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Syndromes of bodily distress or functional somatic syndromes - Where are we heading. Lecture on the occasion of receiving the Alison Creed award 2017

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Background

Bodily symptoms not attributable to any known medical condition are very common in the general population and in any medical setting [1]. The severity of such symptoms range from everyday bodily sensations to severe disabling and persistent symptoms. In severe cases, the conditions are costly for the health care system (diagnostic testing, fruitless treatment attempts) as well as for society (disability, lost working years). Also, patients risk being exposed to iatrogenic harm [2], [3]. The

Prevailing concepts in the classification of pathological bodily distress

In the classification, basically 3 different major characteristics are prevailing: 1) a focus on the physical symptoms or symptom patterns (patient complaints), 2) a focus on cognitions, emotions and behaviour related to the symptoms/ailment and 3) a focus on the cause or the attribution of the symptoms (Table 1).

Regarding patient complaints: in its most simple form, the condition is defined by a symptom such as pain or dizziness. This approach may have merits in mild cases with few symptoms

Stigmatization

Even today, patients with BDS are met with negative attitudes in the health care and social security systems as well as in society in general. They do not feel understood and taken seriously by doctors, they feel accused of not being genuinely sick and they face difficulties in getting disability benefits or compensation from insurance companies because their diagnosis is not recognized.

Mental illness is still plagued by prejudice which unfortunately is reflected in the diagnostic criteria of

A new way forward

The situation today is that we have a profound conceptual and diagnostic confusion, hampering research and communication between medical specialties and making rational treatment and teaching of colleagues difficult. We therefore need to bridge the body and mind gab in understanding this phenomenon between medical specialties.

A first step would be to recognise that bodily distress syndrome/disorder is a distinct disorder of its own, but with different subtypes. Like in depression, it has both a

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