Psychologists

Many psychologists will be meeting people with functional disorders in their practice.

Psychologists can refer patients with Bodily Distress Syndrome (BDS) and health anxiety directly to The Research Clinic for Functional Disorders and Psychosomatics.

See the referral guide.

Diagnosing

It is important for psychologists to be able 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 primarily 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 Bodily Distress Syndrome
Modified from 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 suffering exclusively from health anxiety, which is a kind of anxiety where the patient has fear of and ruminations about sickness 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.

What can the psychologist do?

Mild cases of functional disorders can be treated by a psychologist who is familiar with the condition. It may be an advantage for the psychologist to work together with the GP.

Some patients with severe functional disorders may be in need of continued follow-up and treatment after an intensive course of treatment at a specialist centre. In these cases, follow-up interviews with a psychologist is an option.

There is evidence that cognitive behavioural therapy has an effect on functional disorders, and it is assumed that ACT (Acceptance and Commitment Therapy) has an even better effect. This is currently being tested more thoroughly.

Questions

Please contact the psychologists at the clinic if you have any questions.

Comments on content: 
Revised 10.05.2012