Bodily distress syndrome: Concerns about scientific credibility in research and implementation

Abstract

In recent years, the field of psychosomatic medicine has begun to make its way out of the dark corners of medical practice and into the public light of day. As a small subdiscipline of psychiatry, the scientific credibility of the field was secured in recent years by a large-scale research study, “Pacing, graded activity, and cognitive behaviour therapy; a randomised evaluation” [1], commonly known as the “PACE trial”. A UK government-funded study, the PACE trial established in 2011 that professional debate over the biological reality of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) could be put to rest. Having followed a large group of patients over five years, the study showed that the psychiatric approach succeeds in resolving physical symptoms for the quintessential contested condition. Beginning in 2014, however, scientists [2], journalists [3, 4] and government health authorities [5, 6] joined the patient community in questioning the science behind PACE’s conclusions. Following the conclusion of the US Academy of Medicine in 2015 that ME/CFS is not psychosomatic [7], the US Agency for Healthcare Research and Quality published a report in 2016 offering an extensive list of scientific failings in the PACE trial’s design, including three distinct forms of bias [8]. Several peer-reviewed articles have now examined the original PACE data [9, 10] and concluded that, although PACE dictated management of ME/CFS across the globe for many years, the study fails to meet basic standards of scientific methodology. A challenge to the scientific credibility of the PACE trial can only be viewed as a challenge to the credibility of the field of psychosomatic medicine. No matter which side of the PACE debate we might prefer, there has been enough evidence to call into question the scientific standards of PACE researchers, those who supported the study both scientifically and in terms of funding, and those who allowed the trial to pass through the peer review process. Indeed, it is difficult to imagine how such a large-scale investigation could have developed, proceeded and passed through the review process unless its scientific failings were actually characteristic of its field. For these reasons, the PACE controversy suggests a need to evaluate the scientific credibility of psychosomatic medicine generally. As a first step toward that larger goal, this paper considers the science behind “bodily distress syndrome” (BDS), the newest product of research in psychosomatic medicine [11]. BDS is a Danish diagnostic construct, one developed to replace “somatoform disorders” in a way that would also capture patients with “medically unexplained symptoms” and “functional somatic * E-mail: doleary8@uwo.ca Bodily distress syndrome: