa­tigue, fi­bromyal­gia (char­ac­terised by wide­spread pain and fa­tigue), ir­ri­ta­ble bowel syn­drome, un­ex­plained chest pain or in­ter­sti­tial cys­ti­tis (not caused by in­fec­tion).

Not only do th­ese prob­lems, known as func­tional dis­or­ders, cause mis­ery, but they cost the NHS a for­tune. Treat­ing med­i­cally un­ex­plained symp­toms cost £3.1 bil­lion a year, more than stroke or heart dis­ease.

But re­search sug­gests th­ese dif­fer­ent di­ag­noses are all types of a sin­gle ill­ness, bod­ily dis­tress syn­drome (BDS) — a new con­di­tion that’s just been in­cluded in the draft of the next World Health or­gan­i­sa­tion’s In­ter­na­tional Clas­si­fi­ca­tion of Dis­eases, the di­ag­nos­tic bi­ble for doc­tors.

A study in the Bri­tish Jour­nal of Gen­eral Prac­tice last year, based on 1,400 pa­tients, found around 17 per cent would meet the cri­te­ria for BDS.

The term is used to de­scribe med­i­cally un­ex­plained symp­toms, and recog­nises ill­ness has roots in the body and mind, paving the way for new treat­ments for many pa­tients who may have been told symp­toms were ‘in their heads’.

‘There is in­creas­ing aware­ness that we have to treat the whole per­son and BDS is a recog­ni­tion of that,’ says Dr Alastair San­t­house, a con­sul­tant psy­chi­a­trist at the South London and Maud­s­ley NHS Foun­da­tion Trust.

‘The fact is dis­or­ders do not have to be ei­ther phys­i­cal or psy­cho­log­i­cal: just be­cause we have phys­i­cal symp­toms doesn’t nec­es­sar­ily mean the cause is phys­i­cal.

‘With ten­sion headache, the pain is re­duced with parac­eta­mol, but we also know it’s re­duced if we treat the un­der­ly­ing stress.

‘ Many pa­tients with bod­ily symp­toms don’t get a phys­i­cal ex­pla­na­tion and, there­fore, of­ten feel it is seen as be­ing “in the mind” and per­haps is taken less se­ri­ously. recog­nis­ing we need to look at con­di­tions holis­ti­cally will move us away from the fal­lacy that if there is no ob­vi­ous cause, symp­toms must be imag­ined.’

one the­ory is that peo­ple with BDS have an in­creased sen­si­tiv­ity to bod­ily sig­nals, and the brain’s fil­ter­ing sys­tem, which screens out unim­por­tant mes­sages, stops work­ing prop­erly: it’s th­ese sig­nals that be­come the symp­toms. Anx­i­ety may par­tially trig­ger this. Pa­tients then pay ex­tra at­ten­tion to the sig­nals, be­com­ing more anx­ious; this anx­i­ety leads to more se­vere phys­i­cal symp­toms, which add to the worry in a vi­cious cy­cle.

The symp­toms, which are real but have no mea­sur­able phys­i­cal ba­sis, be­come the prob­lem.

Dr Lene Toscano, from Aarhus Univer­sity Hospi­tal in Den­mark, which car­ries out pi­o­neer­ing work on BDS, says: ‘ In ef­fect, the symp­toms are the dis­ease, yet pa­tients can be told they are imag­i­nary or it’s a men­tal prob­lem. Treat­ing the con­di­tion as though it were 100 per cent phys­i­cal or 100 per cent psy­cho­log­i­cal will not help them get bet­ter.’

The Aarhus team found there is an over­lap in symp­toms be­tween dif­fer­ent dis­or­ders: a pa­tient with fi­bromyal­gia, who ex­pe­ri­ences wide­spread pains, may suf­fer fa­tigue, while some­one with chronic fa­tigue syn­drome can have mus­cle aches.

ProFeSSorPer Fink, who leads the re­search clinic for func­tional dis­or­ders and psy­cho­so­mat­ics at Aarhus, says: ‘Group­ing such pa­tients un­der BDS would help them un­der­stand the symp­toms and treat them.’

Cog­ni­tive be­havioural ther­apy, which aims to change a pa­tient’s be­hav­iour by al­ter­ing the way they think, can help.

He says BDS can also be treated with ex­er­cise and an­tide­pres­sants (which is thought to change the way in which the symp­toms are ex­pe­ri­enced in the brain so they are less both­er­some).

Pro­fes­sor Peter Whor­well, a gas­troen­terol­o­gist at the Univer­sity Hospi­tal of South Manch­ester, says: ‘I’m sure there’s a strong in­ter­ac­tion be­tween mind and body in func­tional dis­or­ders, but that ap­plies to most dis­eases. We do need new ap­proaches to manag­ing func­tional dis­or­ders.

‘How­ever, in­clud­ing the word “dis­tress” in the ti­tle is a backward step, as it im­plies a strong psy­cho­log­i­cal com­po­nent, and th­ese pa­tients are sick of be­ing told it is all in their head.’

Newspapers in English

Newspapers from UK

© PressReader. All rights reserved.