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DSM-5 criteria useless in Fibromyalgia: experts

Tuesday 1 April 2014


From Rheumatology Update:



DSM-5 criteria useless in fibromyalgia: experts

By Hugo Wilcken
21 February, 2014

Virtually all fibromyalgia patients would be classified as having a mental disease under the DSM-5’s new criteria for somatic symptom disorder, a study confirms.

Its authors gave a somatic symptom severity questionnaire to over 6,200 patients diagnosed with fibromyalgia, rheumatoid arthritis and osteoarthritis.

They found that 90% of fibromyalgia patients had scores in the high level, consistent with a diagnosis of somatic symptom disorder according to DSM-5 criteria.

A substantial portion of rheumatoid arthritis patients also met the threshold and could also be considered to have a mental illness under DSM-5, the investigators from the US and Germany said.

The authors pointed out the essential subjectivity of the criteria, which include “disproportionate and persistent thoughts about the seriousness of one’s symptoms”; “persistently high level of anxiety about health or symptoms” and “excessive time and energy devoted to these symptoms”.

Writing in PLOS One, the authors said it was likely some assessors would rate fibromyalgia or RA patients as “disproportionate” in their concern about their symptoms while others would consider the same patients as showing reasonable concern.

“So it is possible that the presence of a mental illness may depend more on the examiner than the patient,” they commented.

“We are dubious that the DSM-5 approach can distinguish validly and reliably which fibromyalgia patients are and which are not mentally ill, particularly in clinical care settings where diagnosis will come most often from generalists,” they concluded.

PLOS One 2014; online


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