Tariq Faridi 45 Minute Talk

  History Of The Chiropractic Adjustment Spinal Manipulative Therapy Dedicated to JULIANA FARIDI Who Died In My Lap, as a result of an undetected uncorrected AtlantoAxial Subluxation which caused Hangman’s Fracture at the Atlas Axis Vertebra The devastating effects of an undetected uncorrected subluxation Is loss of human life – In this case the life of my daughter :

History Of The Chiropractic Adjustment Spinal Manipulative Therapy Dedicated to JULIANA FARIDI Who Died In My Lap, as a result of an undetected uncorrected AtlantoAxial Subluxation which caused Hangman’s Fracture at the Atlas Axis Vertebra The devastating effects of an undetected uncorrected subluxation Is loss of human life – In this case the life of my daughter

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16 th to 19 th Century Scientific Foundation: The Correlation between Somatic Dysfunction And Visceral Disease By Tariq J. Faridi , B .Sc. M.Ed. Ph D ( c )

OPENING STATEMENT :

OPENING STATEMENT WHY DO I WANT TO SHARE THIS? NO VIDEOS, SOFTWARE OR BOOKS FOR SALE JUST THE TRUTH ABOUT CHIROPRACTIC

MY PURPOSE:

MY PURPOSE Show the scientific foundation Chiropractic was laid on so that you can have confidence in the scientific validation of the link between subluxations and visceral disease what two moderately trained hands can do in restoring the memory of wholeness and awaken the innate intelligence for the body to heal itself that you have the confidence in yourself and impart it to your patients, so that they can be confident in and passionate about chiropractic as the best insurance for the detection, prevention and reversal of chronic conditions before they occur that you can detect and reverse them, before they even become symptomatic

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Objectives: Antiquarian research and 16 th to 20 th century scientific research validating the link between somatic dysfunction and visceral disease Scientific Validation of 110 years of chiropractic adjustment and reversal of visceral disease Evidence-based patient education`34

The Edwin Smith Papyrus:

The Edwin Smith Papyrus

Decades Of Scientific Validation Based on a Foundation of Two Millennia:

Decades Of Scientific Validation Based on a Foundation of Two Millennia Avicenna Ambroise Paré Galenz

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1741 Nicholas Andry Writes Patient Education Book on Scoliosis Prevention for Parents

Expand Font Size Of Text Below Split in 3 or more Slides:

Expand Font Size Of Text Below Split in 3 or more Slides

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The word ‘orthopaedia’ was devised by a Parisian paediatrician, Nicholas Andry, who was Professor of Medicine at the University of Paris and also Senior Dean of the Faculty of Physik. In 1741 he published a book entitled ‘Orthopaedia: or, The Art of Correcting and Preventing Deformities in Children. By such means that may be easily put into Correcting and Preventing Deformities in Children. By such means that may easily be put into practice by parents themselves and all such as are employed in Educating Children’. In the preface he stated: “As to the title, I have formed it of two Greek words viz Ỏ ρθος, straight and Πάίδον, a child. Out of the two words I have compounded that of Orthopaedia to express in one term the design I propose which is to teach the different methods of preventing and correcting the deformities of children”. His method for correcting excessive curvature of a child’s leg was “to apply as soon as possible a small plate of iron on the hollow side of the leg and fasten it about the leg with a linen roller. In a word, the same method must be used in this case, for recovering the shape of the leg, as is used for making straight the crooked trunk of a young tree.”

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Sir Nicholas Andry, published at the age of 81: Orthopaedia: The Art of Correcting and Preventing Deformities in Children

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1867 James Paget Warns MDs of the cases DCs will cure, which will take away their Income

1867 James Paget Cases that bonesetters cure BMJ, JANUARY 5, 1867:

“AFTER systematic lectures on the chief injuries of the bones and joints, it may be useful if I try to enforce by particular illustrations some of the general principles that I stated; and it may secure your attention if I use the form of speaking of the Cases that Bone-setters Cure. For few of you are likely to practise without having a bone-setter for an enemy; and if he can cure a case which you have failed to cure, his fortune may be made and yours marred”. 1867 James Paget Cases that bonesetters cure BMJ, JANUARY 5, 1867

1887-1896 James Mackenzie Some Points Bearing on the Association of Sensory Disorders and Visceral Disease.:

1887-1896 James Mackenzie Some Points Bearing on the Association of Sensory Disorders and Visceral Disease . (Brain 1893 , 16:321-352) “In the following pages I deal in a somewhat discursive and desultory manner with the result of several years‘ enquiry into the symptoms evoked in the sensory nervous system by disease of the viscera. For many years the subject, has been present in my mind, and although for a long time I could not appreciate the value of all the phenomena, yet by carefully noticing each circumstance in every case, and by grouping the symptoms together, I formulated for myself certain tentative laws of a somewhat vague nature, trusting that with extended experience these would become more denned and be of a less general nature. What I have published on this subject' does not fully accord with the results obtained by Dr. Head,2 and although in many respects his results are more reliable than mine, there are a few points on which we are in conflict.”

1893 Henry Head :

1893 Henry Head Thesis: DISTURBANCES OF SENSATION WITH SPECIAL REFERENCE TO THE PAIN OF VISCERAL DISEASE (Sherrington’s Friend, includes Sherrington’s unpublished findings)

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1905 CS Sherrington – Integrative Action of the Nervous System and 37 Papers – Nobel Prize In the year 1883, a legacy of $80,000 was left to the President and Fellows of Yale College in the city of New Haven, to be held in trust, as a gift for her children, in memory of their beloved and honored mother Mrs. Hepsa Ely Silliman. On this foundation Yale College was requested and directed to establish an annual course of lectures designed to illustrate the presence and providence, the wisdom and goodness of God, as manifested in the natural and moral world.

1907 Louisa Burns Viscero-Somatic and Somato Visceral Spinal Reflexes (Hypothesis - Case Study – Animal Study, Human Study, Consensus) – 1927 (17 years per Institute of Medicine):

1907 Louisa Burns Viscero-Somatic and Somato Visceral Spinal Reflexes (Hypothesis - Case Study – Animal Study, Human Study, Consensus) – 1927 (17 years per Institute of Medicine)

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1933 Neville T. Ussher Spinal curvatures -- visceral disturbances in relation thereto .

1935 Sherrington Noble Prizes in Physiology and Medicine:

1935 Sherrington Noble Prizes in Physiology and Medicine

1967 Chester Wilk AMA Found Guilty of Conspiracy and Fraud :

1967 Chester Wilk AMA Found Guilty of Conspiracy and Fraud The suit claimed that the defendants had participated for years in an illegal conspiracy to destroy chiropractic. On August 24, 1987, after endless wrangling in the courts, U.S. District Court judge Susan Getzendanner ruled that the AMA and its officials were guilty, as charged, of attempting to eliminate the chiropractic profession. The AMA offered a patient care defense; however, data from Workmen's Compensation Bureau studies served to validate chiropractic care. Specifically, studies comparing chiropractic care to care by a medical physician were presented which showed that chiropractors were “twice as effective as medical physicians, for comparable injuries, in returning injured workers to work at every level of injury severity.” Evidence at the trial showed that the defendants took active steps, often covert, to undermine chiropractic educational institutions, conceal evidence of the usefulness of chiropractic care , undercut insurance programs for patients of chiropractors, subvert government inquiries into the efficacy of chiropractic, engage in a massive disinformation campaign to discredit and destabilize the chiropractic profession and engage in numerous other activities to maintain a medical physician monopoly over health care in this country. Chester Wilk Attorney G. McAndrews

John J. Bonica:

John J. Bonica Bonica, JJ Autonomic Innervation of the Viscera in Relation to Nerve Block Anesthesiology 29:293-813 Jul-Aug 68

1975 Elizabeth Lomax Comments On Her Findings Based on 250 Year Literature Review :

1975 Elizabeth Lomax Comments On Her Findings Based on 250 Year Literature Review " Research Status of Spinal Manipulative Therapy" in 1975, historian Elizabeth Lomax, MD, presented her findings to the US government stating that as a result of her two hundred and fifty year scrutiny of scientific literature, "the physician could clinch the diagnosis by finding tenderness in the appropriate vertebra". She Studied Articles Published between 1725 and 1975 (referenced the works by Andre Nicholas to Osler Head Sherrington, and Pre Beal Authors.

1976 Irvin M. Korr :

1976 Irvin M. Korr (Part 1) The Spinal Cord as the Organizer of Disease Processes : Some Preliminary Perspectives

1979 Irvin M. Korr (Part 2):

1979 Irvin M. Korr (Part 2) The Spinal Cord as the Organizer of Disease Processes : The Peripheral Autonomic Nervous System

1979 Irvin M. Korr (Part 3):

1979 Irvin M. Korr (Part 3) The Spinal Cord as the Organizer of Disease Processes : Hyperactivity of sympathetic innervation as a common factor in disease

1981 Irvin M. Korr (Part 4):

1981 Irvin M. Korr (Part 4) The Spinal Cord as the Organizer of Disease Processes : Axonal transport and neurotrophic function in relation to somatic dysfunction

1983 Myron Beal Viscerosomtic Reflexes, Review of the Literature, tabulating 142 Studies,by Author and Vertebral Segment:

1983 Myron Beal Viscerosomtic Reflexes , Review of the Literature, tabulating 142 Studies,by Author and Vertebral Segment

1983 Myron Beal Viscerosomtic Reflexes, Review of the Literature, tabulating 142 Studies, by Author and Vertebral Segment:

1983 Myron Beal Viscerosomtic Reflexes , Review of the Literature, tabulating 142 Studies, by Author and Vertebral Segment

1983 Myron Beal Viscerosomtic Reflexes, Review of the Literature, tabulating 142 Studies, by Author and Vertebral Segment:

1983 Myron Beal Viscerosomtic Reflexes , Review of the Literature, tabulating 142 Studies, by Author and Vertebral Segment

John McM. Mennel, M.D.:

John McM. Mennel, M.D. In a paper "Understanding Manipulative Medicine in General Practice" published in JMPT in 1989, states " Then suddenly we find ourselves in practice where 80% of our patients complain to us for some sort of musculo-skeletal pain, 80% may sound high, yet remember that visceral and systemic diseases very frequently manifest themselves initially as musculoskeletal pain.“ Again John McM. Mennel concludes his article as follows: "Joint dysfunction is not only a diagnosis but an early sign of visceral and systemic diseases".

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Conclusions MR imaging is a valuable tool for diagnosing atlantoaxial instability and has a sensitivity of 100% and a specificity of 90% based on our proposed diagnostic criteria (peridental effusion, lateral facet arthropathy, focal myelopathy, and an abnormal spinolaminar line). Additionally, MR imaging may provide earlier warning signs of instability that predate the clinical symptoms. Further investigations to confirm both these findings and the diagnostic efficacy of our criteria would be invaluable.

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References 1. Zikou AK, Alamanos Y, Argyropoulou MI, et al. Radiological cervical spine involvement in patients with rheumatoid arthritis: a cross sectional study. J Rheumatol 2005;32:801–06 2. Naranjo A, Carmona L, Gavrila D, et al. Prevalence and associated factors of anterior atlantoaxial luxation in a nation-wide sample of rheumatoid arthritis patients. Clin Exp Rheumatol 2004;22:427–32 3. Kauppi M, Hakala M. Prevalence of cervical spine subluxations and dislocations in a community-based rheumatoid arthritis population. Scand J Rheumatol 1994;23:133–36 4. Rojas CA, Bertozzi JC, Martinez CR, et al. Reassessment of the craniocervical junction: normal values on CT. AJNR Am J Neuroradiol 2007;28:1819–23 5. Brattstrom H, Granholm L. Atlanto-axial fusion in rheumatoid arthritis: a new method of fixation with wire and bone cement. Acta Orthop Scand 1976;47:619–28 6. Kauppi M, Neva MH. Sensitivity of lateral view cervical spine radiographs taken in the neutral position in atlantoaxial subluxation in rheumatic diseases. Clin Rheumatol 1998;17:511–14 7. Bundschuh C, Modic MT, Kearney F, et al. Rheumatoid arthritis of the cervical spine: surface-coil MR imaging. AJR Am J Roentgenol 1988;151:181–87 8. Gupta V, Khandelwal N, Mathuria SN, et al. Dynamic magnetic resonance imaging evaluation of craniovertebral junction abnormalities. J Comput Assist Tomogr 2007;31:354–59 9. Laiho K, Soini I, Kautiainen H, et al. Can we rely on magnetic resonance imaging when evaluating unstable atlantoaxial subluxation? Ann Rheum Dis 2003;62:254–56

1992 – 2002 Nikolai Bogduk:

1992 – 2002 Nikolai Bogduk Only Structures Innervated by c1-c3 are known to cause Migraines!! Example of Headache Pills – Imitrex – Naproxen – 2 % “Cervicogenic headache is pain perceived in the head but referred from a primary sourcen in the cervical spine. The physiologic basis for this pain is convergence between trigeminal afferents and afferents from the upper three cervical spinal nerves. The possible sources of cervicogenic headache lie in the structures innervated by the C1 to C3 spinal nerves, and include the upper cervical synovial joints, the upper cervical muscles, the C2-3 disc, the vertebral and internal carotid arteries, and the dura mater of the upper spinal cord and posterior cranial fossa. Experiments in normal volunteers have established that the cervical muscles and joints can be sources of headache.” Bogduk, Nikolai The anatomical basis for cervicogenic headache JMPT, 15:67-70 January 1992. Bogduk N . Curr Pain Headache Rep. Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. 2001 Aug;5(4):382-6 Abstract: The neuroanatomical basis for cervicogenic headache is convergence in the trigeminocervical nucleus between nociceptive afferents from the field of the trigemenial nerve and the receptive fields of the first three cervical nerves. Only structures innervated by C1-C3 have been shown to be capable of causing headache. These are the muscles, joints and ligaments of the upper three cervical segments, but also include the dura mater of the spinal cord and posterior cranial fossa and the vertebral artery.

2000 Burns Centenary Appreciation Findings Presented in 1899 confirmed! April 2000 JAOA Vol.100, No.4 p.259-264 :

2000 Burns Centenary Appreciation Findings Presented in 1899 confirmed! April 2000 JAOA Vol.100, No.4 p.259-264

2004 Sherrington Centenary Appreciation Noble Prize winning Findings, which were buried by the AMA Presented in 1904 confirmed!:

2004 Sherrington Centenary Appreciation Noble Prize winning Findings, which were buried by the AMA Presented in 1904 confirmed! In 1906 Sir Charles Sherrington published The Integrative Action of the Nervous System, which was a collection of ten lectures delivered two years before at Yale University in the United States. In this monograph Sherrington summarized two decades of painstaking experimental observations and his incisive interpretation of them. It settled the then-current debate between the ‘‘Reticular Theory’’ versus ‘‘Neuron Doctrine’’ ideas about the fundamental nature of the nervous system in mammals in favor of the latter, and it changed forever the way in which subsequent generations have viewed the organization of the central nervous system. Sherrington’s magnum opus contains basic concepts and even terminology that are now second nature to every student of the subject. This brief article reviews the historical context in which the book was written, summarizes its content, and considers its impact on Neurology and Neuroscience.

2004 Sherrington Centenary Appreciation Noble Prize winning Findings, which were buried by the AMA Presented in 1904 confirmed!:

2004 Sherrington Centenary Appreciation Noble Prize winning Findings, which were buried by the AMA Presented in 1904 confirmed! ‘. . . he is the scientist’s philosopher because he had advanced natural knowledge himself by skilled observation and experiment, by 50 years’ unremitting work in the laboratory, and because his own interpretation of his discoveries had given a new extension to the biologist’s outlook. Physiologists will know this well enough. To those who have had to struggle with the mass of detailed material about the brain and cord Sherrington’s Integrative Action of the Nervous System brings order out of chaos; it is hard reading at first, because every sentence is charged with meaning, some of it direct enough, but some reaching out to half formed pictures of wider landscape. Though it was published in 1906 it is still as refreshing as it was then. It has needed no revision, but Sherrington’s experimental work went on at high pressure for another 30 years, filling in the gaps and strengthening the framework. . . .’

RICHARD SMITH, Ed. BMJ Where is the Wisdom? The Poverty of Medical Evidence:

RICHARD SMITH, Ed. BMJ Where is the Wisdom? The Poverty of Medical Evidence "Where is the wisdom we have lost in knowledge, and where," asked T. S. Eliot, "is the knowledge we have lost in information?" There are perhaps 30,000 biomedical journals in the world, and they have grown steadily by 7% a year since the seventeenth century. [ 1, 2 ] Yet only about 15% of medical interventions are supported by, solid scientific evidence , David Eddy, professor, of health policy and management at Duke University, North Carolina, told a conference in Manchester last week. This is partly because only 1% of the articles in medical journals are scientifically sound. [ 2, 3 ] and partly because many treatments have never been assessed at all. "If," said Professor Eddy, "it is true, as the total quality management gurus tell us, that ‘every defect is a treasure’ then we are sitting on King Solomon's mine.“ BMJ 1991 (Oct 5);303:798–9 .

Editorials: The scandal of poor medical research :

Editorials: The scandal of poor medical research We need less research, better research, and research done for the right reasons What should we think about a doctor who uses the wrong treatment, either willfully or through ignorance, or who uses the right treatment wrongly (such as by giving the wrong dose of a drug)? Most people would agree that such behavior was unprofessional, arguably unethical, and certainly unacceptable. What, then, should we think about researchers who use the wrong techniques (either willfully or in ignorance), use the right techniques wrongly, misinterpret their results, report their results selectively, cite the literature selectively, and draw unjustified conclusions? We should be appalled. Yet numerous studies of the medical literature, in both general and specialist journals, have shown that all of the above phenomena are common. This is surely a scandal. BMJ 1994;308:283-284 (29 January)

CLOSING STATEMENT: :

CLOSING STATEMENT: Max Planck Quote: “A scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.”

Explaining MEDICALLY UNEXPLAINED PHYSICAL SYMPTOMS (MUPS) MEDICINE’S ACKNOWLEDGEMENT WHY IT CAN NOT EXPLAIN CERTAIN PROBLEMS NOT EXPLAINABLE BY A MEDICAL EXAM REASONS WHY THAT IS SO A Special First Time Presentation Prepared Exclusively For Chiropractic Patients :

Explaining MEDICALLY UNEXPLAINED PHYSICAL SYMPTOMS (MUPS) MEDICINE’S ACKNOWLEDGEMENT WHY IT CAN NOT EXPLAIN CERTAIN PROBLEMS NOT EXPLAINABLE BY A MEDICAL EXAM REASONS WHY THAT IS SO A Special First Time Presentation Prepared Exclusively For Chiropractic Patients

Medical definition of MUPS:

Medical definition of MUPS Somatization, somatoform symptoms, & somatizing patients (SOMATIC PAIN) 1) the clinical report of multiple somatic complaints that are medically unexplained – STETHOSCOPE TELLS NOTHINHG 2) significant functional impairment or disruption in every day life – THALAMIC NEURON THEORY – THE CURE AND CAUSE OF ALL DISEASE IN THE CNS -

Medical definition of MUPS:

Medical definition of MUPS Somatization, somatoform symptoms, & somatizing patients (SOMATIC PAIN) 1) the clinical report of multiple somatic complaints that are medically unexplained – STETHOSCOPE TELLS NOTHINHG 2) significant functional impairment or disruption in every day life – THALAMIC NEURON THEORY – THE CURE AND CAUSE OF ALL DISEASE IN THE CNS -

Thalamic Neuron Theory: Theoretical Basis for the Role Played by the Central Nervous System (CNS) in the Causes and Cures of All Diseases :

Thalamic Neuron Theory: Theoretical Basis for the Role Played by the Central Nervous System (CNS) in the Causes and Cures of All Diseases LEE, T. N Med Hypotheses. 1994 Nov;43(5):285-302.

Neuropathic Pain:

Neuropathic Pain Pain initiated or caused by a primary lesion or dysfunction in the nervous system Two types Peripheral Neuropathic pain : Lesion in Peripheral Nervous system Central Neuropathic pain : Lesion in Central Nervous system

Medical definition of MUPS:

Medical definition of MUPS The Thalamic Neuron Theory (TNT) postulates that the central nervous system (CNS) is involved in all disease processes, as the CNS not only processes incoming physical and chemical information from the periphery, it also sends out physiological commands to the periphery in order to maintain homeostasis for the entire body. Inherent in its capacity to learn and adapt (i.e. to habituate) is the CNS' ability to learn to be sick (pathological habituation) by looking in certain deranged central neural circuitries, leading to chronic disease states.

Medical definition of MUPS:

Medical definition of MUPS The Thalamic Neuron Theory (TNT) postulates that the central nervous system (CNS) is involved in all disease processes, as the CNS not only processes incoming physical and chemical information from the periphery, it also sends out physiological commands to the periphery in order to maintain homeostasis for the entire body. Inherent in its capacity to learn and adapt (i.e. to habituate) is the CNS' ability to learn to be sick (pathological habituation) by looking in certain deranged central neural circuitries, leading to chronic disease states.

History:

History Ancient Egyptians wandering uterus Hippocrates hysteria Galen (2 nd century) sexual deprivation in females

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History (cont.) Robert Whytt (1714–1766) Spinal reflexes responsible for “nervous” conditions. “Nerves” were a common affliction from the late 18 th to early 20 th century. Paul Briquet (1796–1881) Comprehensive listing of symptoms in 1859 monograph based on 400 (mostly) female patients from the Salpêtrière hospital in Paris from 1849-1859. Reaffirmed Sydenham’s view of hysteria as a nervous condition, not solely seen in women, and characterized by many predisposing factors. In DSM-III somatization disorder was co-named “Briquet’s syndrome” in recognition of the French psychiatrist’s seminal contributions.

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History (cont.) SO WHAT HAPPENED, IF WE KNEW IT THEN? WE DEVIATED FROM LOOKING AT THE CNS AND PALPATING THE SPINE AND SWITCHED TO THE USE OF THE STETHOSCOPE STETHOSCOPE WAS INITIATED ON FEAR BASED MEDICINE AND PALPATION AND ADJUSTMENTS WERE INITIATED BASED ON CNS AS THE MASTER CONTROLLER, PALPATION, CLOSE TOUCH WITH THE PATIENT, LOVE OR FAITH BASED MEDICINE, BELIEF IN THE INNATE INTELLIGENCE AUTO IMMUNE SPECIALISTS BELIEVE IN INNATE INTELLIGENCE

Spinal Reflexes:

Spinal Reflexes Stretch reflex is monosynaptic - causes contraction in response to stretch Regulates skeletal muscle length and tone all monosynaptic reflexes are ipsilateral reflexes - input and output on same side only one synapse in the CNS - between ad single sensory and motor neuron Sensory receptors are found in muscle spindles e.g. Patellar reflex – muscle spindles in the quadriceps muscles, hit with a mallet stretches the quadriceps and its tendon - results in contraction

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History (cont.) Treatment of nervous disorders Contemporary medical establishment focused on methods to bring humors into balance, like… bleeding blistering purging Meanwhile, in France, there was a burgeoning spa industry offering special curative waters, wraps, poultices, and massages. The curative powers of these treatments has never passed peer-review muster, but the spas live on. Go figure…

Nosology (cont.):

Nosology (cont.) All contemporary systems borrow heavily from Briquet’s (1859) monograph (summarized by Mai & Mersky, 1980) 430 patients seen over a 10 year period. Etiologic factors were youth, female gender, “affective” and “impressionable” temperament, family history of the disorder, low social class, migration, sexual licentiousness, situational difficulties, and poor physical health. Briquet considered the "effective part of the brain" the final common pathway that mediated these causative agents. In treatment, Briquet emphasized the importance of an improvement in social circumstances and the need to minimize environmental problems.

SOMATOFORM DISORDERS:

SOMATOFORM DISORDERS Somatization disorder per DSM-IV (APA, 1994) A. A history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning. B. Each of the following criteria must have been met, with individual symptoms occurring at any time during the course of the disturbance: (1) four pain symptoms: a history of pain related to at least four different sites or functions (e.g., head, abdomen, back, joints, extremities, chest, rectum, during menstruation, during sexual intercourse, or during urination)

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Alternative descriptive systems Medically unexplained symptoms Ultimately atheoretical Popular with neuropsychologists (Binder & Campbell, 2004) Abridged somatization (Escobar et al., 1987) Based on this group’s experience with the Epidemiological Catchment Area (ECA) studies of the early 1980s A “less restrictive operational definition of the somatizer ” 4+ unexplained symptoms for men; 6+ such symptoms for women

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Multisomatoform disorder (Kroenke et al., 1997) DSM somatization disorder too restrictive, but undifferentiated somatoform disorder too inclusive Three or more medically unexplained symptoms, regardless of gender 2+ year history of somatization symptoms Functional somatic syndromes (Barsky & Borus, 1999) “are characterized more by symptoms, suffering, and disability than by disease specific, demonstrable abnormalities of structure or function” Nosology (cont.)

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Summary & suggestions for a new diagnostic approach Mayou et al., (2005) suggest: Redistribution of the various somatoform disorders among the different axes of the DSM For instance, hypochondriasis could be renamed “health anxiety” and reclassified as an anxiety disorder. Conversion could be classified as a dissociative disorder. Somatization disorder might more accurately be considered a personality disorder with mood and anxiety disorder features. These suggestions are more consistent with clinical reality. Medicine’s Absurd Explanation

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Mayou et al., (2005): (cont.) Specific symptoms might reasonably be coded on Axis III as "somatic symptoms" or "functional somatic symptoms.” As noted, many studies have indicated that a less extensive level of symptomatology is still associated with clinical impairment and psychiatric comorbidity (Escobar et al., 1987; Kroenke et al., 1997). While it might seem to be a matter of semantics, the fact that patients presenting with even a few somatoform symptoms tend to show marked increases in health care utilization, should be enough to encourage those in clinical and health policy fields to consider changes to the current diagnostic scheme. ABSURDITY (cont.)

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Avoiding dualism As discussed earlier, many have criticized the nature of the DSM typology (Engel, 2006; Kirmayer et al., 2004; Mayou et al., 2005; Sharpe & Carson, 2001). Diagnoses within this category basically call for ruling out physical causes for the symptoms presented thus making such symptoms de facto “mental” or “psychogenic.” The "mental" view of somatoform symptoms has been an obstacle to more effective treatment of such symptoms by primary care personnel (Mayou et al., 2005; Sharpe & Carson, 2001; Stone et al., 2002), perhaps due to stigma or a sense of a lack of seriousness. ABSURDITY (cont.)

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Masi et al., (2000) attempted to identify prevalence of somatic symptoms in children and adolescents (n=162) referred to a pediatric neurology/psychiatry practice for EBD - Somatic symptoms were reported in 69.2% of the sample - Headache was most common, reported in 50.6% of sample - Younger children showed higher reporting of abdominal complaints, and there were no gender differences in overall symptom report - Patients with anxiety and depression reported a higher level of somatic symptomatology, particularly headache - authors concluded that somatoform symptoms should be considered as a possible indication of unidentified psychiatric disorder HEADACHES AND ANXIETY IN CHILDREN