Thread by @JillPiggott

My #migraine was wrongly diagnosed as a mental disorder by a questionnaire widely used in primary care. Migraine is a progressive brain disease. Accurate diagnosis & effective treatment are essential.

Thread: psychologizing #illness & #pain

PHQ assesses 15 symptoms: pain in head, chest, stomach, back, limbs/joints; pain with menstruation or sex; dizziness; heart pounding; fainting; shortness of breath; upper & lower GI distress; low energy; insomnia. qxmd.com/calculate/calc…
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The Patient Heath Questionnaire-15 & the Somatic Symptom Scale (SSS-8, pictured) are used to diagnose people with a newly conceived mental illness known as "somatic symptom disorder": the "expression of mental phenomena as physical (somatic) symptoms" (Merck).

Here's what doctors are told about Somatic Symptom Disorder: "Patients are commonly unaware of their underlying mental problem & believe that they have physical ailments," so they "pressure" doctors for care, even after tests & treatments fail.

The arrogance astounds me.

A person with a physical disease can be diagnosed with a mental illness (somatic symptom disorder) if a psychologist thinks she has "disproportionate & persistent thoughts" about her symptoms or is devoting "excessive time & energy" to them.

Psychologist Beth Darnall, who designed the highly influential Pain Catastrophizing Scale, writes that "psycho-pathology" is both a precursor to & consequence of "persistent #pain." ncbi.nlm.nih.gov/pmc/articles/P…

From my perspective both as someone in year 50 of daily #migraine & as director of @headsUPmigraine, I think pain "catastrophizing" overpsychologizes pain & brings back the kind of sexism & stigma that rightly disappeared from migraine research decades ago.

On this there's no doubt: brain imaging shows #anxiety exacerbates #pain. Reducing anxiety can lessen the impact of pain. Anxiety's often easier to treat than the illnesses that cause us worry, so if you're feeling swamped by anxiety, treating it can help lighten your load.

"For many people with both #anxiety & #pain, solving the pain is the best possible treatment for the anxiety. Others must solve both at once. And a few will find that pain is just one of many ways that they are haunted by anxiety demons." Smart piece: painscience.com/articles/anxie…

Allen Francis, MD, is one of the doctors who objects to the psychologizing of illness. The title of his op-ed summarizes his argument: "The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill." bmj.com/content/346/bm…

In a 2nd, equally engaging piece, Dr Allen Francis writes, “It boils down to this—if you have a medical illness, you can get a diagnosis of Somatic Symptom Disorder just by worrying about it a lot." journals.lww.com/jonmd/Citation…

Overdiagnosis is 1 of my concerns w/ the Pain Catastrophizing Survey, which comes with high stakes unknown to patients: researchers claim #opioid misuse & addiction are "associated" with "catastrophizing." MDs might use test results as a rationale for taper or denial of pain med.

A paper in the Canadian Journal of Psychiatry argues that "pathologizing" #pain "pollutes the therapeutic relationship by introducing ... implicit, if not explicit, blame. It is demoralizing to the patient who feels at fault, disbelieved, and alone" (Katz et al. 2015).

True.

I agree with the paper's conclusion & think it holds true for "catastrophizing," too: "somatic symptom disorder overpsychologizes people with chronic pain" & "contributes to misdiagnosis, as well as unnecessary stigma" (Katz et al. 2015).

Psychologist @BethDarnall, who designed the widely used & influential "Pain Catastrophizing Scale," has a survey pinned to her Twitter page. She's asking for comments from people w/ #ChronicPain.

I applaud her for that outreach & hope others will, too.

#cpp #spoonie

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Here's the very good paper from the Canadian Journal of Psychiatry that critiques the Somatic Symptom Disorder: journals.sagepub.com/doi/pdf/10.117…