Burning Mouth Syndrome

 

A recent article from Lancet "The Art of Medicine- Metaphors and unexplained symptoms-" (August 22nd, 2015) particularly enlightening in regards to BMS.....  

 

"........Estimates of the prevalence of medically unexplained symptoms range from 5–65% in primary care to 37–66% in specialty clinics. It is difficult to pin down a solid approximation partly because it's hard to define what constitutes a medically unexplained symptom. This question was addressed in the overhaul of the previously termed somatoform disorders in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) when the overly restrictive somatisation disorder was supplanted by the exponentially more inclusive somatic symptom disorder. In addition to side-stepping the problem of defi ning something by what it is missing, the DSM-5 authors explained that the criterion of being medically unexplained was dropped because that alone doesn't merit a diagnosis of a mental disorder, and "[t]he individual's suff ering is authentic, whether or not it is medically explained". As a side note, since there are currently no diagnostic biomarkers for any other psychiatric diagnoses, they could have said the same thing about essentially every other entry in the DSM-5. People become patients when they bring medically unexplained symptoms to the doctor. Most are sufficiently comforted by the bleached rituals of the medical encounter to return home as they came in: essentially well. But sometimes the worried well become the worried sick. They still feel like patients when they get back home and so they return to the clinic again and again with chronic symptoms that do not respond well to any treatment. Eff orts to reassure them fall fl at because what they really seek is validation. It is almost as if an invisible director cast them as a patient but neglected to provide the script, and so over time they rehearse the clinical history in search of an agreeable "medical" diagnosis. Questions about psychosocial factors seem to glance off some internal shell, and their answers alight instead on some other complaint. They might withhold some details of their condition because they don't want the doctor to get the "wrong idea". They ask for more tests—each one increasing the risk of misleading or false-positive results. They feel too diminished for their old activities and now spend their time reading about their symptoms online, comparing their narratives to those of other people with similar complaints. Seasons and holidays are eclipsed by phases of illness and milestones of the medical workup. Their relationships suffer. The external boundaries of their former selves recede and the externalisation of these symptoms pushes outwards to fill that void. They say, "This isn't me, I'm not usually like this!" But now they are. ".......