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Medically unexplained physical symptoms
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{{Cleanup/Multiple_issues | date = Oct 2020|reason=Overly long, repeated points. Finish 'Articles and research in favor of lumping CFS, IBS or fibromyalgia into MUS', Controversy and check for potential neutrality issues. New sources may need including from the talk page.}} '''Medically unexplained physical symptoms''' ('''MUPS''' or '''MUS''') or '''Persistent Physical Symptoms''' are symptoms for which the doctor is unable to find a cause, for example unexplained dizziness, pain without a known cause, or unexplained tiredness.<ref name="rcpsych">{{Cite web|url=https://www.rcpsych.ac.uk/mental-health/problems-disorders/medically-unexplained-symptoms | title = Medically unexplained symptoms|website=RC PSYCH ROYAL COLLEGE OF PSYCHIATRISTS|language=en|access-date=2019-07-10}}</ref><ref name="NHS">{{Cite web|url=https://www.nhs.uk/conditions/medically-unexplained-symptoms/ | title = Medically unexplained symptoms | date = 2017-10-19 | website = nhs.uk|language=en|access-date=2019-07-14}}</ref> [[File:ME-CFS-neutological-not-MUS.jpg|alt=M.E. (Myalgic Encephalomyelitis) is not MUS, and categorising it as such contradicts the World Health Organisation’s International Classification of Diseases, which states that M.E. is a neurological condition." "A considerable body of published, peer-reviewed evidence, as comprehensively referenced by the 2015 Institute of Medicine report, indicates growing evidence of potential neurological, immunological and endocrinological biomarkers in M.E." - Action for ME|thumb]] Medically unexplained symptoms may be mild, and can resolve within a few weeks without treatment, but some are more persistent.<ref name="NHS" /> In practice, "medically unexplained" may be used to extremely broadly to describe either symptoms of a diagnosis ''not yet fully understood'' by medicine, especially [[ME/CFS]], [[fibromyalgia]] or [[irritable bowel syndrome]], ''or'' symptoms that are not known to be linked to a medical condition, ''or'' symptoms a medical professional judges to be ''out of proportion'' to the related physical cause or illness.<ref name="NHS" /><ref name="Smith2007">{{Cite journal | last = Smith|first = Robert C. | last2 = Dwamena | first2 = Francesca C. | date = 2007-05-01 | title = Classification and Diagnosis of Patients with Medically Unexplained Symptoms|url=https://doi.org/10.1007/s11606-006-0067-2|journal=Journal of General Internal Medicine|language=en|volume=22|issue=5 | pages = 685–691|doi=10.1007/s11606-006-0067-2|issn=1525-1497}}</ref> ===Classification and alternative names === The following disorders and medical terms are also regarded as '''medically unexplained symptoms"'' and classified only as purely [[:Category:mental disorders|psychiatric disorders]], despite their physical symptoms: *[[Somatoform disorder]]s *[[Somatic symptom disorder]] (in the DSM-5 psychiatric manual) *[[Conversion disorder]] (in the [[ICD-10]] and DSM-5), also known as [[Functional movement disorder|Functional Neurological Symptom Disorder]] (in the DSM-5 psychiatric classification), or sometimes Functional Neurological Disorder (FND) *[[Functional somatic syndrome|Functional Somatic Symptoms]] (FSS) *[[Bodily distress disorder|Bodily Distress Disorder]] (BDD) (in the ICD-11) *Bodily Distress Syndrome (BDS), a term championed by [[Per Fink]], which is different from Bodily Distress Disorder and includes patients with ME/CFS<ref name="Desai2018" /><ref name="Wolfe2013" /><ref name="DXRevWatch-BDD2">https://dxrevisionwatch.com/category/bodily-distress-disorder-2/</ref ><ref name="ICD-11-BDD" /> ====Medically explained physical symptoms and MUPS==== Some patients diagnosed with MUS or MUPS have a diagnosis of a physical illness recognized by the [[World Health Organization]]'s [[ICD-10]] classification, or the newer [[ICD-11]] classification that fully explains the physical symptoms; this is because a clinician believes the physical symptoms are disproportionately "distressing to the individual", and the patient has "excessive attention directed toward the symptoms", which does not reduce with reassurances from medical professionals, causing the related psychiatric disorder.<ref name="ICD-11-BDD">https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/767044268</ref><ref name="DXRevWatch-BDD2" /> Concerns have been raised about the [[ICD-11]]'s Bodily Distress Disorder, a psychiatric disorders chapter potentially being used for patients with [[ME/CFS]], either before a diagnosis has been reached or after diagnosis.<ref name="ICD-11-BDD" /> Consulting many different doctors is a behavior described that may be caused by BDD,<ref name="ICD-11-BDD" /> and the clinician's perception of the severity of the physical symptoms often does not match medical test results in patients with ME/CFS. As a result of significant advocacy work, including proposals by [[Suzy Chapman]], [[postviral fatigue syndrome]], [[chronic fatigue syndrome]], and [[myalgic encephalomyelitis|benign myalgic encephalomyelitis]] have recently been added as exclusions from Bodily Distress Disorder.<ref name="ICD-11-BDD" /><ref name="DXRevWatch-BDD2" /> ====Country-specific variations of the ICD==== The [[World Health Organization]]'s ICD-10 manual has been adapted by several countries with permission to do so, these adapted versions include: *ICD-10-CM used in the [[United States]] *ICD-10-CA used in Canada *ICD-10-GM used in Germany *ICD-10-AM adapted by Australia and also used in Ireland In some cases, an illness classified as physical by the World Health Organization's ICD-10 is classified psychiatric in an adapted version.<ref name="ChapmanDimmock2018">{{Cite web|url=https://dxrevisionwatch.files.wordpress.com/2018/07/comparison-of-classification-and-terminology-systems-v-3.pdf | title=Comparison of Classification and Terminology Systems | authorlink = | first = Suzy | last = Chapman | first2 = Mary | last2 = Dimmock | authorlink2 = Mary Dimmock | date = Jul 2018}}</ref> Country-specific variations of the ICD-11 have not been finalized yet. ==MUS review linked to PACE trial== In the UK there is currently a PROSPERO systematic review of medically unexplained symptoms and their treatments being undertaken by a number of authors including [[Peter White]], first author of the controversial [[PACE trial]] for ME/CFS, into MUS.<ref>{{Cite web|url=http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42015025520 | website = crd.york.ac.uk|access-date=2019-07-10|first = Joanna | last = Leaviss | authorlink = Joanna Leaviss | last2 = Glenys Parry | first2 = | authorlink2 = Glenys Parry | last3 = Stevenson | first3 = Matt | authorlink3 = Matt Stevenson | last4 = Booth | first4 = Andrew | authorlink4 = Andrew Booth | last5 = Scope | first5 = Alison | authorlink5 = Alison Scope | last6 = Davis | first6 = Sarah | authorlink6 = Sarah Davis | last7 = Ren | first7 = Shije | authorlink7 = Shije Ren | last8 = Sutton | first8 = Anthea | authorlink8 = Anthea Sutton | last9 = White | first9 = Peter | authorlink9 = Peter White | last10 = Moss-Morris | first10 = Rona | authorlink10 = Rona Moss-Morris | last11 = Buszewicz | first11 = Marta | authorlink11 = Marta Buszewicz | title = Medically unexplained symptoms (MUS): primary care intervention. PROSPERO 2015 CRD42015025520 | date = 2015}}</ref> ==Somatization and psychologization== A key assumption often made is that medically unexplained physical symptoms are symptoms which have no physical cause - rather than no ''known'' physical cause, and so are assumed be caused by '''somatization''': the physical expression of emotional distress.<ref name="Smith2007" /> Symptoms, or entire diagnosed illnesses such as ME/CFS or fibromyalgia, are assumed to have no underlying illness process but to have "psychosomatic" symptoms or "psychogenic illness".<ref name="Spotalia2013" /> The MUS approach has been used inappropriately to reclassify diagnosed physical illnesses, including ME/CFS, as a [[mental health]] disorders, which can then result in inappropriate treatment,<ref name="bmj2019" /><ref name="continue">{{Cite web|url=https://www.actionforme.org.uk/news/supporting-calls-for-m.e.-to-continue-being-classified-as-neurological/ | title = M.E. must continue to be classified as neurological | last = Action for ME|first = | authorlink = Action for ME | date = 2017 | website = Action for ME|archive-url=|archive-date=|url-status=|access-date=2019-07-15}}</ref><ref name="Williams2014">{{Cite web|url=http://www.margaretwilliams.me/2017/absence-of-evidence.pdf | title=Absence of Evidence | last = Williams | first = Margaret | authorlink=Margaret Williams | date = 2017 | website = |archive-url=|archive-date=|url-status=|access-date=}}</ref><ref name="Spandler2017" /><ref name="Mihelicova" /> for example medical neglect, and in some severely ill patients, forced psychiatric treatment and forced [[Graded exercise therapy|exercise therapy]] combined with medical neglect, factors which contributed to the death of [[Sophia Mirza]] from ME/CFS. ==Absence of evidence of a physical cause== Medically unexplained symptoms are often referred to as lacking evidence of any organic pathology (physical cause) - but have been criticized as '''overly inclusive''' for including patients with symptoms judged to be ''out of proportion'' to the illness or injury; this is problematic because it relies not on medical or psychological tests for MUS but on a doctor's current knowledge of a diagnosed illness or injury, and on medical science's current expectation of particularly severe cases of the each diagnosis.<ref name="Desai2018" /> A patient with a serious medical illness can find themselves also diagnosed with a "medically unexplained physical symptoms" label such as Somatic symptom disorder because of their help-seeking behavior, worry over their health or reporting a disproportionate degree of symptoms.<ref name="Wolfe2013" /> For example, a doctor or psychiatrist assessing a person with [[Severe_and_very_severe_ME#verysevere|very severe ME]] may be unaware that [[paralysis]], [[seizure]]s and speech problems can occur,<ref name="Mihelicova" /> and the illness can, in some cases, [[Causes of death|kill]], so this lack of knowledge may lead to an incorrect diagnosis of MUS, with cognitive or behavioral treatments that may cause significant harm, and a denial of specialist treatment.<ref name="Sophia-Collusion">{{Cite web|url=http://www.sophiaandme.org.uk/collusion.html | title = PSYCHIATRISTS PAID BY OUTSIDE INTERESTS | website = sophiaandme.org.uk|access-date=2019-07-14}}</ref><ref name="continue" /><ref name="Geraghtyharm" /> == Forced treatment == The classification of physically ill patients as having a mental illness purely on the basis of their psychical symptoms allows for a patient to be '''forcibly treated''' if they are judged to be lacking ''mental capacity'', something which can occur in severe ME due to be severe [[Cognitive dysfunction|cognitive]] and concentration problems, or episodes or [[Speech difficulties|speech loss]] and [[paralysis]] that prevent communication.<ref>{{Cite web|url=http://www.sophiaandme.org.uk/ | title = Sophia and M.E. | website = sophiaandme.org.uk|access-date=2019-07-15}}</ref> Despite ME patients not experiencing psychosis or other psychiatric conditions that effect judgement as part of ME, the "mentally ill" label can be, and has been, used to assume patients lack capability for treatment decisions, and to force them into harmful treatments including [[exercise]] or [[Graded exercise therapy|exercise therapies]].<ref name="Spandler2017" /> Historically, illnesses that were previously misunderstood or not yet identified were blamed on patients' [[Personality traits and patient attitudes in ME/CFS|personality]], for example William Henry Day's concept of the "migraine personality" in 1878, Diamond and Dalessio (1973) claims that "up to 90% [of those with migraines] have a psychogenic basis for their complaint", patients were labeled as "untrustworthy", "drug-seeking", or as potential malingerers.<ref name="Segal2007">{{Cite journal | last = Segal|first = Judy Z. | authorlink = | date = 2007-04-01 | title = Illness as argumentation: a prolegomenon to the rhetorical study of contestable complaints|url=https://doi.org/10.1177/1363459307074695|journal=Health|language=en|volume=11|issue=2|pages=227–244|doi=10.1177/1363459307074695|issn=1363-4593|quote=|via=}}</ref><ref name="Spotalia2013">{{Cite web|url=http://occupyme.net/2013/12/19/my-feedback-to-the-institute-of-medicine/ | title = My feedback to the Institute of Medicine | last= Jennie | first = Spotila | authorlink=Jennie Spotila | date = 2013 | website = occupyme.net|archive-url=|archive-date=|url-status=|access-date=2019-07-10}}</ref> [[Systemic lupus erythematosus|Lupus]], [[multiple sclerosis]], and [[Lyme disease]] are all examples of illnesses that were previously assumed to have a psychological origin simply because of the "absence of evidence" of a physical cause.<ref name="English2000" /><ref name="Williams2014" /> English (2000) states that "Absence of evidence may reflect insufficient research, inadequate technology, poor methods, flawed paradigms, closed minds, or lack of clinical experience; for example, in 1980, there was no clear evidence that AIDS was viral—blood products were considered “safe.”"<ref name="English2000">{{Cite journal | last = English|first = T.L. | authorlink = | date = Feb 15, 2000 | title = Functional somatic syndromes|url=https://www.researchgate.net/profile/Ellen_Goudsmit/publication/12634788_Functional_somatic_syndromes/links/00b49532e9e9d67056000000/Functional-somatic-syndromes.pdf?origin=publication_detail|journal=Annals of Internal Medicine|volume=132|issue=4 | pages = 329|issn=0003-4819|pmid=10681297|via=}}</ref> ==Risk of harm in ME/CFS patients== {{Quote2|Evidence-based medicine is driven by the effort to minimize medical risk. In the area of ME/CFS, however, it has long been routine for psychosomatic research to proceed as if medical risk can be ignored, as if it simply is not possible that patients with this poorly understood condition are suffering from a biomedical disease. <br >That oversight can no longer be maintained in credible debate and research.|Diane O'Leary|Journal of Medical Ethics blog<ref name="bmj2019"/> 2019}} ==Criticism and controversy== The whole MUS concept of ''lumping'' different syndromes or illnesses, or groups of symptoms together - all of which are then regarded as "non-diseases" - has been criticized as unscientific and lacking evidence - especially with wrongly including ME/CFS, which is recognized as a [[neurological disorder|neurological ''disease'']] by the [[World Health Organization]].<ref name="continue" /><ref name="MUSFaults" /><ref name="OLeary2018a" /><ref name="Scott2018" /> In the [[United Kingdom|UK]], the effect of this is that patients regarded as having "MUS conditions" or MUS symptoms are treated under the [[Improving Access to Psychological Therapies]] (IAPT) programme, a [[mental health]]-only approach which does not have the facilities or skills to treat complex and severe physical health problems.{{citation needed}} [[File:ME-is-not-MUS.jpg|alt=ME is not Medically Unexplained Symptoms. M.E. is not MUS, and categorising it as such contradicts the World Health Organisation’s International Classification of Diseases, which states that M.E. is a neurological condition. - Action for ME|thumb]] The inclusion of [[ME/CFS]] under MUS has been heavily criticized by advocates and patients with ME,<ref>{{Cite web|url=https://forums.phoenixrising.me/threads/mus-pps-services-and-iapt-integration-into-nhs-primary-care-whats-happening-across-the-uk.48710/ | title = MUS, PPS services and IAPT integration into NHS primary care - what's happening across the UK? | website = Phoenix Rising ME / CFS Forums|language=en-US|access-date=2019-07-10}}</ref> especially in the [[UK]] which is obliged to follow the World Health Organization's classification system - which recognizes ME / CFS / Post-viral syndrome under [[:Category:neurological diseases and disorders|neurological diseases]], and excludes then from other categories.<ref name="MEA201707" /><ref name="Spoonseeker2018Holes" /><ref name="Marks2018" /> An article in ''Positive Health'' stated that MUS will divert funding from the UK's [[mental health]] system by wrongly including [[ME/CFS]].<ref name="Diverting">{{Cite web|url=http://www.positivehealth.com/article/cfs-me/medically-unexplained-symptoms-diverting-5-year-funding-from-mental-health | title = ‘Medically Unexplained Symptoms’ - Diverting 5-Year Funding from Mental Health | website = positivehealth.com|access-date=2019-07-10}} </ref> The [[Countess of Mar]] has asked questions about the problems of MUS and ME/CFS in the UK parliament's House of Lords.<ref name="MEA201707">{{Cite web|url=https://www.meassociation.org.uk/2017/07/countess-of-mar-and-lord-hunt-defend-mecfs-in-lords-debate-on-medically-unexplained-symptoms-05-july-2018/ | date = Jul 2017 | title = Countess of Mar and Lord Hunt defend ME/CFS in Lords debate on medically unexplained symptoms {{!}} 05 July 2017 | last = The ME Association |language=en-|access-date=2019-07-10}} </ref> Dr [[James Coyne]] revealed that [[Peter White]], lead author of the highly controversial [[PACE trial]] and advisor to the UK [[Department for Work and Pensions]], did not disclose his financial interests with health insurers for the PROSPERO review.<ref>{{Cite web|url=https://jcoynester.wordpress.com/2016/01/05/undisclosed-conflicts-of-interest-in-a-systematic-review-protocol-of-interventions-for-medically-unexplained-symptoms/ | date = May 1, 2016 | title = Undisclosed conflicts of interest in a systematic review protocol of interventions for medically unexplained symptoms (Protected Blog)|website=jcoynester.wordpress.com|access-date=2019-07-10 | last = Coyne | first = James | authorlink = James Coyne}}</ref> Patient advocates have critiqued the basis and motive of the rollout of the MUS concept and treatments in the UK.<ref>{{Cite web|url=https://spoonseeker.com/2018/06/20/a-morass-of-mus/ | title = A Morass of MUS | last = Spoonseeker | first = | date = 2018-06-20 | website = spoonseekerdotcom|language=en|access-date=2019-07-10}}</ref><ref name="Spoonseeker2018Holes">{{Cite web|url=https://spoonseeker.com/2018/07/29/probing-the-holes-in-mus/ | title = Probing the Holes in MUS | last = Spoonseeker | first = | date = 2018-07-29 | website = spoonseekerdotcom|language=en|access-date=2019-07-10}}</ref> ==Costs of medically unexplained symptoms== A highly influential study by Bermingham et al (2008) attempted to calculate the health care costs of patients with MUS, but incorrectly included costs of treating diseases that are not classified as MUS, including [[ME/CFS]], inflating the overall costs.<ref name="Bermingham2008" /> Further controversy has erupted with the repeated incorrect references to Bermingham et al. which have been published in further reviews and articles by influential journals. [[David Tuller]] PhD, a public health professor at Berkeley has repeatedly highlighted this, contacting [[Carolyn Chew-Graham]] and others who incorrectly cited the paper and the journals that published it to request corrections.<ref name="TullerPayne8July2019">{{Cite web|url=http://www.virology.ws/2019/07/08/trial-by-error-some-thoughts-on-mus-and-bermingham-my-letter-to-professor-payne/ | title = Trial By Error: Some Thoughts on MUS and Bermingham; My Letter to Professor Payne | last = Tuller | first = David | authorlink = David Tuller | date = Jul 8, 2019 | website = [[Virology blog]]|archive-url=|archive-date=|url-status=|access-date=2019-07-14}}</ref> == Medical neglect == Medically unexplained symptoms guidance recommendations includes avoiding doing "unnecessary" diagnostic tests due to the believe in the risk of "iatrogenic harm" and patients may be taught to avoid "[[illness beliefs|symptom focusing]]", leaving people with a physical illness at risk of [[Medical neglect and abuse|medical neglect]] due to the lack of investigation of comorbidities, or failure to correctly diagnose other causes for symptoms or other illnesses, and lack of biomedical treatment.<ref name="Mihelicova">{{Cite journal | last = Mihelicova | first = Martina | authorlink = Martina Mihelicova | last2 = Siegel | first2 = Zachary | authorlink2 = Zachary Siegel | last3 = Evans | first3 = Meredyth | authorlink3 = Meredyth Evans | last4 = Brown | first4 = Abigail | authorlink4 = Abigail Brown | last5 = Jason | first5 = Leonard | authorlink5 = Leonard Jason | date = Dec 2016 | title = Caring for People with Severe Myalgic Encephalomyelitis: An Interpretative Phenomenological Analysis of Parents’ Experiences|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675701/|journal=Journal of health psychology|volume=21|issue=12|pages=2824–2837|doi=10.1177/1359105315587137|issn=1359-1053|pmc=4675701|pmid=26063209|quote=|via=}}</ref><ref name="Disdain">{{Cite web|url=http://www.wakeupcallbeweging.be/pdf/30yearsdisdainsummary.pdf | title=THIRTY YEARS OF DISDAIN: How HHS and a group of psychiatrists Buried Myalgic Encephalomyelitis | last = Dimmock|first = Mary | authorlink = Mary Dimmock | last2 = Lazell-Fairman | first2 = Matthew | authorlink2 = Matthew Lazell-Fairman | date = Dec 2015 | website = |archive-url=|archive-date=|url-status=|access-date=Nov 5, 2018}}</ref><ref name="Geraghtyharm">{{Cite journal | last = Geraghty|first = Keith J. | authorlink = Keith Geraghty | last2 = Blease | first2 = Charlotte | authorlink2 = Charlotte Blease | date = 2018-06-21 | title = Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter |url = https://www.tandfonline.com/action/captchaChallenge?redirectUri=%2Fdoi%2Ffull%2F10.1080%2F09638288.2018.1481149|journal=Disability and Rehabilitation|language=en|volume=41|issue=25 | pages = 3092-3102|doi=10.1080/09638288.2018.1481149|issn=0963-8288|quote=|via=}}</ref><ref name="Ten-yr">{{Cite web|url=http://www.forward-me.org.uk/Reports/10%20year%20surveillance%20(2017).pdf | title=10 year surveillance report consultation comments {{!}} NICE CFS/ME guidelines | last = Forward-ME|first = | authorlink = Forward-ME | date = 2017 | website = |archive-url=|archive-date=|url-status=|access-date=2019-02-10}}</ref> {{See also|Medical neglect and abuse}} ==Biopsychosocial model == The [[biopsychosocial model]] (BPS) is usually used to provide treatment for medically unexplained physical symptoms.<ref name="rcpsych" /><ref name="MUSFaults" /> A key part of this model is the use of psychological approaches, often including a form of psychotherapy called [[cognitive behavioral therapy]]. In patients with ME/CFS, patient groups and a number of different authors, have reported that the biopsychosocial approach has led to substantial rates of harm and multiple types of harm have been identified in this patient group.<ref name="Disdain" /><ref name="Geraghtyharm" /><ref name="OxfordBrookesSurvey" /><ref name="OLeary2018b" /> A survey of over 2,000 British patients with ME/CFS was conducted in 2019 to help inform the revision of the [[NHS]] treatment guidelines, and found that the treatment was more harmful then helpful. The survey reported that more than 1 in 5 patients developed new symptoms while undergoing [[cognitive behavioral therapy]] for ME/CFS, 26% said their physical health had deteriorated as a result, with only 16% reporting improved physical health. Alarmingly, 26% found their mental health deteriorated with this psychological approach.<ref name="ForwardMEsurvey">{{Cite web|url = https://www.meassociation.org.uk/2019/04/forward-me-and-oxford-brookes-university-announce-results-of-patient-survey-on-cbt-and-get-in-me-cfs-03-april-2019/| title = Forward-ME and Oxford Brookes University announce results of patient survey on CBT and GET in ME/CFS | last = The ME Association | date = Apr 2019 | authorlink = The ME Association}}</ref><ref name="OxfordBrookesSurvey">{{Cite web|url = https://www.meassociation.org.uk/wp-content/uploads/NICE-Patient-Survey-Outcomes-CBT-and-GET-Final-Consolidated-Report-03.04.19.pdf | title =Evaluation of a survey exploring the experiences of adults and children with ME/CFS who have participated in CBT and GET interventional programmes. FINAL REPORT | last = Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS)|location=Oxford Brookes University | date = Feb 27, 2019}}</ref> The ''[[psychologization]]'' of patients' illness in the absence of psychological symptoms assumes that psychological help must be needed or beneficial in patients with medically unexplained symptoms, despite the fact that an unknown number of patients may have symptoms caused by an undiagnosed medical condition, a medical condition not yet recognized by modern science, or a recognized medical condition like ME/CFS that is not fully understood yet. {{See also|Cognitive behavioral therapy}} ==Patient experiences == Patients with medically unexplained physical symptoms have described many types of negative medical encounters, including: * harmful medical advice or treatment * inappropriate psychological explanations) (the [[psychologization]] of symptoms) * disbelief and disrespectful treatment from doctors and health care professionals * marginalization of patients' experiences * lack of physical examination and denial of tests or access to specialists that other patients receive * failure to investigate new or worsening symptoms * increased risk of psychiatric medications bring inappropriately prescribed * disregarding patients' knowledge and autonomy * the use of the MUS label to [[Medical gaslighting|challenge the validity of patients' experience]] and their existing diagnosis of ME/CFS * gender bias: female patients are more likely to be diagnosed with medically unexplained physical symptoms<ref name="Desai2018" /><ref name="Lian2017" /><ref name="Mihelicova" /><ref name="continue" /> ==Improving Access to Psychological Therapies== [[Improving Access to Psychological Therapies]] (IAPT) is the treatment arm of the MUS rollout in the UK. It has been accused of diverting millions in mental health care funding to patients without mental illness, and for its lack of effectiveness in patients with MUS.<ref name="Diverting" /> The [[Journal of Health Psychology, Special Issue: The PACE Trial|Journal of Health Psychology]] published [[Michael Scott|Michael Scott's]] ''Improving Access to Psychological Therapies (IAPT) - The Need for Radical Reform,'' which used the [[PACE trial]] as an example of inflating rates of recovery from psychological treatments, and concluded that the IAPT similarly had little evidence to justify the treatments even for psychological conditions.<ref name="Scott2018">{{Cite journal | last = Scott | first = Michael J | date = 2018-08-01 | title = Improving Access to Psychological Therapies (IAPT) - The Need for Radical Reform|url=https://doi.org/10.1177/1359105318755264|journal=Journal of Health Psychology|language=en|volume=23|issue=9|pages=1136–1147|doi=10.1177/1359105318755264|issn=1359-1053}}</ref> The editor of the Journal of Health Psychology, Dr [[David Marks]], published the editorial ''IAPT under the microscope'' in July 2018, which concluded "A service based on the promise of savings by taking people off benefits is a political hot potato. There is an urgent need for an independent review of IAPT by impartial experts."<ref name="Marks2018">{{Cite journal | last = Marks | first = David F | author-link = David Marks | date = Aug 2018 | title = IAPT under the microscope|url=http://journals.sagepub.com/doi/10.1177/1359105318781872|journal=Journal of Health Psychology|language=en|volume=23|issue=9|pages=1131–1135|doi=10.1177/1359105318781872|issn=1359-1053|quote=|via=}}</ref> ==Articles and research critical of CBT for MUS== *2013, The Somatic Symptom Disorder in DSM 5 risks mislabelling people with major medical diseases as mentally ill<ref name="Wolfe2013">{{Cite journal | last = Häuser | first = Winfried | authorlink = Winfried Häuser | last2 = Wolfe | first2 = Frederick | authorlink2 = Frederick Wolfe | date = 2013-12-01 | title = The somatic symptom disorder in DSM 5 risks mislabelling people with major medical diseases as mentally ill|url=http://www.sciencedirect.com/science/article/pii/S0022399913003450|journal=Journal of Psychosomatic Research|volume=75|issue=6 | pages = 586–587|doi=10.1016/j.jpsychores.2013.09.005|issn=0022-3999|quote=|via=}}</ref> - [https://www.researchgate.net/profile/Winfried_Haeuser/publication/259107928_The_Somatic_Symptom_Disorder_in_DSM_5_risks_mislabelling_people_with_major_medical_diseases_as_mentally_ill/links/5b3c67d80f7e9b0df5ec8900/The-Somatic-Symptom-Disorder-in-DSM-5-risks-mislabelling-people-with-major-medical-diseases-as-mentally-ill.pdf (Full text)] * 2017, Medically Unexplained Symptoms (MUS): Faults and Implications<ref name="MUSFaults">{{Cite journal | last = Tack|first = Michiel | authorlink = Michiel Tack | date = Jan 2019 | title = Medically Unexplained Symptoms (MUS): Faults and Implications|url=https://www.mdpi.com/1660-4601/16/7/1247|journal=International Journal of Environmental Research and Public Health|language=en|volume=16|issue=7|pages=1247|doi=10.3390/ijerph16071247|quote=|via=}}</ref> [https://www.mdpi.com/1660-4601/16/7/1247/htm (Full text)] * 2019, Bodily Distress Syndrome: Concerns About Scientific Credibility in Research and Implementation<ref name="OLeary2018a">{{Cite journal | last = O'Leary|first = D. | authorlink = Diane O'Leary | date = Jun 30, 2018 | title = Bodily distress syndrome: Concerns about scientific credibility in research and implementation | url = https://www.researchgate.net/publication/325708039_Bodily_Distress_Syndrome_Concerns_About_Scientific_Credibility_in_Research_and_Implementation|journal=Journal of Biological Physics and Chemistry|volume=18|issue=2 | pages = 67–77t|doi=10.4024/07LE18A.jbpc.18.02|quote=|via=}}</ref> [https://www.researchgate.net/publication/325708039_Bodily_Distress_Syndrome_Concerns_About_Scientific_Credibility_in_Research_and_Implementation (Full text)] * 2020, Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified<ref name="Scott2020">{{Cite journal | last = Geraghty|first = Keith | authorlink = Keith Geraghty | last2 = Scott | first2 = Michael J. | authorlink2 = | date = Dec 2020 | title = Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified | url = https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-020-0380-2|journal=BMC Psychology|language=en|volume=8|issue=1|pages=13|doi=10.1186/s40359-020-0380-2|issn=2050-7283|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001321/ (Full text)] *2020, Ethical Psychotherapeutic Management of Medically Unexplained Symptoms<ref name="Geraghty2020Ch">{{Cite web|url=https://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780198817338.001.0001/oxfordhb-9780198817338-e-72 | title = Ethical Psychotherapeutic Management of Patients with Medically Unexplained Symptoms: The Risk of Misdiagnosis and Harm | last = O'Leary|first = Diane | authorlink=Diane O'Leary | last2 = Geraghty | first2 = Keith | authorlink2 = Keith Geraghty | date = 2021-08-27 | website = Oxford Handbook of Psychotherapy Ethics|language=en|doi=10.1093/oxfordhb/9780198817338.013.72|archive-url=|archive-date=|url-status=|access-date=2022-01-13}}</ref> - [https://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780198817338.001.0001/oxfordhb-9780198817338-e-72 (Abstract, Book Chapter)] ==Articles and research critical of lumping ME/CFS into MUS== *2013, The Somatic Symptom Disorder in DSM 5 risks mislabelling people with major medical diseases as mentally ill<ref name="Wolfe2013">{{Cite journal | last = Häuser | first = Winfried | authorlink = Winfried Häuser | last2 = Wolfe | first2 = Frederick | authorlink2 = Frederick Wolfe | date = 2013-12-01 | title = The somatic symptom disorder in DSM 5 risks mislabelling people with major medical diseases as mentally ill|url=http://www.sciencedirect.com/science/article/pii/S0022399913003450|journal=Journal of Psychosomatic Research|volume=75|issue=6 | pages = 586–587|doi=10.1016/j.jpsychores.2013.09.005|issn=0022-3999|quote=|via=}}</ref> - [https://www.researchgate.net/profile/Winfried_Haeuser/publication/259107928_The_Somatic_Symptom_Disorder_in_DSM_5_risks_mislabelling_people_with_major_medical_diseases_as_mentally_ill/links/5b3c67d80f7e9b0df5ec8900/The-Somatic-Symptom-Disorder-in-DSM-5-risks-mislabelling-people-with-major-medical-diseases-as-mentally-ill.pdf (Full text)] *2017, Contesting the psychiatric framing of ME/CFS<ref name="Spandler2017">{{Cite journal | last = Spandler | first = Helen | authorlink = Helen Spandler | last2 = Allen | first2 = Meg | authorlink2 = Meg Allen | date = 2017-08-16 | title = Contesting the psychiatric framing of ME/CFS|url=https://www.researchgate.net/profile/Helen_Spandler/publication/319157873_Contesting_the_psychiatric_framing_of_MECFS/links/599b082545851574f4ac5ba0/Contesting-the-psychiatric-framing-of-ME-CFS.pdf | journal=Social Theory & Health|language=en|volume=16|issue=2|pages=127–141|doi=10.1057/s41285-017-0047-0|issn=1477-8211|quote=|via=}}</ref> [https://www.researchgate.net/profile/Helen_Spandler/publication/319157873_Contesting_the_psychiatric_framing_of_MECFS/links/599b082545851574f4ac5ba0/Contesting-the-psychiatric-framing-of-ME-CFS.pdf (Full text)] *2017, Absence of evidence<ref name="Williams2014" /> - focusing on ME/CFS [http://www.margaretwilliams.me/2017/absence-of-evidence.pdf (Full text)]- [[Margaret Williams]] * 2017, Medically Unexplained Symptoms (MUS): Faults and Implications<ref name="MUSFaults">{{Cite journal | last = Tack|first = Michiel | authorlink = Michiel Tack | date = Jan 2019 | title = Medically Unexplained Symptoms (MUS): Faults and Implications|url=https://www.mdpi.com/1660-4601/16/7/1247|journal=International Journal of Environmental Research and Public Health|language=en|volume=16|issue=7|pages=1247|doi=10.3390/ijerph16071247|quote=|via=}}</ref> [https://www.mdpi.com/1660-4601/16/7/1247/htm (Full text)] * 2019, Bodily Distress Syndrome: Concerns About Scientific Credibility in Research and Implementation<ref name="OLeary2018a">{{Cite journal | last = O'Leary|first = D. | authorlink = Diane O'Leary | date = Jun 30, 2018 | title = Bodily distress syndrome: Concerns about scientific credibility in research and implementation | url = https://www.researchgate.net/publication/325708039_Bodily_Distress_Syndrome_Concerns_About_Scientific_Credibility_in_Research_and_Implementation|journal=Journal of Biological Physics and Chemistry|volume=18|issue=2 | pages = 67–77t|doi=10.4024/07LE18A.jbpc.18.02|quote=|via=}}</ref> [https://www.researchgate.net/publication/325708039_Bodily_Distress_Syndrome_Concerns_About_Scientific_Credibility_in_Research_and_Implementation (Full text)] ==Articles and research in favor of lumping CFS, IBS or fibromyalgia into MUS== *2003, Medically unexplained symptoms: exacerbating factors in the doctor-patient encounter<ref name="Wesselyiatrogenesis">{{Cite journal | last = Page | first = La | authorlink = | last2 = Wessely | first2 = S | authorlink2 = Simon Wessely | date = May 2003 | title = Medically Unexplained Symptoms: Exacerbating Factors in the Doctor-Patient Encounter |url = http://journals.sagepub.com/doi/10.1177/014107680309600505|journal=Journal of the Royal Society of Medicine|language=en|volume=96|issue=5|pages=223–227|doi=10.1177/014107680309600505|issn=0141-0768|pmc=|pmid=|access-date=|quote=|via=}}</ref>[https://journals.sagepub.com/doi/pdf/10.1177/014107680309600505 (Full text)] *2004, There is only one functional somatic syndrome<ref name="WesselyFSS2004">{{Cite journal | last = Wessely|first = Simon | authorlink = Simon Wessely | last2 = White | first2 = Peter D. | authorlink2 = Peter White | first8 = | date = Aug 2004 | title = There is only one functional somatic syndrome|url=https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/there-is-only-one-functional-somatic-syndrome/4110CF970D44700E5CD43F4BCEFDE360|journal=The British Journal of Psychiatry|language=en|volume=185|issue=2 | pages = 95–96|doi=10.1192/bjp.185.2.95|issn=0007-1250|pmc=|pmid=|access-date=|quote=|via=}}</ref> [https://www.researchgate.net/profile/Simon_Wessely/publication/8424117_There_is_only_one_functional_somatic_syndrome/links/5652eff308aeafc2aabacc90/There-is-only-one-functional-somatic-syndrome.pdf (Full text)] ==Notable studies and articles == *2010, The cost of somatisation among the working‐age population in England for the year 2008–2009<ref name="Bermingham2008">{{Cite journal | last = Bermingham|first = Sarah | authorlink = Sarah Bermingham | last2 = Cohen | first2 = Alan | authorlink2 = Alan Cohen | last3 = Hague | first3 = John | authorlink3 = John Hague | last4 = Parsonage | first4 = Michael | authorlink4 = Michael Parsonage | date = 2010 | title=The cost of somatisation among the working-age population in England for the year 2008–2009|url=https://www.ncbi.nlm.nih.gov/pubmed/22477925|journal=Mental Health in Family Medicine|language=en|volume=7|issue=2 | pages = 71–84|issn=1756-834X|pmid=22477925|quote=|via=}}</ref> [[pubmed:22477925|(Full text)]] *2015, Managing medically unexplained illness in general practice<ref name="Stone2015">{{Cite web|url=https://www.racgp.org.au/afp/2015/september/managing-medically-unexplained-illness-in-general-practice/ | title = RACGP - Managing medically unexplained illness in general practice | last = The Royal Australian College of General Practitioners | website = racgp.org.au|language=en|access-date=2019-07-14}}</ref> [https://www.racgp.org.au/afp/2015/september/managing-medically-unexplained-illness-in-general-practice/ (Full text)] *2017, “It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters<ref name="Lian2017">{{Cite journal | last = Lian | first = Olaug S. | last2 = Robson | first2 = Catherine | date = 2017-01-01 | title = “It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters|url=https://doi.org/10.1080/17482631.2017.1392219|journal=International Journal of Qualitative Studies on Health and Well-being|volume=12|issue=1|pages=1392219|doi=10.1080/17482631.2017.1392219}}</ref> [https://www.tandfonline.com/doi/full/10.1080/17482631.2017.1392219 (Full text)] * 2018, Nosological journey of somatoform disorders: From briquet's syndrome to bodily distress disorder<ref name="Desai2018">{{Cite journal|url=http://www.indjsp.org/article.asp?issn=0971-9962;year=2018;volume=34;issue=5;spage=29;epage=33;aulast=Desai | title = Nosological journey of somatoform disorders: From briquet's syndrome to bodily distress disorder | last = Desai|first = Geetha | last2 = Sagar | first2 =Rajesh | authorlink2 = Rajesh Sagar | first3 =Santosh K | last3 =Chaturvedi | authorlink=Geetha Desai | authorlink3 = Santosh Chaturvedi | date = 2018 | pages=29-33|archive-url=|archive-date=|url-status=|access-date=2019-07-15|volume=34|issue=5|journal=Indian Journal of Social Psychiatry}}</ref> [http://www.indjsp.org/article.asp?issn=0971-9962;year=2018;volume=34;issue=5;spage=29;epage=33;aulast=Desai (Full text)] * 2018, Why Bioethics Should Be Concerned With Medically Unexplained Symptoms<ref name="OLeary2018b">{{Cite journal | last = O'Leary|first = Diane | authorlink = Diane O'Leary | authorlink2 = | date = May 2018 | title = Why Bioethics Should Be Concerned With Medically Unexplained Symptoms|url=https://www.researchgate.net/profile/Diane_Oleary/publication/324785079_Why_Bioethics_Should_Be_Concerned_With_Medically_Unexplained_Symptoms/links/5beb4023a6fdcc3a8dd4674d/Why-Bioethics-Should-Be-Concerned-With-Medically-Unexplained-Symptoms.pdf?origin=publication_detail|journal=The American journal of bioethics: AJOB|volume=18|issue=5 | pages = 6–15|doi=10.1080/15265161.2018.1445312|issn=1536-0075|pmid=29697324|quote=|via=}}</ref> [https://www.researchgate.net/profile/Diane_Oleary/publication/324785079_Why_Bioethics_Should_Be_Concerned_With_Medically_Unexplained_Symptoms/links/5beb4023a6fdcc3a8dd4674d/Why-Bioethics-Should-Be-Concerned-With-Medically-Unexplained-Symptoms.pdf?origin=publication_detail (Full text)] * [https://25megroup.org/download/2527/ KNOWLEDGE IN THE HOPE OF PROTECTING M.E. SUFFERERS FROM UNNECESSARY SECTIONING]<ref name="PreventUnnecessarySectioning">{{Cite web|url=https://25megroup.org/download/2527/ | title = KNOWLEDGE IN THE HOPE OF PROTECTING M.E. SUFFERERS FROM UNNECESSARY SECTIONING | last2 = 25% ME Group | first2 = | authorlink2 = 25 Percent ME Group | last = The Grace Charity for M.E. | first = | authorlink = The Grace Charity for M.E. | date = Jan 2019 | website = |archive-url=|archive-date=|url-status=|access-date=2019-07-12}}</ref> - Preventing the unnecessary forced mental health sectioning of severely ill patients - [[The Grace Charity for M.E.]] with [[25 Percent ME Group |25% ME Group]] ==Letters, talks and blogs== * [https://www.actionforme.org.uk/news/supporting-calls-for-m.e.-to-continue-being-classified-as-neurological/ M.E. must continue to be classified as neurological]<ref name="continue" /> - [[Action for ME]] *2019, [https://blogs.bmj.com/medical-ethics/2019/03/05/its-time-to-pay-attention-to-chronic-fatigue-syndrome/ It's time to pay attention to Chronic Fatigue Syndrome]<ref name="bmj2019">{{Cite web|url=https://blogs.bmj.com/medical-ethics/2019/03/05/its-time-to-pay-attention-to-chronic-fatigue-syndrome/ | title = It's Time to Pay Attention to "Chronic Fatigue Syndrome" | last = O'Leary|first = Diane | authorlink=Diane O'Leary | date = Mar 5, 2019 | website = |publisher=Journal of Medical Ethics|language=en-US|archive-url=|archive-date=|url-status=|access-date=2019-03-05}}</ref> *2015, [https://www.youtube.com/watch?v=XK1KIlL8ye8 Medically Unexplained Symptoms] - [[Jim Bolton]] describes the psychological paradigm == See also == *[[Cognitive behavioral therapy]] *[[Psychologization]] *[[Misdiagnosis of myalgic encephalomyelitis and chronic fatigue syndrome]] *[[Biopsychosocial model]] *[[David Tuller]] *[[Ethical issues]] *[[Stigma and discrimination]] *[[Medical neglect and abuse]] ==Learn more== *[https://dxrevisionwatch.files.wordpress.com/2018/07/comparison-of-ssd-bdd-bds-bss-in-classification-systems-v1.pdf Comparison of SSD, BDD, BDS, BSS in classification systems] - Suzy Chapman and [[Mary Dimmock]], Jul 2018 *[https://dxrevisionwatch.files.wordpress.com/2018/07/comparison-of-classification-and-terminology-systems-v-3.pdf Comparison of Classification and Terminology Systems], [[Suzy Chapman]] and [[Mary Dimmock]], Jul 2018 *[http://www.margaretwilliams.me/2017/absence-of-evidence.pdf Absence of Evidence] - [[Margaret Williams]] *[https://www.rcpsych.ac.uk/mental-health/problems-disorders/medically-unexplained-symptoms Medically unexplained symptoms] - Royal College of Psychiatrists *[http://www.virology.ws/2019/07/08/trial-by-error-some-thoughts-on-mus-and-bermingham-my-letter-to-professor-payne/ Trial by Error: Some thoughts on MUS and Bermingham: My letter to Professor Payne] - [[David Tuller]] *[https://www.nhs.uk/conditions/medically-unexplained-symptoms/ Medically unexplained symptoms] - NHS ==References== {{reflist}} [[Category:Psychological paradigm]] [[Category:Diagnoses]]
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