Clearly, disability insurers have bought into the controversy of renaming the DSM-IV “Somatoform Disorder” (300.81) to “Somatic Symptom Disorder” or SSD. Under the old DSM-IV Somatoform Disorder was defined as “a preoccupation with physical symptoms that suggest general medical conditions not fully explained by medical science.” (The word “somatoform” generally refers to imagined or “all in one’s head.)
However, in the new DSM-V SSD is defined as:
- Disproportionate thoughts about the seriousness of symptoms lasting at least 6 months;
- A high level of anxiety about symptoms and health;
- Devoting excessive time and energy to their symptoms or health concerns.
However, under the DSM-V criteria 1 in 6 cancer and CAD patients meet the definition of Somatic Symptom Disorder and has psychiatrists wondering if we really want to burden and stigmatize seriously ill people with an added diagnosis of mental illness.
“That’s OK with us”, claims the insurance industry that has its eyes on unimaginable profits from denying claims after 24 months. The DSM-V simply defines SSD as “excessive preoccupation with thoughts about bodily symptoms and functions in combination with high levels of anxiety about health.” Who doesn’t worry about their health these days? Are we all mentally ill?
The new criteria of the DSM-V comes after nearly a decade of cultural, governmental, media and social awareness of “better health for America.” Populations today are much better informed about “living healthier and longer”; perhaps more attention is paid today on “wellness” than at any time in our history. Worry and concern about “eating right” and “getting up on that treadmill” has become an American obsession but has not ever been defined as a “mental disorder.”
Will there ever be a “normal concern” over one’s health allowed without being classified as “somatic” or “it’s all in your head?” As with many other things, once the line is crossed with hypocrisy, it’s hard to take it back.
Impairments redefined by the DSM-V as Somatic Symptom Disease include CFS, FMS, IBS, chronic Lyme disease (late stage), Interstitial Cystitis, Gulf War Syndrome or PTSD, and Chemical Sensitivity. These medical illnesses will become misdiagnosed as mental disorders because of the criteria listed in the DSM-V.
In other words, if you have cancer, diabetes, heart disease or kidney failure and your worries and concerns about your illness are (in a psychiatrist’s opinion) chronic and excessive, then you will be diagnosed with a mental illness. For private disability, the DSM-V opens the door to even more abuse of the Mental and Nervous 24-month limitation in LTD policies.
After all, according to the insurance industry, it is a widely accepted fact that some people do indeed worry to a considerable degree about illnesses they believe they have, even though repeated examinations by physicians produce no evidence of illness. Individuals are in effect worrying about non-existent conditions. For nearly 10 years the American Psychological Association has label these people as mentally ill, why not redefine “imaginary illness” for what it is?
Redefine indeed since the DSM-V goes so far as to include parents and other family members into its diagnostic criteria. Parents with terminally ill children who obsessively worry about losing their children can now be classified as mentally ill.
As a 20-year veteran consultant it is my opinion that recent changes in the DSM-V should come as no great surprise. Disability insurance lobbyists and renowned research physicians in America and the UK have long been searching for ways to eliminate CFS and FMS from permanent causes of disability. Unable to convince the CDC to officially defined CFS as a mental disorder, changes in the DSM-V are more underhanded and less visible to those who apply for disability insurance.
It is also clear disability insurers can now classify nearly any diagnosis as mental illness if patient notes and other medical records show evidences of “excessive thought” or worry about symptoms that cannot be proven to exist by medical examination or science.” The implication here is that if upon examination, physician’s can’t find anything wrong with you, you’re not sick; if you keep worrying about it, you’re mentally ill.
The ultimate consequences to those who file private disability claims could be astounding because of the increased numbers of disability claims that potentially could be denied, or limited to 24-months of paid benefits. The logic contained within the new Somatic Symptom Disorder diagnostic criteria is missing. How does a heart transplant or cancer insured NOT excessively worry about his/her health?
Clearly, disability insurers will have a financial vested interest in taking advantage of the DSM-V and its redefinition of what constitutes a “somatic disorder.”