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The Metabolic Treatment of
Fibromyalgia
by Dr. John C. Lowe
Contents of Chapter 1.5
Debunking an Unscientific Hypothesis:
Fibromyalgia is Not a Somatoform Disorder
View an Excerpt from
Chapter 1.5
- • Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
- • Exclusion of Fibromyalgia the Classification of Mental Disorders . . . .
. . . . . . . . . . . . . .
- • Exclusion Based on Organic Findings in Fibromyalgia . . . . . . . . . . .
. . . . . . . . .
- • Exclusion Based on the Expectation of Emotional Disturbance
from Long-Duration Fibromyalgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . .
- • Somatoform Diagnoses Fibromyalgia Patients are Most Likely to Receive
- • Conversion Disorder (or Conversion-Type Hysterical Neurosis) . . . . . .
. . . . . . .
- • Hypochondriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . .
- • Somatization Disorder . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
- • Somatoform Pain Disorder . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
- • Undifferentiated Somatoform Disorder . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . .
- • Logical Analysis of the Putative Somatoform Disorders and
their Hypothesized Underlying Psychogenic Mechanisms . . . . . . . . . . . . . . . . . . .
. . . . . . .
- • Traditional Rationalism and Somatoform Disorders . . . . . . . . . . . .
. . . . . . . . .
- • Critical Rationalism and Somatoform Disorders . . . . . . . . . . . . . .
. . . . . . . . . .
- • Problems in Diagnosing Somatoform Disorders . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
- • Absence of Physical Findings . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
- • Limitations in Diagnostic Skill or Technology . . . . . . . . . . . . . .
. . . . . . . . . . . . .
- • Neglect in Testing for Physical Sources of Patient Complaints . . . . . .
. . . . . . . .
- • Diagnosing Hysteria through Physical Tests . . . . . . . . . . . . . . .
. . . . . . . . . . . . . .
- • Absence of Positive Findings from Psychological Tests . . . . . . . . . .
. . . . . . . . . . .
- • Inappropriate Psychological Testing . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
- • The All-Inclusive "Hysterical Personality" as a Diagnostic
Criterion . . . . . . . . .
- • Adverse Effects to the Patient from the Use of Somatoform Disorders
Diagnoses . . . . . . .
- • Iatrogenic Psychological Distress . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
- • Delayed Care for Physical Lesions . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
- • Adverse Effects on the Patient/Clinician Relationship . . . . . . . . . .
. . . . . . . . . . . .
- • Adverse Legal and Financial Results . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
- • Three Categories of Clinicians Who are Likely to Diagnosis Fibromyalgia
as a Somatoform Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
- • Clinicians Who Use the Diagnosis with Indifference . . . . . . . . . . .
. . . . . . . . . . . .
- • Clinicians Who Continue to Believe that Fibromyalgia is
a Somatoform Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . .
- • Clinicians Who Use Somatoform Diagnoses for
Business Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
- • "Disturbed Physician Syndrome" . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .
- • Delusional (Paranoid) Disorder . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
- • Financial Incentives for Insurance Companies and their Expert Witnesses
to Define Fibromyalgia and Similar Disorders as Somatoform . . . . . . . . . . . . . . . .
. . . . . . . .
- • Psychology of a Subset of Clinicians Who Use Somatoform
Diagnoses on Behalf of Third Party Payers . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . .
- • Fibromyalgia Viewed as Psychogenic Pain . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .
- • Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .
- • Confusion Based on Lack of Proven Pathophysiological Mechanisms . . . . .
. . . .
- • The Psychological Status of Fibromyalgia Patients . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
- • Factors that may Account for Psychological Disturbance among
Fibromyalgia Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
- • Referral Bias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
- • Persistent Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . .
- • Financial Distress . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . .
- • Reactions of Other People to the Patient . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
- • Abandoning Somatoform Diagnoses for Scientific and Humane Reasons . . . .
. . . . . . . . . . . .
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