What's the difference between TMS and MBS?

Hey, folks, it looks like I'm late to the party. It seems like the terminology wars have been going on forever, and I have to confess that I shy away from them. I watched The Hobbit with friends this weekend and when this subject comes up, I feel a bit like Bilbo. I want to say, "Oh, Bother..." and work on other parts of the nonprofit. I feel a bit like Falstaff from Bruce's quote.

To answer Bruce's question, I don't know what Howard's preferred term for TMS is. When he is at PPD Association events he generally uses the term PPD. At events that are organized based on his book, he probably uses the term MBS because that is what he uses in his book.

Just to throw a monkey wrench into the discussion, in the end, I wouldn't be surprised if 50 years from now most people call it BDS. That is the term advocated by a number of European academics. Now, I don't like the term BDS. I also don't think that they understand TMS very well at all. I wouldn't for a second consider suggesting that any one of you visit a "BDS Doctor" or "BDS Therapist." However, I wouldn't be completely surprised if BDS became the most common word for TMS if 50 years. Why? Because doctors are the ones who teach us about diagnoses and doctors care an awful lot about the academic literature. BDS seems to have a lock on that right now, more or less.

I have no idea what term will end up being used the most. I'd like TMS to come out on top just to honor Dr. Sarno, but I know how much he cared for his patients, so I'm sure that he personally would prefer whatever term would help the largest number of people get the help they deserve. In the end, Dr. Sarno was writing about TMS as early as the mid 70s in journal articles and had put down the key theoretical points in writing already in 1998, with the publication of Mindbody Prescription. All that historians will care about is the written record, so I'm quite sure that in the long run, he'll get the credit. As Steve noted, he is the one who figured it all out. The written record is unambiguous.

I will note that, as a precaution, I have taken steps to position us well to make web sites about BDS, so that if the term does become big, we can put up information about Dr. Sarno.

Later on, I'll also update our wiki page on terminology. I think that there sometimes misconceptions about what Dr. Sarno really said about terminology, and this will hopefully help with that. Specifically, Dr. Sarno precisely defined the following four categories in Chapter 1 and the introduction of The Divided Mind:

1. Psychogenic disorders
2. Psychosomatic disorders
3. Psychosomatic disorders that are directly induced by unconscious emotions
4. TMS

Each category is a subcategory of the type above it. For example, there are five categories of psychogenic disorders, one of which is is the category of psychosomatic disorders. Likewise, not all psychosomatic disorders are directly induced by unconscious emotions, and not all such psychosomatic disorders are TMS. The Divided Mind itself is primarily about the category of Psychosomatic disorders.

When I talk with people about TMS, and they say the word TMS, sometimes they actually mean psychogenic disorders. Other times they actually mean psychosomatic. Other times they mean psychosomatic disorders that are directly induced by unconscious emotions. Finally, sometimes they actually mean TMS.

... At least that is my interpretation from what I've been able to put together so far. Of course I'd love people's feedback on it.

Finally, if anyone is curious about BDS, I'll include some information below about BDS from an email I wrote earlier this fall to the list that I maintain for TMS Therapists. I actually think that the understanding of TMS from the BDS crew is pretty awful. At this point, they really don't get it. Science can get caught in little eddies, but it generally tends to proceed from ignorance to truth, so my hunch is that as the decades pass they will straighten things out. Perhaps one day one of them will even start reading Dr. Sarno!

Here's the info: (alternatively, click here for a nice simple description of BDS for patients)

Hi everyone,

I stumbled across a series of articles and a book that I wanted to share with all of you. They relate to a research agenda of unifying the functional syndromes and several of the somatoform disorders under a single diagnosis: bodily distress syndrome. They seem important in that one of the great virtues of the TMS diagnosis is that it does the same thing. Implicit in such a unification and in their treatment approach is a mindbody approach. There are quite a few papers supporting the tradition, many seemingly arising from The Research Clinic for Functional Disorders and Psychosomatics (Denmark) and the research agenda of Per Fink. One notable research article is "One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders." Here is the abstract:

Background
In order to clarify the classification of physical complaints not attributable to verifiable, conventionally defined diseases, a new diagnosis of bodily distress syndrome was introduced. The aim of this study was to test if patients diagnosed with one of six different functional somatic syndromes or a DSM-IV somatoform disorder characterized by physical symptoms were captured by the new diagnosis.

Method
A stratified sample of 978 consecutive patients from neurological (n=120) and medical (n=157) departments and from primary care (n=701) was examined applying post-hoc diagnoses based on the Schedules for Clinical Assessment in Neuropsychiatry diagnostic instrument. Diagnoses were assigned only to clinically relevant cases, i.e., patients with impairing illness.

Results
Bodily distress syndrome included all patients with fibromyalgia (n=58); chronic fatigue syndrome (n=54) and hyperventilationsyndrome (n=49); 98% of those with irritable bowel syndrome (n=43); and at least 90% of patients with noncardiac chest pain (n=129), pain syndrome (n=130), or any somatoform disorder (n=178). The overall agreement of bodily distress syndromewith any of these diagnostic categories was 95% (95% CI 93.1–96.0; kappa 0.86, P<.0001). Symptom profiles of bodilydistress syndrome organ subtypes were similar to those of the corresponding functional somatic syndromes with diagnostic agreement ranging from 90% to 95%.

Conclusion
Bodily distress syndrome seem to cover most of the relevant “somatoform” or “functional” syndromes presenting with physical symptoms, not explained by well-recognized medical illness, thereby offering a common ground for the understanding of functional somatic symptoms. This may help unifying research efforts across medical disciplines and facilitate delivery of evidence-based care.​

It's not available on the web, but the PDF can be downloaded here:https://dl.dropboxusercontent.com/u/637348/Bodily Distress Syndrome.pdf

There is also an edited volume, published by Cambridge University Press. It is an evidence based game plan for better clinical services for MUS, somatization and Bodily Distress Syndrome. The aforementioned Per Fink is one of the coauthors. Interestingly, there are only two contributors from outside of Europe: Boston based hypochondria/psychosomatic expert Arthur Barsky and Kurt Kroenke, whom Dave Clarke has blogged about. This makes me wonder if we might have an easier time finding allies in Europe.

Here is the link for the book: http://www.amazon.com/Medically-Unexplained-Symptoms-Somatisation-Distress/dp/0521762235

I think that the Amazon reviews of the book can safely be ignored. There are 12 reviews of the book, which was published August 22, 2011. 11 of them were 1 star reviews and were published within the next week, specifically between August 29 and August 31, 2011. I refer to the reviewers as representatives of "the ME/CFS hit squad," because the timing and common themes can't just be a coincidence. Basically, someone must have published excerpts of the book on a ME/CFS internet site. If you'll permit me some dark humor, I suspect that 11 people with very severe TMS took offense and found what felt to them like a socially acceptable way of venting their frustration and repressed rage. The only other review was very positive: "Cogent, well written review of current literature on bodilydistress/MUS/somatization. I recommend this text to medical students and all physicians working in a clinical setting, Dr Peter I. M. Moran. "

The book has a great deal to recommend it. My only complaint is that it may be evidence based to a fault in that it focuses only on therapies that already have significant evidence-based support. For psychodynamic, it includes Allan Abbass's work on short term psychodynamic for somatization but not much else.

Anyway, I've never heard mention of the Bodily Distress Syndrome literature within TMS circles, so I was very excited to have come across the book a little while back. I was hoping to write a big article about it for my newsletter, but I'm heading out of the country until September and couldn't keep it under my hat. Perhaps existence of the book is common knowledge, but I've never heard anyone mention it yet, which is pretty exciting.​