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Is it really all in our heads?

sjoboyssjoboy Posts: 25
edited 12/28/2012 - 6:57 AM in Chronic Pain
I have become aware from a blog I visit often of an addition to the new DSM-5. DSM stands for the "Diagnostic and Statistical Manual of Mental Disorders" which is published by the American Psychiatric Association (5 being its 5th edition which is about to go to the printers and will be released in May 2013.) The DSM is sort of the Bible of mental disorders because it’s what health care practitioners use to decide if their patients have a psychiatric disorder or not.

The new addition is the Somatic Symptom Disorder or SSD. The word “somatization” refers to psychological stress that manifests in the form of physical symptoms. In other words, a person’s physical symptoms are traceable to a mental or emotional cause rather than to a physical one.

Which is troublesome is the way SSD is diagonosed:

A person will meet the criteria for SSD by reporting just one bodily symptom that is distressing and/or disruptive to daily life and having just one of the following three reactions to it that persists for at least six months:

1) 'disproportionate' thoughts about the seriousness of their symptom(s); or
2) a high level of anxiety about their health; or,
3) devoting excessive time and energy to symptoms or health concerns.

And indeed, the words "disproportionate", "high" and "excessive" are subjective and open to interpreation. And I think, I could even fall in every category: I'm worried about how my spinal issues will progress, sometimes I get very anxious (especially during flare-ups) reaching almost panick attacks (however these are consequences not the cause of my being in pain) and I continue to research looking for options for my condition.

However, MRI and EMG tests confirm my problem so I wouldn't expect to be diagnosed with SSD. But how about those many people whose level of pain do not match any test results or whose diagnosis could take more than six months (if ever) to come to light. Are they at risk of being diagnosed as having a psychiatric disorder and not a bodily one?

And what about the stigma of mental illness, prescription of drugs, one's self perception, missed diagnoses, insurance consequences and more?

I encourage you to get more informed about this topic. You may look for an article intitled "Mislabeling Medical Illness as Mental Disorder". I didn't include its link because I think it's against this forum policies, but you may look for it as well.


  • In my long pain journey I often believed it was all in my head especially when early mri were done and the NS said your not a candidate for surgery, in 2003. So I took it to mean there wasn't anything wrong and didn't get a copy of the report for the MRI which showed obvious disc issues. Also there are problems that weren't evident on the cervical MRI and only became visible with the myleogram and led to first cervical surgery.

    I was reading an article while waiting for my rheumatologist appointment last year and in it they had mapped the part of the brain that they think is responsible for chronic pain. They are in early testing in mice but if it pans out it could be a big breakthrough for many of us. They will be able to target medication to that specific area and hopefully break some of the pain cycles.
    Don't allow yourself to be labeled with a mental disorder, 10 years ago that is what they thought those suffering from fibromyalgia had...
    laminectomy c4/c5 2008, ACDF c4-c7 Jan 20 2014 sched
  • So, in case the DSM-5 gets published in its current form many of us could potentially fall in the wide Somatic Symptom Disorder (SDD) net.
  • both how much pain we're in and whether or not the doctors believe us. I remember that I had all sorts of tests run, even the disco gram, and the doctor telling me I had too many levels that were damaged to be a candidate for surgery -- I think she still didn't believe my pain levels, because she asked me to bend forward, slightly to each side, and then to bend back. ACK! I had no idea -- I immediately fell to my knees, the pain was so severe. She said, "oh - sorry I had to ask you that -- I just needed to be sure." SAY WHAT??? My spine looked like an aerial photograph of a train wreck, and she needed to cause pain to bring me to my knees to be sure I wasn't faking it??? The world has truly gone nuts.
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • dilaurodilauro ConnecticutPosts: 9,875
    I think that people that first start with chronic pain this may be true. Their lives are being turned upside down, so many doctors, so many tests, so its easy to see how some pain might be something we are thinking about but may note be real.

    But, for those long time chronic pain sufferers., they understand what is real and what is not

    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I have had chronic pain for over twenty years and I have no trouble discerning between real and imaginary pain.

    As for those three criteria:

    1. 'disproportionate' thoughts about the seriousness of the symptoms -- not at all, in my case. I have many problems in my spine at several different levels, all of which range from moderate to severe, most of them being severe. They are well documented on my many MRIs, CT scans, X-Rays, etc. as is the neurological damage (on my NCV and EMG tests).

    2. high level of anxiety about it -- I would think being in constant pain would make anybody anxious, but not disproportionately so, in my case. Frankly, my other health concerns cause me more anxiety than the chronic pain.

    3. devoting excessive time and energy to symptoms -- again, not really. Of course, anybody with chronic pain needs to devote time (along with their pain management doctor) to finding the best strategies for helping keep the pain under control, and obviously when you are in pain it is going to be on your mind at least some of the time. Nothing out of the ordinary about that, I'd say.
  • I had neurologists throw that somatic (conversion) disorder at me. Bounced me around for a year. Saw movement disorder specialists. I saw a psychiatrist who has extensive experience with conversion disorder and he said the neurologists were wrong. He was very angry and said that there is a big push in the neurology community to assign a psychiatric diagnosis to problems they do not understand. He said that after my after 2 surgeries due to cuada equina events, another surgery to remove a 3 inch tumor that was compressing spinal cord and my 25 year work history of working with toxic chemicals a conversion disorder diagnosis was irresponsible. Well a few weeks ago had a brain MRI and they found a new tumor. What do you know. Clowns. They want to cut it out. Don't think I'm going to do it. Just don't trust doctors anymore.
  • Dave, hi.

    Is a new and better neurosurgeon on your bucket list?

    "Irresponsible" mis-diagnosis.
  • thepretendertthepretender Posts: 36
    edited 01/01/2013 - 9:38 PM
    It might be better if it was all in our heads? Surgery certainly isn't fun!

    Needless to say, in all my trips to the hospital for tests/injections/surgeries/etc. I've considered checking out the psych ward. I mean, surely they've got good drugs to knock us out right? Haha
  • Its not in my head !! I had MRI of my head and proved to my doctors my head is empty ! Not a single brain cell ,
    They asked if i ate a lot of paint chips as a child, I said yes why ?

    They must be good doctors to actualy know what i ate as a child !
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
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