DSM-5 Task Force Ponders Round 2 of Public Feedback: Deborah Brauser for Medscape Medical News

DSM-5 Task Force Ponders Round 2 of Public Feedback: Deborah Brauser for Medscape Medical News

Post #110 Shortlink: http://wp.me/pKrrB-1lA

The American Psychiatric Association’s DSM-5 Task Force published no breakdowns for the number of submissions received by each of its 13 Work Groups during the first and second public stakeholder reviews of draft proposals for revision of DSM-IV categories and criteria.

Nor has the Task Force made public lists of names of those professional bodies, organizations and institutions that have submitted feedback.

These stakeholder reviews of draft proposals are not organized as formal consultation processes and few organizations appear to receive any response from the Task Force.

But the British Psychological Society (BPS) did receive a reply to their critical submission, published in June, and the response from Dr Darrel Regier, Vice-Chair of the DSM-5 Task Force, can be read here.

At the end of August, Deborah Brauser, writing for Medscape Medical News, reported on the closure of the second public stakeholder review with quotes from DSM-5 Task Force Chair, David Kupfer, MD, around which DSM categories had received the greatest number of responses during the second review.

Ms Brauser reports:

“According to Dr. Kupfer, the specific diagnostic categories that received the most feedback were sexual and gender identity disorders, followed closely by somatic symptom and anxiety disorders.”

“In addition, the Neurodevelopmental Work Group continued to receive commentary on the issue of autism. But I think it was much, much less than it had received previously. After that, there was a reasonable drop-off in the other groups,” he said.

“Substance abuse and mood disorders received the next highest number of comments, followed by personality disorders.”

On May 4, the Task Force posted revised draft proposals for categories and criteria on its DSM-5 Development website with no prior announcement on the site, itself, and with no news release being issued by the APA. The comment period, which had been scheduled to run only until June 15, was extended by an additional four weeks on the day after it had been due to close.

There were 2120 individual comments in the second public review. 8600 comments were reported to have been received during the first public review, in the Spring of 2010.

A third and final public feedback period is scheduled for early 2012. The full Medscape report can be read here.

 

Medscape Medical News > Psychiatry

DSM-5 Task Force Ponders Round 2 of Public Feedback

New Diagnostic Manual Still on Track for Publication in 2013

by Deborah Brauser | August 31, 2011

Deborah Brauser is a freelance writer for Medscape

August 31, 2011 — The second public feedback period for the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), ended July 15 and has garnered more than 2000 registered comments.

In an interview with Medscape Medical News, David Kupfer, MD, chair of the American Psychiatric Association’s (APA’s) DSM-5 Task Force, said the distribution of comments was “somewhat similar to the first go-round.”

Read full article

Related information

1] DSM-5 Development: http://www.dsm5.org/Pages/Default.aspx

2] DSM-5 Timeline: http://www.dsm5.org/about/Pages/Timeline.aspx

3] “Somatic Symptom Disorders” proposals: http://www.dsm5.org/proposedrevision/Pages/SomaticSymptomDisorders.aspx

4] Published response by the British Psychological Society to the DSM-5 2nd Review of Draft Proposals, June 2011: http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5%202011%20-%20BPS%20response.pdf

5] Response to above from Darrel Regier, MD, Vice-Chair, DSM-5 Task Force, July 2011: http://www.thepsychologist.org.uk/blog/11/blogpost.cfm?threadid=2102&catid=48

Coalition 4 ME/CFS – Letter to the Medical Community

Coalition 4 ME/CFS – Letter to the Medical Community

Post #109 Shortlink: http://wp.me/pKrrB-1kN

From Mike Munoz, via Co-Cure | October 25, 2011

On July 15, the Coalition 4 ME/CFS submitted a written proposal to the ICD-9-CM Coordination and Maintenance Committee to restore CFS to Chapter 6 “Diseases of the Nervous System” code G93.3 in the ICD-10 Clinical Modification (ICD-10-CM) in the US.

This action follows the September 2004, August 2005 and May 2011 recommendations of the federally-appointed Chronic Fatigue Syndrome Advisory Committee (CFSAC). In each case, the committee recommended that CFS be in the neurological classification in the ICD-10-CM, in line with the rest of the world.

On September 14, the Coalition 4 ME/CFS made an oral presentation to the committee and responded to concerns expressed by audience members.

The coalition has written a letter to clinicians, researchers and other medical professionals outlining the National Center for Health Statistics (NCHS) and the coalition option for modification

PDF: Coalition for ME/CFS Letter to the Medical Community

We have also included a sample letter for medical professionals and the public to give input rejecting NCHS’s option #2 in favor of the coalition’s proposal option

Html: Coalition for ME/CFS Sample Letter

We are asking medical professionals to comment on this important issue before the comment period ends on November 18.

Medical professionals wanting to add their signature to the coalition’s prepared letter to NCHS that will be submitted prior to the November 18 deadline can contact Mike Munoz at info@coalition4MECFS.org

More information concerning the coalition and the ICD initiative can be found at

http://coalition4mecfs.org/ICD-Home.html

Website: http://coalition4mecfs.org/

Facebook: https://www.facebook.com/home.php#!/pages/Coalition-4-ME-CFS/126612960745896

Twitter: https://twitter.com/#!/Coalition4MECFS

Contact: info@coalition4MECFS.org

The PDF of the Letter to the Medical Community can also be downloaded from Dx Revision Watch here: Coalition 4 ME/CFS Letter to Medical Community

 

Related material:

Comments on proposals need to be submitted by November 18.

Comments from stakeholders, preferably via email, should be submitted to:

Donna Pickett RHIA, MPH
Medical Classification Administrator
National Center for Health Statistics – CDC
3311Toledo Road Hyattsville, MD 20782
Via email: nchsicd9CM@cdc.gov

You can download an Audio of the September 14 NCHS meeting here:

http://www.cms.gov/ICD9ProviderDiagnosticCodes/Downloads/091411_Meeting_Audio.zip

[Note this is a large Zipped file.  The section for discussions on CFS coding starts at 2 hours 27 minutes in from start and ends at 3 hours 02 minutes.]

 

1] Full NCHS meeting Proposals document:

http://www.cdc.gov/nchs/data/icd9/TopicpacketforSept2011a.pdf

2] Full NCHS meeting Summary document:

http://www.cdc.gov/nchs/data/icd9/2011SeptemberSummary.pdf

3] Post: Coding CFS in ICD-10-CM: CFSAC and the Coalition4ME/CFS initiative

4] Post: Extracts: ICD-9-CM Coordination and Maintenance Committee Meeting September 14, 2011 (Coding of CFS in ICD-10-CM)

Media coverage: Open Letter and Petition to DSM-5 Task Force by Society for Humanistic Psychology

Round up 1: Media coverage: Open Letter and Petition to DSM-5 Task Force by Society for Humanistic Psychology

Post #108 Shortlink: http://wp.me/pKrrB-1jZ

An Open Letter and Petition sponsored by a coalition of several Divisions of the American Psychological Association has attracted nearly 7000 signatures since its launch on October 22.

The Petition sponsors are inviting mental health professionals and mental health organizations to sign up in support of an Open Letter to the American Psychiatric Association’s DSM-5 Development Task Force.

The Open Letter, which is highly critical of proposals for the revision of DSM-IV by American Psychiatric Association DSM-5 Work Groups, is sponsored by the Society for Humanistic Psychology (Division 32 of the American Psychological Association) in alliance with the following:

Open Letter and Petition Sponsors

Division of Behavioral Neuroscience and Comparative Psychology (Division 6 of APA)
Division of Developmental Psychology (Division 7 of APA)
Society of Counseling Psychology (Division 17 of APA)
Society for Community Research and Action: Division of Community Psychology (Division 27 of APA)
Division of Psychotherapy (Division 29 of APA)
Society for the Psychology of Women (Division 35 of APA)
Division of Psychoanalysis (Division 39 of APA)
Psychoanalysis for Social Responsibility (Section IX of Division 39 of APA)
Psychologists in Independent Practice (Division 42 of APA)
Society for the Psychological Study of Lesbian, Gay, Bisexual, and Transgender Issues (Division 44 of APA)
Society for Group Psychology and Psychotherapy (Division 49 of APA)
Society for the Psychological Study of Men & Masculinity (Division 51 of APA)

Association for Counselor Education and Supervision (Division of the American Counseling Association)
Association for Humanistic Counseling (Division of the American Counseling Association)
The Association for Creativity in Counseling (ACC, Division of the American Counseling Association)
The Association for Women in Psychology,
The Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling (ALGBTIC)
Society of Indian Psychologists
National Latina/o Psychological Association
The Society for Personality Assessment,
The Society for Descriptive Psychology,
The UK Council for Psychotherapy (UKCP),
The Constructivist Psychology Network (CPN),
The Taos Institute
Psychoanalysis for Social Responsibility (Section IX of Division 39 of APA)

[See Coalition for DSM-5 Reform website for most recent list of official endorsers.]

For a copy of the coalition’s letter see previous Post #97 or go here iPetitions DSM-5

Media coverage is being collated below as it comes to my attention.

  

Media coverage

[See Coalition for DSM-5 Reform Tab page on Dx Revision Watch website for most recent media coverage.]

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Newsworks

Expanding catalog of mental disorders worries some

Maiken Scott | November 16, 2011

The so-called bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, is getting a make-over. The latest version, DSM 5, will come out in 2013. In the meantime, conflicts over which diagnoses should be added, removed or changed are heating up.

Thousands of mental health professionals who are not happy with the direction of the new DSM are signing an online petition…

Read full article

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Irish Medical Times

Pat Kelly is Web Editor and Sub Editor at Irish Medical Times

DSM-V revisions may ‘stigmatise eccentric people’

Pat Kelly | November 15, 2011

Read full article

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American Counseling Association

ACA blogs, written by counselors, for counselors

Paul R. Peluso is a counselor and Associate Professor in the Department of Counselor Education at Florida Atlantic University

A Letter to my Colleagues on the DSM-5

Paul Peluso | November 15, 2011

When I read the response to the criticisms offered by Dr. Darrel A. Regier, vice-chair of the DSM-5 task force that the DSM is “a set of scientific hypotheses that are intended to be tested” I became deeply concerned. My first thought was: “When I go to my physician, I don’t want her to have a hypothesized diagnosis that she is going to test on me, I want her to know what is wrong and how to fix it!” And while Dr. Regier’s comment (and a subsequent one that he “hoped” that there would be regular updates to DSM 5, like software) might have been meant to ameliorate the criticism against DSM-5, the reality is that once it is published they will go from being “editable hypotheses” to “diagnostic canon” that insurance companies, government agencies, and courts will all hold clinicians to (to say nothing of the pharmaceutical industry), which will have serious consequences for the entire field. The problem is that the process and its proposed remedy fails to take into consideration the criticisms against it: namely, that it has been based on VERY shaky science (if any at all).

This should concern us all.

Read full commentary

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Russell Friedman is Executive Director of The Grief Recovery Institute, and co-author of The Grief Recovery Handbook, When Children Grieve, and Moving On.

Psychology Today

Broken Hearts

Exploring myths and truths about grief, loss, and recovery.
by Russell Friedman

Speaking out on behalf of millions of unsuspecting grievers

From Travesty to Potential Tragedy

Russell Friedman | November 4, 2011

The intent of this blog post is to encourage you to read and sign a petition titled, Open Letter to the DSM-5. We are particularly focused on the proposed change in the bereavement exclusion which is one of the major protests in the petition. You can skip the blog and go directly to the petition: http://www.ipetitions.com/petition/dsm5/

The Dangerous DSM-5 Bereavement Exclusion Train Must Be Derailed BEFORE It Causes Permanent Harm To Unsuspecting Grievers

We are: John W. James and Russell Friedman, co-founders of The Grief Recovery Institute Educational Foundation, and co-creators of The Grief Recovery Method®. We are also co-authors of The Grief Recovery Handbook and When Children Grieve [both published by HarperCollins] and Moving On [M. Evans].

Read full commentary

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Labor Related blog

David Foley’s Labor and Employment Law Blog

Furor Over DSM-V

David Foley | November 12, 2011

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DSM5 in Distress

The DSM’s impact on mental health practice and research.

DSM 5- ‘Living Document’ or ‘Dead on Arrival: ‘untested ‘scientific hypotheses’ must be dropped

Allen J. Frances, MD | November 11, 2011

News flash From Medscape Medical News—“APA Answers DSM-5 Critics”—a defense of DSM-5 offered by Darrel A. Regier, MD, vice-chair of the DSM-5 Task Force. Wonderful news that the American Psychiatric Association (APA) is attempting to address the fact that DSM-5 alarms many of its potential users—it is long past time for an open dialog.

Unfortunately, however, Dr Regier dodges the concerns that must be addressed if DSM-5 is to become a safe and credible document. Five simple questions were previously posed to APA with a request for straight answers…

Read full commentary

also at

Psychiatric Times

(Registration for Psychiatric Times site required)

DSM-5: Living Document or Dead on Arrival

Allen J. Frances, MD | November 11, 2011

Read full commentary   

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DSM5 in Distress

The DSM’s impact on mental health practice and research.

The User’s Revolt Against DSM 5
will it work?

Allen J. Frances, MD | November 10, 2011

When it comes to DSM 5, experience has proven conclusively that the American Psychiatric Association (APA) will not attend to the science, evaluate the risks, or listen to reason. A user’s revolt has become the last and only hope for derailing the worst of the DSM 5 suggestions…

…Will the petition work?

Read full commentary

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USA Today

Psychologists challenge proposed new diagnoses in DSM-5

Rita Rubin, Special for USA TODAY | November 10, 2011

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Forbes

The New Mental Health Disorders Manual Is Driving Psychologists Nuts

Forbes | November 10, 2011

The new manual of mental disorders coins bizarre new psychological disorders, lowers the threshold for diagnosing old ones, and has some critics pulling their hair out…

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Psychology Today

DSM-5 in Distress

APA Responds Lamely to the Petition to Reform DSM 5
How about straight answers to simple questions?

Allen J. Frances, MD | November 8, 2011

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Registration is required in order to view Medscape article

Medscape Medical News > Psychiatry

APA Answers DSM-5 Critics

Deborah Brauser | November 9, 2011

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Before you take that pill

New Questionable Diagnoses on the Horizon from the DSM-5 Committee

Doug Bremner | November 8, 2011

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The Great DSM-5 Personality Bazaar

James Phillips, MD | November 7, 2011

Evaluating the evaluation

There is something quite elegant about the DSM-5 Personality Disorders diagnostic system—an architectonic of divisions, subdivisions, and sub-subdivisions. On the other hand, for all their scholastic erudition, the work group have created a monster—a bloated, pedantic, cumbersome diagnostic instrument that will never be used by anyone working in the hurly-burly of clinical practice. Just imagine doing a routine new-patient evaluation and trying to include the personality disorder assessment, each of the first two criteria with its many-item scale, each item to be scored on a 4- or 5-point rating system. It’s hard to imagine anyone having the patience or motivation to use this instrument.”

Read full article

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Registration is required in order to view Medscape article

Medscape Medical News > Psychiatry

Petition Calls for Critical Changes to Upcoming DSM-5

Group Says It Has ‘Serious Reservations’ About Lowering Diagnostic Thresholds

Deborah Brauser | November 4, 2011

November 4, 2011 — Divisions of the American Psychological Association have created an online petition addressing “serious reservations” about the upcoming Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Launched October 22, the petition has already garnered more than 3000 signatures from mental health professionals, students, and organizations.

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Psychology Today

DSM-5 in Distress

The DSM’s impact on mental health practice and research.

Why Psychiatrists Should Sign the Petition to Reform DSM 5 the fight for the future of psychiatry

Allen J. Frances, MD | November 4, 2011

Psychiatrists may be more reluctant than are other mental health clinicians to sign a petition questioning the safety and value of DSM 5. After all, it is the American Psychiatric Association that is sponsoring DSM 5 and there is a natural tendency to want to trust the wisdom of one’s own Association. We also tend to feel the greatest loyalty to our profession when it seems to be under sharp attack from without.

All this is completely understandable to me. I have not felt the least bit comfortable assuming the role fate assigned me as critic of DSM 5 and of the APA. It was a case of responsibility calling and my feeling compelled to answer. If DSM 5 were not proposing some really dangerous changes, I would have stayed comfortably on the sidelines. But I think DSM 5 is too risky to ignore and that all psychiatrists should feel the same call that I did to restrain it before it is too late.

Read full commentary

also on Psychiatric Times (Registration for Psychiatric Times site required)

Why Psychiatrists Should Sign the Petition to Reform DSM 5

Allen J. Frances, MD | November 4, 2011

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More from Allen J Frances, MD

DSM5 in Distress

The DSM’s impact on mental health practice and research.

by Allen Frances, M.D.

Why Doesn’t DSM 5 Defend Itself?

Perhaps because no defense is possible

Allen J. Frances, MD | November 3, 2011

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Nature.com

Nature News

Mental-health guide accused of overreach

Dispute grows over revisions to diagnostic handbook.

Heidi Ledford | Published online November, 2 2011

Nature 479, 14 (2011) | doi:10.1038/479014a

Corrected online: 3 November 2011

Psychologist David Elkins had modest ambitions for his petition. He and his colleagues were worried that proposed changes to an influential handbook of mental disorders could classify normal behaviours as psychological conditions, potentially leading to inappropriate treatments. So they laid out their concerns in an open letter, co-sponsored by five divisions of the American Psychological Association in Washington DC. “I thought, ‘Well, maybe we’ll get a couple or maybe 30 signatures’,” says Elkins, an emeritus professor at Pepperdine University in Malibu, California.

But the letter, posted online on 22 October (http://www.ipetitions.com/petition/dsm5/), touched a nerve. Within 10 days more than 2,800 people had signed it, many identifying themselves as mental-health professionals…

Read full article

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Psychology Today Do the Right Thing

Thomas Plante, Ph.D., ABPP, is Professor of Psychology and Director of the Spirituality and Health Institute at Santa Clara University

All the Fuss with DSM-5: The Ethics of the Psychiatric Bible Is DSM5 sacred scripture?

Thomas G. Plante, Ph.D | November 1, 2011

There has been a great deal of controversy already about DSM5 and it isn’t scheduled to be published until May 2013! So, what’s up with that?

You may have heard of some of the controversy surrounding the new edition of the DSM, the “psychiatric bible,” published periodically by the American Psychiatric Association. It is the “go to” document that defines all mental health disorders and is used for diagnosis, treatment approaches, and perhaps most especially, for insurance coverage and reimbursement for professional psychiatric services. If you are a mental health professional or a patient of a mental health professional, this is an important document…

Read full commentary

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A sixth commentary from Allen J Frances 

(Registration for Psychiatric Times site required)

Psychiatric Times

DSM-5 Will Not Be Credible Without An Independent Scientific Review

Allen J Frances, MD | November 2, 2011

After all this controversy and opposition, there is one thing (and one thing only) that will save the credibility of DSM-5 and guarantee its safety – a credible process of external scientific review. APA is conducting its own internal scientific review, but it strikes out badly on all 4 requirements that must be met before a review deserves to be taken seriously as a trustworthy stamp of approval…

Read full text

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A fifth commentary from Allen J Frances 

Psychology Today

Blogs

DSM5 in Distress

The DSM’s impact on mental health practice and research.

Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine

DSM 5 Against Everyone Else Its Research Types Just Don’t Understand The Clinical World

Allen J Frances, MD | DSM5 in Distress | November 1, 2011

also at

Psychiatric Times

(Registration for Psychiatric Times site required)

DSM-5 Against Everyone Else: Research Types Just Don’t Understand The Clinical World

Allen J Frances, MD  | November 1, 2011

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Psychology Today

Blogs

Side Effects

From quirky to serious, trends in psychology and psychiatry.

by Christopher Lane, Ph.D.

Saving Psychiatry from Itself: The DSM-5 Controversy Heats Up Again

Why an Open Letter to the DSM-5 task force is generating widespread interest

Christopher Lane, PhD | October 31, 2011

Last weekend, without any fanfare or publicity, the Society for Humanistic Psychology, a division of the American Psychological Association, posted an open letter to the DSM-5 task force listing in precise, scholarly detail its many concerns about the edition’s working assumptions, procedures, and recommendations. Three other APA Divisions supported the move, which also was endorsed by the Association for Women in Psychology, the Society for Descriptive Psychology, and the UK Council for Psychotherapy (UKCP).

In the space of just a week, the open letter has caught fire…

Read full commentary

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A fourth commentary from Allen J Frances 

Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine

Psychology Today

What Would A Useful DSM 5 Look Like? And An Update On The Petition Drive

Allen J Frances, MD | DSM5 in Distress | October 31, 2011

The petition to reform DSM 5 continues to gain momentum. After just one week, more than 2000 people have expressed their disapproval of the DSM 5 proposals and their desire to see dramatic changes. You can join them at http://www.ipetitions.com/petition/dsm5/.

Read full commentary

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The Constructivist Psychology Network | October 30, 2011

CPN Supports DSM-5 Petition 

The Constructivist Psychology Network has signed a petition supporting an open letter by psychologists to the DSM-5 task force. The open letter objects to many of the proposed revisions being considered by the for inclusion in its forthcoming DSM-5.

Read full statement

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Psychology Today

Rethinking Depression

How to shed mental health labels and create personal meaning

by Eric Maisel, Ph.D. | October 28, 2011

The DSM-5 Controversy

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The UK Council for Psychotherapy (UKCP)

UKCP signs an online petition about DSM-5 | October 26, 2011

UKCP has signed an online petition which expresses serious reservations about the proposed content of the future DSM-5. In the latest issue of The Psychotherapist (issue 49, autumn 2011), Tom Warnecke explains the controversy surrounding the forthcoming fifth edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders)…

Read full text

PDF The Psychotherapist (issue 49, autumn 2011) , Page 24, Mass psychosis or the brave new world of DSM-5: Tom Warnecke

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A second blog from Karen Franklin

Forensic Psychologist

Karen Franklin Ph.D. | October 27, 2011

DSM-5 petition takes off like wildfire

Karen Franklin, Ph.D. is a forensic psychologist and adjunct professor at Alliant University in Northern California.

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A second commentary  from Allen J Frances 

Psychiatric Times

DSM-5 Blog

Petition Against DSM-5 Gets Off To Racing Start: A Game Changer?

By Allen J Frances, MD | October 26, 2011

Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine

(Registration for Psychiatric Times site required)

also at Psychology Today | October 27, 2011

The Petition Against DSM 5 Gets Off To Fast Start

Could It Be A Game Changer

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Counseling Today

Psychologists circulate petition against DSM-5 revisions

CT Daily | October 24, 2011

Heather Rudow

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Britsh Psychological Society (BPS)

Psychologists petition against DSM-5 | October 25, 2011

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Psychology Today

DSM-5 in Distress

Dr Allen Frances

Psychologists Petition Against DSM-5: Users Revolt Should Capture APA Attention

By Allen J Frances, MD | October 24, 2011

Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine

also (with registered access) same text at Psychiatric Times 

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Forensic Psychologist

Karen Franklin, Ph.D. | October 23, 2011

Psychology coalition urges rethinking of DSM-5 expansions

Karen Franklin, Ph.D. is a forensic psychologist and adjunct professor at Alliant University in Northern California.

Dr Franklin also blogs at Psychology Today Witness, A blog about forensic psychology

Open Letter and Petition to DSM-5 Task Force by Society for Humanistic Psychology (Division 32 of the American Psychological Association)

Open Letter and Petition to DSM-5 Task Force by Society for Humanistic Psychology (Division 32 of the American Psychological Association)

Post #107 Shortlink: http://wp.me/pKrrB-1jI

Update @ January 11, 2012: The third and final draft of proposals for changes to DSM-IV categories and criteria is delayed because field trials and evaluations are running behind schedule and extended to March. The final draft is now expected to be released for public review and comment, “no later than May 2012″, according to DSM-5 Task Force Vice-chair, Darrel Regier, MD [1].

Third review of DSM-5 draft proposals on the horizon

This time last year, folk were mailing me saying – I don’t know why you bother continuing to monitor DSM-5 and ICD-11, XMRV is going to render the DSM-5 proposals meaningless.

Well that was then, and this is now. And in a couple of months’ time we’ll be anticipating the third and final public review and feedback on the APA’s draft proposals for changes to categories and criteria for the revision of DSM-IV.

During the first stakeholder feedback exercise, over 8,600 comments rolled in; during the second comment period (which was extended by an additional four weeks), the Task Force and work groups received over 2000 submissions.

According to the current DSM-5 Timeline:

September-November 2011: Work groups will be provided with results from both field trials and will update their draft criteria as needed. Field trial results and revised proposals will be reviewed at the November Task Force meeting.

January-February 2012: Revised draft diagnostic criteria will be posted on http://www.dsm5.org and open to a third public feedback period for two months. Feedback will be shared directly with work group members, and further edits to proposals will be made as needed.” [1]

According to the DSM-5 Development home page:

“…Following analysis of field trial results, we will revise the proposed criteria as needed and, after appropriate review and approval, we will post these changes on this Web site. At that time, we will again open the site to a third round of comments from visitors, which will be systematically reviewed by each of the work groups for consideration of additional changes. Thus, the current commenting period is not the final opportunity for you to submit feedback, and subsequent revisions to DSM-5 proposals will be jointly informed by field trial findings as well as public commentary…” [2]

Assuming the APA’s schedule remains on target, US and international patient organizations and advocates need to start preparing well in advance of the New Year for how best to engage our own medical and allied professionals in this process and encourage their input.

As soon as DSM-5 Draft 3 is posted on the DSM-5 Development site, I shall put out alerts on my websites, via Co-Cure and on other platforms and I shall be contacting UK patient organizations, as I have done for the previous two public review exercises.

But I hope that other advocates and groups, in the US and internationally, will work to take this forward and ensure that as many international patient organizations, ME and CFS clinicians and researchers, like those who collaborated on the new ME International Consensus Criteria, allied health professionals, medical lawyers, social workers and other end uses of the DSM are made aware of the proposals of the “Somatic Symptom Disorders” Work Group and the implications for ME, CFS, FM, IBS, CI, CS and GWS patient groups, and encouraged to submit comments as professional stakeholders.

 

Open Letter and Petition to DSM-5 Task Force

Today I was alerted to an Open Letter and Petition sponsored by the Society for Humanistic Psychology, Division 32 of the American Psychological Association, in alliance with the Society for Community Research and Action: Division of Community Psychology (Division 27 of APA) and the Society for Group Psychology and Psychotherapy (Division 49 of APA) [3]. (No press release, but I’ll update if one is issued.)

These American Psychological Association Divisions are inviting mental health professionals and mental health organizations to sign up in support of an open letter to the American Psychiatric Association’s DSM-5 Task Force.

Their response to DSM-5 structure and proposals may be of interest to psychiatrists and psychologists affiliated to, or on the boards of our own ME and CFS patient organizations.

The Open Letter to the DSM-5 Task Force can be read here and a copy is appended:

http://www.ipetitions.com/petition/dsm5/

Under the subheading “New Emphasis on Medico-Physiological Theory”, the Open Letter sponsors comment on some aspects of the DSM-5 proposals for the “Somatic Symptom Disorders” categories. The Open Letter also supports concerns set out within the formal response to DSM-5 draft proposals submitted by the British Psychological Society, earlier this year, and more recent concerns published by the American Counseling Association.

A couple of points: both the American Psychological Association, three of whose Divisions are sponsors of this Open Letter, and the American Psychiatric Association use the acronym “APA”. It is the American Psychiatric Association’s DSM-5 Task Force that is developing the DSM-5.

Secondly, although the first release of the DSM-5 draft proposals did have the diagnosis “Factitious Disorder” placed under “Somatic Symptom Disorders (SSDs)”, the most recent (May 2011) DSM-5 draft proposes placing “Factitious Disorder” under the diagnostic chapter “Other Disorders”, not within the SSDs, as the Open Letter, below, states [4], [5].

Suzy Chapman

[1] DSM-5 Development Timeline: http://www.dsm5.org/about/Pages/Timeline.aspx

[2] DSM Development website: http://www.dsm5.org/Pages/Default.aspx

[3] Society for Humanistic Psychology: http://www.apadivisions.org/division-32/index.aspx

[4] DSM-5 Draft Proposals, Somatic Symptom Disorders: http://www.dsm5.org/proposedrevision/Pages/SomaticSymptomDisorders.aspx

[5] DSM-5 Draft Proposals, Other Disorders: http://www.dsm5.org/proposedrevision/Pages/OtherDisorders.aspx


The Open Letter and Petition can be read here: http://www.ipetitions.com/petition/dsm5/

There’s also a copy on the blog of  Society for Humanistic Psychology

Sponsor

Society for Humanistic Psychology, Division 32 of the American Psychological Association, in alliance with Society for Community Research and Action: Division of Community Psychology (Division 27 of APA) and Society for Group Psychology and Psychotherapy (Division 49 of APA). We invite mental health professionals and mental health organizations to sign on in support of this petition to the DSM5 Task Force of the American Psychiatric Association

To the DSM-5 Task Force and the American Psychiatric Association:

As you are aware, the DSM is a central component of the research, education, and practice of most licensed psychologists in the United States. Psychologists are not only consumers and utilizers of the manual, but we are also producers of seminal research on DSM-defined disorder categories and their empirical correlates. Practicing psychologists in both private and public service utilize the DSM to conceptualize, communicate, and support their clinical work.

For these reasons, we believe that the development and revision of DSM diagnoses should include the contribution of psychologists, not only as select individuals on a committee, but as a professional community. We have therefore decided to offer the below response to DSM-5 development. This document was composed in recognition of, and with sensitivity to, the longstanding and congenial relationship between American psychologists and our psychiatrist colleagues.

Overview

Though we admire various efforts of the DSM-5 Task Force, especially efforts to update the manual according to new empirical research, we have substantial reservations about a number of the proposed changes that are presented on www.dsm5.org. As we will detail below, we are concerned about the lowering of diagnostic thresholds for multiple disorder categories, about the introduction of disorders that may lead to inappropriate medical treatment of vulnerable populations, and about specific proposals that appear to lack empirical grounding. In addition, we question proposed changes to the definition(s) of mental disorder that deemphasize sociocultural variation while placing more emphasis on biological theory. In light of the growing empirical evidence that neurobiology does not fully account for the emergence of mental distress, as well as new longitudinal studies revealing long-term hazards of standard neurobiological (psychotropic) treatment, we believe that these changes pose substantial risks to patients/clients, practitioners, and the mental health professions in general.

Given the changes currently taking place in the profession and science of psychiatry, as well as the developing empirical landscape from which psychiatric knowledge is drawn, we believe that it is important to make our opinions known at this particular historical moment. As stated at the conclusion of this letter, we believe that it is time for psychiatry and psychology collaboratively to explore the possibility of developing an alternative approach to the conceptualization of emotional distress. We believe that the risks posed by DSM-5, as outlined below, only highlight the need for a descriptive and empirical approach that is unencumbered by previous deductive and theoretical models.

In more detail, our response to DSM-5 is as follows:

Advances Made by the DSM-5 Task Force

We applaud certain efforts of the DSM-5 Task Force, most notably efforts to resolve the widening gap between the current manual and the growing body of scientific knowledge on psychological distress. In particular, we appreciate the efforts of the Task Force to address limitations to the validity of the current categorical system, including the high rates of comorbidity and Not Otherwise Specified (NOS) diagnoses, as well as the taxonomic failure to establish ‘zones of rarity’ between purported disorder entities (Kendell & Jablensky, 2003). We agree with the APA/DSM-5 Task Force statement that, from a systemic perspective,

The DSM-III categorical diagnoses with operational criteria were a major advance for our field, but they are now holding us back because the system has not kept up with current thinking. Clinicians complain that the current DSM-IV system poorly reflects the clinical realities of their patients. Researchers are skeptical that the existing DSM categories represent a valid basis for scientific investigations, and accumulating evidence supports this skepticism. (Schatzberg, Scully, Kupfer, & Regier, 2009)

As researchers and clinicians, we appreciate the attempt to address these problems. However, we have serious reservations about the proposed means for doing so. Again, we are concerned about the potential consequences of the new manual for patients and consumers; for psychiatrists, psychologists, and other practitioners; and for forensics, health insurance practice, and public policy. Our specific reservations are as follows:

Lowering of Diagnostic Thresholds

The proposal to lower diagnostic thresholds is scientifically premature and holds numerous risks. Diagnostic sensitivity is particularly important given the established limitations and side-effects of popular antipsychotic medications. Increasing the number of people who qualify for a diagnosis may lead to excessive medicalization and stigmatization of transitive, even normative distress. As suggested by the Chair of DSM-IV Task Force Allen Frances (2010), among others, the lowering of diagnostic thresholds poses the epidemiological risk of triggering false-positive epidemics.

We are particularly concerned about:

“Attenuated Psychosis Syndrome,” which describes experiences common in the general population, and which was developed from a “risk” concept with strikingly low predictive validity for conversion to full psychosis.

• The proposed removal of Major Depressive Disorder’s bereavement exclusion, which currently prevents the pathologization of grief, a normal life process.

• The reduction in the number of criteria necessary for the diagnosis of Attention Deficit Disorder, a diagnosis that is already subject to epidemiological inflation.

• The reduction in symptomatic duration and the number of necessary criteria for the diagnosis of Generalized Anxiety Disorder.

Though we also have faith in the perspicacity of clinicians, we believe that expertise in clinical decision-making is not ubiquitous amongst practitioners and, more importantly, cannot prevent epidemiological trends that arise from societal and institutional processes. We believe that the protection of society, including the prevention of false epidemics, should be prioritized above nomenclatural exploration.

Vulnerable Populations

We are also gravely concerned about the introduction of disorder categories that risk misuse in particularly vulnerable populations. For example, Mild Neurocognitive Disorder might be diagnosed in elderly with expected cognitive decline, especially in memory functions. Additionally, children and adolescents will be particularly susceptible to receiving a diagnosis of Disruptive Mood Dysregulation Disorder or Attenuated Psychosis Syndrome. Neither of these newly proposed disorders have a solid basis in the clinical research literature, and both may result in treatment with neuroleptics, which, as growing evidence suggests, have particularly dangerous side-effects (see below)—as well as a history of inappropriate prescriptions to vulnerable populations, such as children and the elderly

Sociocultural Variation

The DSM-5 has proposed to change the Definition of a Mental Disorder such that DSM-IV’s Feature E: “Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual,” will instead read “[A mental disorder is a behavioral or psychological syndrome or pattern] [t]hat is not primarily a result of social deviance or conflicts with society.” The latter version fails to explicitly state that deviant behavior and primary conflicts between the individual and society are not mental disorders. Instead, the new proposal focuses on whether mental disorder is a “result” of deviance/social conflicts. Taken literally, DSM-5’s version suggests that mental disorder may be the result of these factors so long as they are not “primarily” the cause. In other words, this change will require the clinician to draw on subjective etiological theory to make a judgment about the cause of presenting problems. It will further require the clinician to make a hierarchical decision about the primacy of these causal factors, which will then (partially) determine whether mental disorder is said to be present. Given lack of consensus as to the “primary” causes of mental distress, this proposed change may result in the labeling of sociopolitical deviance as mental disorder.

Revisions to Existing Disorder Groupings

Several new proposals with little empirical basis also warrant hesitation:

• As mentioned above, Attenuated Psychosis Syndrome and Disruptive Mood Dysregulation Disorder (DMDD) have questionable diagnostic validity, and the research on these purported disorders is relatively recent and sparse.

• The proposed overhaul of the Personality Disorders is perplexing. It appears to be a complex and idiosyncratic combined categorical-dimensional system that is only loosely based on extant scientific research. It is particularly concerning that a member of the Personality Disorders Workgroup has publicly described the proposals as “a disappointing and confusing mixture of innovation and preservation of the status quo that is inconsistent, lacks coherence, is impractical, and, in places, is incompatible with empirical facts” (Livesley, 2010), and that, similarly, Chair of DSM-III Task Force Robert Spitzer has stated that, of all of the problematic proposals, “Probably the most problematic is the revision of personality disorders, where they’ve made major changes; and the changes are not all supported by any empirical basis.”

• The Conditions Proposed by Outside Sources that are under consideration for DSM-5 contain several unsubstantiated and questionable disorder categories. For example, “Apathy Syndrome,” “Internet Addiction Disorder,” and “Parental Alienation Syndrome” have virtually no basis in the empirical literature.

New Emphasis on Medico-Physiological Theory

Advances in neuroscience, genetics, and psychophysiology have greatly enhanced our understanding of psychological distress. The neurobiological revolution has been incredibly useful in conceptualizing the conditions with which we work. Yet, even after “the decade of the brain,” not one biological marker (“biomarker”) can reliably substantiate a DSM diagnostic category. In addition, empirical studies of etiology are often inconclusive, at best pointing to a diathesis-stress model with multiple (and multifactorial) determinants and correlates. Despite this fact, proposed changes to certain DSM-5 disorder categories and to the general definition of mental disorder subtly accentuate biological theory. In the absence of compelling evidence, we are concerned that these reconceptualizations of mental disorder as primarily medical phenomena may have scientific, socioeconomic, and forensic consequences. New emphasis on biological theory can be found in the following DSM-5 proposals:

• The first of DSM-5’s proposed revisions to the Definition of a Mental Disorder transforms DSM-IV’s versatile Criterion D: “A manifestation of a behavioral, psychological, or biological dysfunction in the individual” into a newly collapsed Criterion B: [A behavioral or psychological syndrome] “That reflects an underlying psychobiological dysfunction.” The new definition states that all mental disorders represent underlying biological dysfunction. We believe that there is insufficient empirical evidence for this claim.

• The change in Criterion H under “Other Considerations” for the Definition of a Mental Disorder adds a comparison between medical disorders and mental disorders with no discussion of the differences between the two. Specifically, the qualifying phrase “No definition adequately specifies precise boundaries for the concept of ‘mental disorder” was changed to “No definition perfectly specifies precise boundaries for the concept of either ’medical disorder’ or ‘mental/psychiatric disorder’.” This effectively transforms a statement meant to clarify the conceptual limitations of mental disorder into a statement equating medical and mental phenomena.

• We are puzzled by the proposals to “De-emphasize medically unexplained symptoms” in Somatic Symptom Disorders (SSDs) and to reclassify Factitious Disorder as an SSD. The SSD Workgroup explains: “…because of the implicit mind-body dualism and the unreliability of assessments of ‘medically unexplained symptoms,’ these symptoms are no longer emphasized as core features of many of these disorders.” We do not agree that hypothesizing a medical explanation for these symptoms will resolve the philosophical problem of Cartesian dualism inherent in the concept of “mental illness.” Further, merging the medico-physical with the psychological eradicates the conceptual and historical basis for somatoform phenomena, which are by definition somatic symptoms that are not traceable to known medical conditions. Though such a redefinition may appear to lend these symptoms a solid medico-physiological foundation, we believe that the lack of empirical evidence for this foundation may lead to practitioner confusion, as might the stated comparison between these disorders and research on cancer, cardiovascular, and respiratory diseases.

• The proposed reclassification of Attention Deficit/Hyperactivity Disorder (ADHD) from Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence to the new grouping “Neurodevelopmental Disorders” seems to suggests that that ADHD has a definitive neurological basis. This change, in combination with the proposal to lower the diagnostic threshold for this category as described above, poses high risk of exacerbating the extant over-medicalization and over-diagnosis of this disorder category.

• A recent publication by the Task Force, The Conceptual Evolution of DSM-5 (Regier, Narrow, Kuhl, & Kupfer, 2011), states that the primary goal of DSM-5 is “to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience.” We believe that the primary goal of DSM-5 should be to keep pace with advances in all types of empirical knowledge (e.g., psychological, social, cultural, etc.).

Taken together, these proposed changes seem to depart from DSM’s 30-year “atheoretical” stance in favor of a pathophysiological model. This move appears to overlook growing disenchantment with strict neurobiological theories of mental disorder (e.g., “chemical imbalance” theories such as the dopamine theory of schizophrenia and the serotonin theory of depression), as well as the general failure of the neo-Kraepelinian model for validating psychiatric illness. Or in the words of the Task Force:

“…epidemiological, neurobiological, cross-cultural, and basic behavioral research conducted since DSM-IV has suggested that demonstrating construct validity for many of these strict diagnostic categories (as envisioned most notably by Robins and Guze) will remain an elusive goal” (Kendler, Kupfer, Narrow, Phillips, & Fawcett, 2009, p. 1).

We thus believe that a move towards biological theory directly contradicts evidence that psychopathology, unlike medical pathology, cannot be reduced to pathognomonic physiological signs or even multiple biomarkers. Further, growing evidence suggests that though psychotropic medications do not necessarily correct putative chemical imbalances, they do pose substantial iatrogenic hazards. For example, the increasingly popular neuroleptic (antipsychotic) medications, though helpful for many people in the short term, pose the long-term risks of obesity, diabetes, movement disorders, cognitive decline, worsening of psychotic symptoms, reduction in brain volume, and shortened lifespan (Ho, Andreasen, Ziebell, Pierson, & Magnotta, 2011; Whitaker, 2002, 2010). Indeed, though neurobiology may not fully explain the etiology of DSM-defined disorders, mounting longitudinal evidence suggests that the brain is dramatically altered over the course of psychiatric treatment.

Conclusions

In sum, we have serious reservations about the proposed content of the future DSM-5, as we believe that the new proposals pose the risk of exacerbating longstanding problems with the current system. Many of our reservations, including some of the problems described above, have already been articulated in the formal response to DSM-5 issued by the British Psychological Society (BPS, 2011) and in the email communication of the American Counseling Association (ACA) to Allen Frances (Frances, 2011b).

In light of the above-listed reservations concerning DSM-5’s proposed changes, we hereby voice agreement with BPS that:

• “…clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.”

• “The putative diagnoses presented in DSM-V are clearly based largely on social norms, with ‘symptoms’ that all rely on subjective judgments, with little confirmatory physical ‘signs’ or evidence of biological causation. The criteria are not value-free, but rather reflect current normative social expectations.”

• “… [taxonomic] systems such as this are based on identifying problems as located within individuals. This misses the relational context of problems and the undeniable social causation of many such problems.”

• There is a need for “a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with ‘normal’ experience” and the fact that strongly evidenced causal factors include “psychosocial factors such as poverty, unemployment and trauma.”

• An ideal empirical system for classification would not be based on past theory but rather would “ begin from the bottom up – starting with specific experiences, problems or ‘symptoms’ or ‘complaints’.”

The present DSM-5 development period may provide a unique opportunity to address these dilemmas, especially given the Task Force’s willingness to reconceptualize the general architecture of psychiatric taxonomy. However, we believe that the proposals presented on www.dsm5.org are more likely to exacerbate rather than mitigate these longstanding problems. We share BPS’s hopes for a more inductive, descriptive approach in the future, and we join BPS in offering participation and guidance in the revision process.

References

American Psychiatric Association (2011). DSM-5 Development. Retrieved from http://www.dsm5.org/Pages/Default.aspx

British Psychological Society. (2011) Response to the American Psychiatric Association: DSM-5 development.
Retrieved from http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5%202011%20-%20BPS%20response.pdf

Compton, M. T. (2008). Advances in the early detection and prevention of schizophrenia.
Medscape Psychiatry & Mental Health. Retrieved from http://www.medscape.org/viewarticle/575910

Frances, A. (2010). The first draft of DSM-V. BMJ. Retrieved from http://www.bmj.com/content/340/bmj.c1168.full

Frances, A. (2011a). DSM-5 approves new fad diagnosis for child psychiatry: Antipsychotic use
likely to rise. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/display/article/10168/1912195

Frances, A. (2011b). Who needs DSM-5? A strong warning comes from professional counselors
[Web log message]. Psychology Today. Retrieved from http://www.psychologytoday.com/blog/dsm5-in-distress/201106/who-needs-dsm-5

Hanssen, M., Bak, M., Bijl, R., Vollebergh, W., & van Os, J. (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology, 44, 181-191.

Ho, B-C., Andreasen, N. C., Ziebell, S., Pierson, R., & Magnotta, V. (2011). Long-term antipsychotic treatment and brain volumes. Archives of General Psychiatry, 68, 128-137.

Johns, L. C., & van Os, J. (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21, 1125-1141.

Kendell, R., & Jablensky, A. (2003). Distinguishing between the validity and utility of psychiatric diagnoses. The American Journal of Psychiatry, 160, 4-11.

Kendler, K., Kupfer, D., Narrow, W., Phillips, K., & Fawcett, J. (2009, October 21). Guidelines
for making changes to DSM-V. Retrieved August 30, 2011, from
http://www.dsm5.org/ProgressReports/Documents/Guidelines-for-Making-Changes-to-DSM_1.pdf

Livesley, W. J. (2010). Confusion and incoherence in the classification of Personality Disorder: Commentary on the preliminary proposals for DSM-5. Psychological Injury and Law, 3, 304-313.

Moran, M. (2009). DSM-V developers weigh adding psychosis risk. Psychiatric News Online.
Retrieved from http://pn.psychiatryonline.org/content/44/16/5.1.full

Regier, D. A., Narrow, W. E., Kuhl, E. A., & Kupfer, D. J. (2011). The conceptual evolution of DSM-5. Arlington, VA: American Psychiatric Publishing.

Schatzberg, A. F., Scully, J. H., Kupfer, D. J., & Regier, D. A. (2009). Setting the record straight: A response to Frances commentary on DSM-V. Psychiatric Times, 26. Retrieved from http://www.psychiatrictimes.com/dsm/content/article/10168/1425806

Whitaker, R. (2002). Mad in America. Cambridge, MA: Basic Books. Also see http://www.madinamerica.com/madinamerica.com/Schizophrenia.html

Whitaker, R. (2010). Anatomy of an epidemic. New York, NY: Random House.

New: Online ICD-10 Version for 2010

New: Online ICD-10 Version for 2010

Post #106 Shortlink: http://wp.me/pKrrB-1jm

The information in this report refers only to the existing international WHO ICD-10 and not to the forthcoming ICD-11 or to any country specific, clinical modification of ICD-10.

New: Online ICD-10 Version for 2010

I reported some months ago that according to documentation from WHO-FIC meeting materials, it was understood that a version of ICD-10 for 2010 was planned to be published online by WHO, Geneva, earlier this year.

This would replace the ICD-10 online version for 2007 and incorporate all the annual updates to ICD-10 from 2007 to 2010.

This is now up online.

A searchable version of ICD-10 for 2010 is available at this URL:

http://apps.who.int/classifications/icd10/browse/2010/en

International Statistical Classification of Diseases and Related Health Problems 10th Revision

It is presented on a platform similar to the platform being used for the ICD-11 Alpha Draft, that is, a list of ICD-10 Chapters on the left side of the screen, arranged with hierarchical parent > child categories, with the category codings set out on the right side of the screen.

This is the URL for ICD Title term G93.3 Postviral fatigue syndrome:

http://apps.who.int/classifications/icd10/browse/2010/en#/G93.3

If “Chronic fatigue syndrome” is entered into the Search box, a drop down reads:

“Syndrome – fatigue – chronic – G93.3″

(Which is the way it is set out in Volume 3 The Alphabetical Index.)

Mouse hover over the orange square on the left of the dark blue drop down and the “Alt text” reads:

“Found in Index”

There is a User Guide for ICD-10 Version: 2010 but the platform is not difficult to navigate, just select a chapter and click on the little grey arrows to display parent class and Title term categories and their child categories – you can’t break anything:

http://apps.who.int/classifications/icd10/browse/Help

Those of us with websites that have URLs pointing to specific ICD-10 version for 2007 categories will need to adjust URLs for the new platform, as code specific URLs are pointing only to the ICD-10 Version: 2010 opening page, for example:

what displayed in ICD-10 version for 2007 at this path:

http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933

would need updating to:

http://apps.who.int/classifications/icd10/browse/2010/en#/G93.3

and the Chapter V entry for the F40-48 categories:

http://www.who.int/classifications/apps/icd/icd10online/?gf40.htm+f480

would need updating to:

http://apps.who.int/classifications/icd10/browse/2010/en#/F40-F48

or

http://apps.who.int/classifications/icd10/browse/2010/en#/F45.0

to point to F45 Somatoform Disorders

or

http://apps.who.int/classifications/icd10/browse/2010/en#/F48.0

to point to F48.0 Neurasthenia.

Compiled by Suzy Chapman


Medical Classification WHO ICD codes by Mary Schweitzer

Medical Classification WHO ICD codes by Mary Schweitzter

Post #105 Shortlink: http://wp.me/pKrrB-1j9

Mary Schweitzer

October 14, 2011

There has of late been speculation that it would be bad for U.S. patients if CFS and M.E. were placed in the same category in the neurology chapter of ICD-10-CM, the “clinical manual” of ICD-10 that will be adopted for use in the United States.

But the fact of the matter is that in ICD-10, CFS already IS coded to G93.3, “PVFS and M.E.” in the index, which is as authoritative as the tabular version. [PVFS stands for Post-Viral Fatigue Syndrome, and is not diagnosed very frequently any more - not at all in the U.S.]. It already IS coded in neurology.

110 nations use ICD-10 as-is, including the UK. Australia has a clinical version that does not alter the codes for M.E. or CFS. But Canada and Germany have clinical versions that place CFS in the tabular version of ICD-10, in G93.3 with M.E. In fact, it was the Canadian clinical version, ICD-10-CA, which led to the highly regarded Canadian Consensus Criteria for ME/CFS in 2003.

NOBODY EXCEPT THE UNITED STATES CODES CFS IN THE “R” CHAPTER. If we coded CFS at R53.82, which was the plan of NCHS, we would have been the ONLY nation in the world to do so.

Furthermore, M.E. is not a known diagnosis in the U.S. (WE know about it, but very few doctors do.) There is no definition for it approved by CDC. We can now point to the new definition that was published in the Journal of Internal Medicine, but that is more likely to enable researchers in the US and Canada to use M.E. if they want to, than to trickle down to U.S. clinicians [1]. Part of the problem is that when M.E. replaced atypical polio as a disease name in British commonwealth nations and Europe, in the U.S. the new name was epidemic neuromyesthenia, which has not (to my knowledge) been diagnosed in decades.

So if CFS gets coded as R53.82 in the U.S.’s ICD-10-CM, yes, M.E. will be less likely to confuse with CFS – but that would only be in the U.S., and in the U.S. we only get diagnosed with that revolting name CFS anyway. At least we could get them scratching their heads and asking, “What is M.E.?” if both diseases were placed together where those of you outside the U.S. already have it.

Given that U.S. doctors do not have a high opinion of CFS, keeping it under “R” in “vague signs and symptoms” would only reinforce their prejudice against it as a “garbage diagnosis” – something you diagnose when you run out of ideas.

Finally, there was an inadvertent error in an earlier Co-Cure message about getting CFS out of the “R” category. The “R” category is not for psychiatric diagnoses.

British psychiatrists use “fatigue syndrome,” which is coded at F48.0 under neuroses at “neurasthenia.”. Then when they write about it, they mix and match terms so it looks as if CFS is the same thing, and therefore it goes in F48.0. That is a serious problem in the UK. [I have to admit to being alarmed recently when a U.S. virologist connected CFS not to the history of atypical polio, which is pretty well established, but to the arcane nineteenth century diagnosis of neurasthenia. Please don't do that!]

We are not (I hope) in current danger of being coded under neuroses at F48.0, neurasthenia, in the U.S. But the “R” diagnosis is sufficiently vague that it wouldn’t be difficult to use it to claim CFS patients really have CSSD (Complex Somatic Symptom Disorder), the category British psychiatrist and CBT advocate Michael Sharpe is trying to shoehorn into DSM-5, the new version of the American Psychiatric Association’s huge diagnostic tome. So it does leave us vulnerable [2].

To those outside the U.S. I would say, look to ICD-11. That’s what will affect you the most. To those in the U.S. (where we are finally getting around to adopting ICD-10-CM two decades after ICD-10 was written), what WE need is simply to get in step with the rest of the world now.

Mary M. Schweitzer PhD

Related material

[1] New International Consensus Criteria for M.E., Journal of Internal Medicine

Volume 270, Issue 4, pages 327–338, October 2011

Carruthers, B. M., van de Sande, M. I., De Meirleir, K. L., Klimas, N. G., Broderick, G., Mitchell, T., Staines, D., Powles, A. C. P., Speight, N., Vallings, R., Bateman, L., Baumgarten-Austrheim, B., Bell, D. S., Carlo-Stella, N., Chia, J., Darragh, A., Jo, D., Lewis, D., Light, A. R., Marshall-Gradisbik, S., Mena, I., Mikovits, J. A., Miwa, K., Murovska, M., Pall, M. L. and Stevens, S. (2011), Myalgic encephalomyelitis: International Consensus Criteria. Journal of Internal Medicine, 270: 327–338. doi: 10.1111/j.1365-2796.2011.02428.x

Abstract
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02428.x/abstract

Full text in html
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02428.x/full

Full text in PDF
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02428.x/pdf

Or Open PDF here:  International ME Consensus Criteria

[2] DSM-5 Development: Somatic Symptom Disorders

http://www.dsm5.org/proposedrevision/Pages/SomaticSymptomDisorders.aspx

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