Diagnosing

It is important to differentiate between the two most important subgroups of functional disorders:

  1. Bodily Distress Syndrome
  2. Health anxiety

 

1. Bodily Distress Syndrome (BDS)

Bodily Distress Syndrome, or 'BDS', is a term mainly used in connection with scientific research. BDS is an attempt to gather the many syndrome diagnoses that basically cover the same condition.

BDS patients have multiple physical symptoms, and they will often, understandably, worry that these symptoms are caused by an unknown somatic illness. For BDS patients, it is the symptoms and not the worries that constitute the problem. The symptoms will not disappear even when the patient is reassured that they are not caused by a serious somatic illness.

The patient needs to be moderately to severely affected by the symptoms every day to meet the diagnostic criteria.

 

Diagnostic criteria for Bodily Distress Syndrome (BDS)

Yes

No

Symptom groups

? 3 cardiopulmonary/autonomic symptoms

Palpitations/heart pounding, precordial discomfort, breathlessness without exertion, hyperventilation, hot or cold sweats, shaking or trembling, mouth dryness, churning in stomach/'butterflies', flushing or blushing.

? 3 gastrointestinal symptoms

Frequent thin stools, abdominal pain, feeling bloated/full of gas/distended, abdominal tension or pressure, diarrhoea, regurgitations, constipation, uneasiness or nausea, vomiting, burning sensation in the chest or epigastrium..

? 3 musculoskeletal symptoms

Arm or leg pain, muscular aches or pains, pains in the joints, unpleasant numbness or tingling sensations, feelings of parasis or localised weakness, back ache, pain moving from one place to another.

? 3 general symptoms

Concentration difficulties, excessive fatigue, headache, impairment of memory, dizziness.

? 4 symptoms from one of the above groups

1-3 x 'yes': Moderate or single-organ system Bodily Distress Syndrome
4-5 x 'yes': Severe or multi-organ system Bodily Distress Syndrome
Modified after Fink P, Rosendal M, Olesen F. Classification of somatization and functional somatic symptoms in primary care. Aust.N.Z.J.Psychiatry 2005.
   

2. Health anxiety

Some patients are exclusively suffering from health anxiety, which is a kind of anxiety where the patient suffers from fear of and ruminations about illness and health. For patients with health anxiety, it is not the symptoms that constitute the problem, but the thoughts and fear that the symptoms could be caused by a serious illness.

People with health anxiety are often aware that it is the thoughts themselves that constitute the problem. It is a temporary relief to patients when a doctor reassures them that they are not suffering from a serious illness. But it does not cure the underlying anxiety.

 

Both BDS and health anxiety

Some patients are suffering from both health anxiety and Bodily Distress Syndrome. They will at the same time be experiencing physical symptoms and have a constant fear that the symptoms are caused by a serious illness.

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Revised 10.05.2012