Category Archives: Allen Frances

‘Somatic Symptom Disorder’ – the most ubiquitous mental health diagnosis you never heard of

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‘Somatic Symptom Disorder’ – the most ubiquitous mental health diagnosis you never heard of

Lead psychiatrist for DSM-IV voices opposition to DSM-5′s new ‘catch-all’ criteria in BMJ, today

Post #229 Shortlink: http://wp.me/pKrrB-2GI

Update: Rapid Responses to the BMJ article can be read here:

http://www.bmj.com/content/346/bmj.f1580?tab=responses

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The opinion piece published under BMJ’s “Personal View” section, on Wednesday, is now featured in this week’s “Editor’s Choice”:

http://www.bmj.com/content/346/bmj.f1918

Editor’s Choice
US Editor’s Choice

DSM-5 and the rough ride from approval to publication

BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f1918 (Published 22 March 2013)

Edward Davies, US news and features editor, BMJ

Update: Media coverage for BMJ article:

Times of India

Eat or surf a lot? You risk being labelled mentally ill

Malathy Iyer, TNN | Mar 24, 2013

…Earlier this week, American psychiatrist Allen Frances, who helped devise the fourth edition of the manual (DSM-IV), lashed out against the new installment in the British Medical Journal. “It risks mislabelling a sizeable number of population as mentally ill,” Frances wrote.

He is disturbed about a new introduction called ‘somatic symptom disorder’ that will need only one bodily symptom distressing or disrupting daily life for about six months. “This new category will extend the scope of mental disorder classification by eliminating the requirement that somatic symptoms must be medically unexplained,” he wrote. In a field trial study to check for somatic symptom disorder, the results included 15% of patients with cancer or heart disease and 26% with irritable bowel syndrome or fibromyalgia. “The rate of psychiatric disorder among medically ill patients is unknown, but these rates seem high,” added Frances.

Doctors in India are not too supportive of the somatic symptom disorder…

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Medscape Medical News > Psychiatry

DSM-5 Somatic Symptom Disorder Debate Rages On

Deborah Brauser | March 21, 2013

The inclusion of the new somatic symptom disorder category in the soon-to-be-released Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) continues to spark heated debate in the field of psychiatry.

In a “Personal View” published online March 19 in BMJ, Allen Frances, MD, writes that the new disorder could result in “inappropriate diagnoses of mental disorder and inappropriate medical decision making” and urged clinicians to ignore the category completely…

…”The proposed diagnosis is unsupported by any substantial evidence on its likely validity and safety and was strongly opposed by patients, families, caregivers, and advocacy organizations,” he writes.

“Every diagnostic decision is a delicate balancing act between definitions that will result in too much versus too little diagnosis — the DSM-5 work group chose a remarkably sensitive definition that is also remarkably non-specific.”

He adds that clinicians should just ignore this classification altogether…

(Free registration for access to full article.)

Rheumatology Update

New ‘somatic symptom disorder’ captures fibromyalgia

Tony James | March 22, 2013

The new diagnosis of ‘somatic symptom disorder’ due for inclusion in the American Psychiatric Association’s updated diagnostic manual will capture up to a quarter of fibromyalgia patients…

Psychiatry Update (Australia)

Clinicians urged to ignore DSM-5 ‘somatic symptom disorder’

Tony James | March 20, 2013

The chair of the DSM-IV task force has told clinicians to ignore the new diagnosis of ‘somatic symptom disorder’ in DSM-5.

In a strongly-worded critique in this week’s BMJ, Professor Frances said that every diagnostic decision was a delicate balancing act between over-diagnosis and under-diagnosis…

“…The diagnosis of somatic symptom disorder is based on subjective and difficult to measure cognitions that will enable a ‘bolt-on’ diagnosis of mental disorder to be applied to all medical conditions, irrespective of cause.”

Field trials had shown that the new definition captured 15% of patients with cancer or heart disease and 26% with irritable bowel syndrome or fibromyalgia.

(Registered Medical Practitioner site; registration required for access to full article.)

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Inform 21

Un nuevo trastorno podría clasificar a millones de personas como enfermos mentales

March 21, 2013

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UK Times

The Times Mental Health

Psychologists to fight new list of mental illnesses

Martin Barrow, Health Editor | March 21, 2013

Everyday Health

Why Obsessing Over Physical Symptoms Could Equal Mental Illness

A psychiatrist argues in a new paper that a change in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) could lead to misdiagnosis of people with cancer and heart disease as mentally ill.

Jaimie Dalessio | Everyday Health Staff Writer | March 20, 2013

Come May, everyone with chronic medical illness or long-term pain – from cancer to coronary disease, MS to myalgia, becomes a potential candidate for a new mental health label.

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On Wednesday, BMJ publishes a commentary on the DSM-5 ‘Somatic Symptom Disorder’ by Allen Frances, MD, who chaired the Task Force for DSM-IV, with contribution from Dx Revision Watch:

http://www.bmj.com/uk/comment

Full article available without subscription, here:

http://www.bmj.com/content/346/bmj.f1580

PDF here:

http://www.bmj.com/highwire/filestream/636761/field_highwire_article_pdf/0/bmj.f1580.full.pdf

PERSONAL VIEW

The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill

This new condition suggested in the bible of mental health diagnoses lacks specificity, says Allen Frances

Allen Frances chair of the DSM-IV task force

The fuzzy boundary between psychiatry and general medicine is about to experience a seismic shift. The next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is scheduled for release this May amid controversy about many of its new disorders. Among these, DSM-5 introduces a poorly tested diagnosis—somatic symptom disorder—which risks mislabeling a sizeable proportion of the population as mentally ill…

BMJ Media release will be available here:

http://group.bmj.com/group/media/latest-news

Psychiatric creep

For DSM-5, the somatoform disorders section is being dismantled and four rarely used disorders are being replaced by a single new diagnosis, ‘Somatic Symptom Disorder.’

Out go DSM-IV’s rigorous criteria sets and the requirement for multiple symptoms to be medically unexplained; in comes a far looser definition that doesn’t distinguish between ‘medically unexplained’ symptoms or somatic symptoms in association with diagnosed medical illness.

From May, patients with common diseases like cancer, angina, diabetes or multiple sclerosis; with long-term pain, chronic illnesses like irritable bowel syndrome, fibromyalgia or CFS, or with unexplained conditions that have so far presented with somatic (bodily) symptoms of unclear cause may qualify for an additional mental disorder diagnosis of ‘Somatic Symptom Disorder’ if the clinician considers they also meet the criteria for ‘Somatic Symptom Disorder,’ and may benefit from treatment.

The SSD criteria set focuses on the psychological impact of persistent, distressing bodily symptoms on the patient’s thoughts, feelings and behaviors and the degree to which their response is considered ‘disproportionate’ or ‘excessive.’

As the criteria stand, this new disorder will potentially result in a ‘bolt-on’ mental health diagnosis being applied to all chronic illnesses and medical conditions if the clinician decides the patient’s response to distressing symptoms is ‘excessive’ or their coping strategies are ‘maladaptive,’ or that they are ‘catastrophising’ or displaying ‘fear avoidance.’ Or if the practitioner feels the patient is spending too much time on the internet researching data, symptoms and treatments, or that their lives have become ‘dominated’ by ‘illness worries,’ they may be vulnerable to an additional diagnosis of SSD.

Patients with chronic, multiple bodily symptoms due to rare conditions or multi-system diseases like Behçet’s syndrome or Systemic lupus, which may take several years to diagnose, will also be vulnerable to misdiagnosis with a mental disorder.

There is no substantial body of research to support the validity, reliability or safety of the ‘Somatic Symptom Disorder’ diagnosis.

During the second public review of draft criteria for DSM-5, the ‘Somatic Symptom Disorder’ section received more submissions from advocacy organizations, patients, and professionals than almost any other disorder category. But rather than tighten up the criteria or subject the entire disorder section to independent scientific review, the SSD Work Group’s response has been to lower the threshold even further – potentially pulling even more patients under a mental disorder label.

The ‘Somatic Symptom Disorder’ Work Group rejected eleventh hour calls from professionals and patients to review its criteria before going to print.

APA says there will be opportunities to reassess and revise DSM-5s new disorders, post publication, and that it intends to start work on a ‘DSM-5.1′ release. Patient groups, advocates and professionals are not reassured by a ‘publish first – patch later’ approach to science.

Notes for media, websites, bloggers:

1. The next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will be published by American Psychiatric Publishing Inc. in May 2013. It will be known as ‘DSM-5′ and has been under development since 1999.
http://www.dsm5.org/Pages/Default.aspx
http://www.dsm5.org/Documents/DSM%205%20development%20factsheet%201-16-13.pdf

2. The American Psychiatric Association (APA) has spent $25 million on the development of DSM-5.

3. The Diagnostic and Statistical Manual of Mental Disorders is used by mental health and medical professionals for diagnosing and coding mental disorders. It is used by psychiatrists, psychologists, therapists, counselors, primary health care physicians, nurses, social workers, occupational and rehabilitation therapists and allied health professionals.

The DSM is also used for medical insurance reimbursement and informs government, public health policy, courts and legal specialists, education, forensic science, prisons, drug regulation agencies, pharmaceutical companies and researchers. Diagnostic criteria defined within DSM determine what is considered a mental disorder and what is not, which treatments and therapies health insurers will authorise funding for, and for how long.

4. Four existing disorder categories in the DSM-IV ‘Somatoform Disorders’ section: somatization disorder [300.81], hypochondriasis [300.7], pain disorder, and undifferentiated somatoform disorder [300.82] will be eliminated and replaced with a single new category – ‘Somatic Symptom Disorder’ for DSM-5.

5. APA has held three stakeholder comment periods during which professional and public stakeholders have been invited to submit comment on the proposals for the revision of DSM-IV categories and criteria (in February-April 2010; May-June 2011; May-June 2012).

6. DSM-5 is slated for release at the American Psychiatric Association’s 166th Annual Meeting, San Francisco (May 18-22, 2013). The new manual is available for pre-order and will cost $199: http://www.psychiatry.org/dsm5

7. Allen Frances, MD, was chair of the DSM-IV Task Force and of the Department of Psychiatry at Duke University School of Medicine, Durham, NC; Dr Frances is currently professor emeritus, Duke.

8. Dr Frances blogs at DSM 5 in Distress, and Saving Normal at Psychology Today.

Mislabeling Medical Illness As Mental Disorder was published on December 8, 2012

Bad News DSM-5 Refuses To Correct Somatic Symptom Disorder was published on January 16, 2013

For additional information on ‘Somatic Symptom Disorder’:

Somatic Symptom Disorder could capture millions more under mental health diagnosis by Suzy Chapman for Dx Revision Watch, May 26, 2012

Suzy Chapman

DSM-5 Round up: March #1

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DSM-5 Round up: March #1

Post #229 Shortlink: http://wp.me/pKrrB-2H2

New York Times

Letter to the Editor

RONALD PIES
Lexington, Mass., March 18, 2013

The writer is a professor of psychiatry at SUNY Upstate Medical University and Tufts University.

Letter
Invitation to a Dialogue: Psychiatric Diagnoses

Published: March 19, 2013

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Macleans Canada

Normal behaviour, or mental illness?

Temper tantrum, or ‘disruptive mood dysregulation disorder’? A look at the new psychiatric guidelines that are pitting doctors against doctors

Anne Kingston | Tuesday, March 19, 2013

…Under the new “somatic symptom disorder” (SSD), for instance, people who express any anxiety about physical symptoms could also be saddled with a mental illness diagnosis, which could thwart their attempts to have their physical issues taken seriously. To meet the definition one only needs to report a single bodily symptom that’s distressing and/or disruptive to daily life and have just one of the following three reactions for at least six months: “ ‘disproportionate’ thoughts about the seriousness of their symptom(s); a high level of anxiety about their health; devoting excessive time and energy to symptoms or health concerns.”

Continue reading →

APA website: New documents and videos on ‘Somatic Symptom Disorder; article: Psychiatric News

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APA website: New documents and videos on ‘Somatic Symptom Disorder; article: Psychiatric News

Post #228 Shortlink: http://wp.me/pKrrB-2Gi

Updates at March 7

Article in Die Psychiatrie

Somatic Symptom Disorders: a new approach in DSM-5

J. E. Dimsdale, University of California, San Diego, DSM Task force, Somatic Symptoms Work Group

Die Psychiatrie 2013; 10: 30–32

Summary

Following a brief historic discourse, problems with the current use and concepts the of somatoform disorders are described. The rationale for substituting the term “somatoform” with “somatic symptom” in DSM5 is explained and the new classification criteria for the group of “somatic symptom related disorders” are described, which include severity ratings.

A special aspect is that “Illness anxiety disorder” is introduced as a new diagnostic entity in DSM-5.

“Störung mit somatischen Symptomen”: ein neuer Ansatz in DSM-5

Zusammenfassung

Nach einem kurzen historischen Diskurs werden die Problembereiche und die Konzepte der somatoformen Störungen erläutert. Das Rational für einen Ersatz der “somatoformen” Störung durch eine “Störung mit somatischen Symptomen” in DSM5 wird erläutert. Die Klassifikationskriterien der Gruppe der “Störungen mit somatischen Symptomen” wird dargestellt.

Ein besonderer Aspekt ist die Einführung einer “Erkrankungsangst-Störung” in DSM-5.

Full paper can be downloaded here: http://bit.ly/W7filu

Doug Bremner, MD, comments on ‘Somatic Symptom Disorder’ here:

DSM-5 Somatic Symptoms Disorder is Going to Make Us All Mental

Doug Bremner | February 12, 2013

 

A number of new documents and short videos on ‘Somatic Symptom Disorder’ have been published on the APA’s new webpages, plus an article in Psychiatric News, published on March 1.

These are followed by recent, mainstream media coverage of concerns for all illness groups for the implications of misdiagnosis with ‘Somatic Symptom Disorder’ or for an additional diagnosis of ‘Somatic Symptom Disorder.’

http://www.psychiatry.org/practice/dsm/dsm5/dsm-5

Fact Sheet: Click link for PDF document   Somatic Symptom Disorder

Videos:

Joel E Dimsdale, Chair, DSM-5 Somatic Symptom Disorders Work Group

What is Somatic Symptom Disorder?

http://www.psychiatry.org/practice/dsm/dsm5/dsm-5-video-series-somatic-symptom-disorder

What was the rationale behind changes to Somatic Symptom Disorder?

http://www.psychiatry.org/practice/dsm/dsm5/dsm-5-video-series-changes-to-somatic-symptoms

Will Somatic Symptom Disorder result in the missing of other medical problems?

http://www.psychiatry.org/practice/dsm/dsm5/dsm-5-video-series-somatic-symptom-disorder-and-other-medical-problems

Article: Psychiatric News (organ of the APA):

http://psychnews.psychiatryonline.org/newsArticle.aspx?articleid=1659603

Psychiatric News | March 01, 2013
Volume 48 Number 5 page 7-7
10.1176/appi.pn.2013.3a26
American Psychiatric Association
Professional News

Somatic Chapter Drops Centrality Of Unexplained Medical Symptoms

Mark Moran

“…But Joel Dimsdale, M.D., chair of the Somatic Symptom and Related Disorders Work Group, emphasized that the most important change overall in this set of disorders is removal of the centrality of medically unexplained symptoms. “That was a defining characteristic of these disorders in DSM-IV, but we believe it was unhelpful and promoted a mind-body dualism that is hard to justify,” he told Psychiatric News.

So, for instance, the diagnosis of somatization disorder in DSM-IV was based on a long and complex symptom count of medically unexplained symptoms. DSM-5 criteria eliminate that requirement and recognize that individuals who meet criteria for somatic symptom disorder—the new designation, marked by disproportionate thoughts, feelings, and behaviors related to somatic symptoms—may or may not have a medically diagnosed condition.

Hypochondriasis has been eliminated; most individuals who would previously have been diagnosed with hypochondriasis have significant somatic symptoms in addition to their high health anxiety and should receive a DSM-5 diagnosis of somatic symptom disorder. Those with high health anxiety without somatic symptoms should receive a diagnosis of illness anxiety disorder…

Read full article here

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Related material

Dimsdale JE. Medically Unexplained Symptoms: A Treacherous Foundation for Somatoform Disorders? Psychiatr Clin North Am, Volume 34, Issue 3, Pages 511-513 [PUBMED 21889675]

Overlapping Conditions Alliance (OCA)

“Members of the Overlapping Conditions Alliance (OCA) produced a white paper, Chronic Pain in Women: Neglect, Dismissal and Discrimination, to promote awareness and research of neglected and poorly understood chronic pain conditions that affect millions of American women. This report, which can be viewed and downloaded below, includes detailed policy recommendations to further these goals.” (Report 2010 and Report 2011)

http://www.endwomenspain.org/resources/policy-analysis-recommendations

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Recent mainstream media coverage of the SSD issue

ABC News Radio:
Guidelines for Diagnosing Psychiatric Disorder May Overlook Physical Illnesses

ABC News:
New Psych Disorder Could Mislabel Sick as Mentally Ill

Canada.com and syndicated to a number of other Canadian media sites:
New “catch all” psychiatric disorder could label people who worry about their health as mentally ill

Fox News Health:
Does somatic symptom disorder really exist?

DSM-5 Task Force Chair, David J Kupfer, MD, defends the SSD construct on Huffington Post (but provides no answers to my questions):

David J. Kupfer, M.D. Chair, DSM-5 Task Force

Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care

DSM-5 Round up: February #2

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DSM-5 Round up: February #2

Post #226 Shortlink: http://wp.me/pKrrB-2FC

Front page National Post, syndicated to Ottawa Citizen, Vancouver Sun, Montreal Gazette, Edmonton Journal and others. With contributions from Allen Frances, MD, Professor Frank Farley, Suzy Chapman.

New “catch all” psychiatric disorder could label people who worry about their health as mentally ill

Sharon Kirkey | February 18, 2013

A controversial new mental diagnosis could label thousands of people with legitimate medical illnesses as psychiatrically sick and in need of treatment if they worry “excessively” about their symptoms, observers says.

The newest version of psychiatry’s official catalogue of mental disorders, due to be published in May, will contain a newly expanded definition of “somatic symptom disorder,” or SSD.

Under the previous edition of the Diagnostic and Statistical Manual of Mental Disorders — an influential guidebook used by doctors around the globe — somatoform disorders applied to people with medically unexplained health complaints. The diagnosis required that physical, bodily symptoms couldn’t be traced to any identifiable, underlying medical cause.

In the fifth and latest edition of the manual, known as DSM-5, that proviso has been removed.

The new diagnosis doesn’t distinguish between “medically unexplained” symptoms or symptoms related to an actual underlying medical problem…

The Hindu

In search of a revolutionary road

K.S. Jacob | February 16, 2013

UK Times

Anna Maxted | February 19, 2013

In America, the bereaved may now be diagnosed with depression.

Experts here are appalled, says Anna Maxted (with contributions from Professor Peter Kinderman, head of the Institute of Psychology, Health and Society at the University of Liverpool, Debbie Kerslake, chief executive, Cruse Bereavement Care, Kathleen Walton).

Psychomédia

Accueil ›

DSM-5 : une catégorie controversée de troubles de symptôme somatique remplace les troubles somatoformes

Soumis par Gestion le 18 février 2013

DSM-5
Actualités
Troubles de symptôme somatique (somatoformes)

La prochaine édition du Manuel diagnostique et statistique des troubles mentaux (1) (DSM-5) dont la publication par l’American Psychiatric Association (APA) est prévue pour mai 2013, remplace la catégorie des troubles somatoformes par la catégorie troubles de symptômes somatiques.

Les troubles somatoformes du DSM-IV incluent la somatisation, la conversion, le trouble douloureux, l’hypocondrie et la peur d’une dysmorphie corporelle. Ces troubles, explique le psychiatre David J. Kupfer, qui a dirigé les travaux de révision, sont caractérisés par la présence de symptômes évocateurs d’une maladie ou d’une blessure physique, mais qui ne peuvent être entièrement être expliqués par une affection médicale générale, un autre trouble mental, ou par des effets secondaires de médicaments ou de substances. Les symptômes entraînent une grande détresse ou d’importantes perturbations de la capacité à fonctionner dans la vie quotidienne…

Psychomédia avec sources:
- David J. Kupfer, Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care
- Allen Frances, DSM-5 Refuses to Reduce Overdiagnosis of ‘Somatic Symptom Disorder’

DSM-5 goes to press with ‘Somatic Symptom Disorder’ amid widespread professional and consumer concern

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DSM-5 goes to press with ‘Somatic Symptom Disorder’ amid widespread professional and consumer concern

Post #224 Shortlink: http://wp.me/pKrrB-2EV

Update: On February 8, David J. Kupfer, MD, Chair, DSM-5 Task Force, published in defence of the ‘Somatic Symptom Disorder’ category on Huffington Post:

Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care

Last week, the American Psychiatric Association sent the next edition of its Diagnostic and Statistical Manual of Mental Disorders to the publishers.

When DSM-5 is released in May, it will introduce a new ‘catch-all’ diagnosis that could capture many thousands more patients under a mental disorder label.

Today, on Saving Normal at Psychology Today, Allen Frances, MD, who chaired the DSM-IV Task Force, publishes the third in a series of commentaries voicing considerable concern for all illness groups for the implications of an additional diagnosis of ‘Somatic Symptom Disorder.’

Why Did DSM 5 Botch Somatic Symptom Disorder?

Allen Frances writes:

“Once it is an official DSM 5 mental disorder, SSD is likely to be widely misapplied – to 1 in 6 people with cancer and heart disease and to 1 in 4 with irritable bowel syndrome and fibromyalgia…The definition of SSD is so loose it will capture 7% of healthy people (14 million in the US alone) suddenly making this pseudo diagnosis one of the most common of all ‘mental disorders’ in the general population.”

Suzy Chapman writes:

“These highly subjective, difficult to assess criteria have the potential for widespread misapplication, particularly in busy primary care settings – causing stigma to the medically ill and potentially resulting in poor medical workups, inappropriate treatment regimes and medico-legal claims against clinicians for missed diagnoses.

“Why has the Task Force and APA Board of Trustees been prepared to sign off on a definition and criteria set that lacks a body of rigorous evidence for its validity, safety and prevalence, thereby potentially putting the public at risk? And why is APA prepared to abrogate its duty of care as a professional body and expose its membership, physicians and the allied health professional end-users of its manual to the risk of potential law suits?”

From May, an additional mental health diagnosis of ‘Somatic Symptom Disorder’ (SSD) can be applied whether patients have diagnosed medical diseases like diabetes, angina, cancer or multiple sclerosis, chronic illnesses like IBS, fibromyalgia, chronic fatigue syndrome or chronic pain disorders, or unexplained conditions that have so far presented with bodily symptoms of unclear etiology.

A person will meet the criteria for ‘Somatic Symptom Disorder’ by reporting just one or more bodily symptoms that are distressing or disruptive to daily life, that have persisted for at least six months, and having just one of the following three responses:

1) disproportionate, persistent thoughts about the seriousness of their symptoms;
2) persistently high level of anxiety about their health or symptoms;
3) devoting excessive time and energy to symptoms or health concerns.

In the DSM-5 field trials, 15% of the ‘diagnosed illness’ study group (the trials looked at patients with either cancer or coronary heart disease) met the criteria for an additional mental health diagnosis of SSD.

26% of patients who comprised the irritable bowel syndrome or fibromyalgia study group were coded for SSD.

A disturbingly high 7% of the ‘healthy’ control group were also caught by these overly-inclusive criteria.

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Psychiatric creep

As the criteria stand, this new disorder will potentially result in a ‘bolt-on’ mental health diagnosis being applied to all chronic illnesses and medical conditions if the clinician decides the patient’s response to distressing symptoms is ‘excessive’ or their coping strategies are ‘maladaptive,’ or that they are ‘catastrophising’ or displaying ‘fear avoidance.’ Or if the practitioner feels the patient is spending too much time on the internet researching data, symptoms and treatments, or that their lives have become ‘dominated’ by ‘illness worries,’ they may be vulnerable to an additional diagnosis of SSD.

Patients with chronic, multiple bodily symptoms due to rare conditions or multi-system diseases like Behçet’s syndrome or Systemic lupus, which may take several years to diagnose, will also be vulnerable to misdiagnosis with a mental disorder.

There is no substantial body of research to support the validity, reliability or safety of the ‘Somatic Symptom Disorder’ diagnosis.

During the second public review of draft criteria for DSM-5, the ‘Somatic Symptom Disorder’ section received more submissions from advocacy organizations, patients, and professionals than almost any other disorder category. But rather than tighten up the criteria or subject the entire disorder section to independent scientific review, the SSD Work Group’s response has been to lower the threshold even further – potentially pulling even more patients under a mental disorder label.

The ‘Somatic Symptom Disorder’ Work Group has rejected eleventh hour calls from professionals and patients to review its criteria before going to print.

APA says there will be opportunities to reassess and revise DSM-5‘s new disorders, post publication, and that it intends to start work on a ‘DSM-5.1′ release. But patient groups, advocates and professionals are not reassured by a ‘publish first – patch later’ approach to science.

Read Parts One and Two, here:

Part One: Mislabeling Medical Illness As Mental Disorder | Allen Frances, December 8, 2012

Part Two: Bad News DSM-5 Refuses To Correct Somatic Symptom Disorder | Allen Frances, January 16, 2013

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Notes for media, websites, bloggers:

1. The next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will be published by American Psychiatric Publishing Inc. in May 2013. It will be known as ‘DSM-5 ‘ and has been under development since 1999.
http://www.dsm5.org/Pages/Default.aspx
http://www.dsm5.org/Documents/DSM%205%20development%20factsheet%201-16-13.pdf

2. The American Psychiatric Association (APA) has spent $25 million on the development of DSM-5.

3. The Diagnostic and Statistical Manual of Mental Disorders is used by mental health and medical professionals for diagnosing and coding mental disorders. It is used by psychiatrists, psychologists, therapists, counselors, primary health care physicians, nurses, social workers, occupational and rehabilitation therapists and allied health professionals.

The DSM is also used for reimbursement and informs government, public health policy, courts and legal specialists, education, forensic science, prisons, drug regulation agencies, pharmaceutical companies and researchers. Diagnostic criteria defined within DSM determine what is considered a mental disorder and what is not, which treatments and therapies health insurers will authorise funding for, and for how long.

4. Four existing disorder categories in the DSM-IV ‘Somatoform Disorders’ section: somatization disorder [300.81], hypochondriasis [300.7], pain disorder, and undifferentiated somatoform disorder [300.82] will be eliminated and replaced with a single new category – ‘Somatic Symptom Disorder’ for DSM-5.

5. APA has held three stakeholder comment periods during which professional and public stakeholders have been invited to submit comment on the proposals for the revision of DSM-IV categories and criteria (in February-April 2010; May-June 2011; May-June 2012).

6. DSM-5 is slated for release at the American Psychiatric Association’s 166th Annual Meeting, San Francisco (May 18-22, 2013). The new manual is available for pre-order and will cost $199: http://www.psychiatry.org/dsm5

7. Allen Frances, MD, was chair of the DSM-IV Task Force and of the Department of Psychiatry at Duke University School of Medicine, Durham, NC; Dr Frances is currently professor emeritus, Duke.

8. Dr Frances blogs at DSM 5 in Distress, and Saving Normal at Psychology Today.

Mislabeling Medical Illness As Mental Disorder was published on December 8, 2012

Bad News DSM-5 Refuses To Correct Somatic Symptom Disorder was published on January 16, 2013

For additional information on ‘Somatic Symptom Disorder’:

Somatic Symptom Disorder could capture millions more under mental health diagnosis by Suzy Chapman for Dx Revision Watch, May 26, 2012

Suzy Chapman

Deutschlandfunk Radio: Wissenschaft Im Brennpunkt: Störungswahn? DSM-5 with Allen Frances

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Deutschlandfunk Radio: Wissenschaft Im Brennpunkt: Störungswahn? (DSM-5) with Allen Frances, MD

Post #223 Shortlink: http://wp.me/pKrrB-2EH

Flash:
http://www.dradio.de/dlf/sendungen/wib/1990949

Mp3 (12MB):
http://ondemand-mp3.dradio.de/file/dradio/2013/02/03/dlf_20130203_1630_c745d088.mp3

Deutschlandfunk Radio

http://www.dradio.de/dlf/sendungen/wib/1990949/

27:21 mins

WISSENSCHAFT IM BRENNPUNKT (Science In Focus)
03.02.2013

Störungswahn? (Delusional disorder?)

Psychiater streiten um die Zukunft ihres Fachs (Psychiatrists argue about the future of their profession)

Von Martin Hubert with contributions from Allen Frances, MD, and others

In einigen Monaten erscheint das neue amerikanische Handbuch zur Diagnose psychiatrischer Krankheiten, das “DSM-5″. Aber schon heute erzeugt es heftigen Streit. Denn das “DSM-5″ wird die Entwicklung der Psychiatrie auf Jahre hinaus wesentlich beeinflussen.

Kritiker meinen, dass es zu viel neue und überflüssige Störungsbilder enthalte. Außerdem definiere es Störungen oft so weich, dass auch Durchschnittsmenschen künftig zum psychiatrischen Fall würden. Die Verteidiger des Handbuchs kontern: Es habe in der Geschichte immer wieder neue Störungen gegeben, auf die die Psychiater zu reagieren hätten. Außerdem seien weiche Kriterien nötig, um Risikopatienten früh erkennen und therapieren zu können. Wann ist ein Patient wirklich gefährdet – und wann leiden die Psychiater selbst unter Störungswahn? Der Streit zeigt, in welche Richtung sich die Psychiatrie insgesamt entwickeln könnte.

Weiterführende Links:

Seiten des Deutschlandradios:

Links ins Netz:

Brief update on DSM-5 ‘Somatic Symptom Disorder’

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Brief update on DSM-5 ‘Somatic Symptom Disorder’

Post #221 Shortlink: http://wp.me/pKrrB-2Dd

As previously reported, all draft proposals for categories and criteria for DSM-5 were frozen on the DSM-5 Development website on June 15, 2012, immediately following the closure of the third and final stakeholder review and comment period.

Changes made to the draft after June 15, 2012 are embargoed and final disorder descriptions and criteria sets won’t be evident until DSM-5 is released, in May, this year, unless APA elects to release selected information.

The manual texts that expand on the various disorder sections and the categories that sit within them have not been made public at any stage in the development process. It is understood that for the ‘Somatic Symptom Disorders’ group, for example, the manual text that accompanies these new categories and criteria sets will run to five or six pages.

On November 15, 2012, APA removed the entire third draft from the DSM-5 Development website.

According to this APA Permissions, Licensing & Reprints page, because the most recently posted draft [the third draft that was released on May 2, 2012] has undergone revisions and is no longer current, the criteria texts have been removed from the website in order to avoid confusion or use of outdated categories and definitions. [1]

The page also states that although APA Board of Trustees approved all the proposed diagnoses [in December, 2012] there continue to be minor editorial and content changes as APA moves towards the final stages of the publication process.

Although the DSM-5 Development Timeline has “Final Revisions by the APA Task Force; Final Approval by APA Board of Trustees; Submission to American Psychiatric Publishing, Inc” scheduled for December 2012, according to my sources, the manual texts were now expected to be finalized for the publishers by end of January.

 

DSM-5 Table of Contents

As also previously reported, APA has created new pages for information and resources for DSM-5, where a number of new articles and documents are available to download. [2][3]

http://www.psychiatry.org/dsm5

Documents include a DSM-5 Table of Contents which lists the disorder sections and the category terms that sit within them.

The DSM-5 Table of Contents reveals that changes to the overall section name for  the ‘Somatic Symptom Disorders’ categories and to the category names that sit within this section have been made since closure of the third and final draft.

For the overall disorder section name, DSM-5 will now be using

‘Somatic Symptom and Related Disorders’

rather than

‘Somatic Symptom Disorders’ as per the first, second and third drafts.

For the third draft, the 6 disorders proposed to sit under this disorder section were:

Somatic Symptom Disorders (SSD)

J 00 Somatic Symptom Disorder
J 01 Illness Anxiety Disorder
J 02 Conversion Disorder (Functional Neurological Symptom Disorder)
J 03 Psychological Factors Affecting Medical Condition
J 04 Factitious Disorder
J 05 Somatic Symptom Disorder Not Elsewhere Classified

7 categories are now listed (on Page 3) of the DSM-5 Table of Contents as follows:

Somatic Symptom and Related Disorders

Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder (Functional Neurological Symptom Disorder)
Psychological Factors Affecting Other Medical Conditions
Factitious Disorder
Other Specified Somatic Symptom and Related Disorder
Unspecified Somatic Symptom and Related Disorder

Other than these revisions to the SSD disorder section name and category names, there are no other texts disclosed within the DSM-5 Table of Contents. So whatever text is included for the latter two categories, ‘Other Specified Somatic Symptom and Related Disorder’ and ‘Unspecified Somatic Symptom and Related Disorder,’ isn’t known.

Whether any revisions have been made to the disorder descriptions and criteria for the five other disorders since the third draft proposals were posted is also unknown because of the embargo on disclosure of changes to categories and criteria beyond June 15, last year.

 

SSD Work Group asked to reconsider

In December, Allen Frances, MD, who had chaired the Task Force that had oversight of the development of DSM-IV, asked the SSD Work Group, key APA Board of Trustees members and Task Force Chairs to reconsider the proposals for specifically the ‘Somatic Symptom Disorder’ category. [4]

These representations were made in response to Dr Frances’ own considerable concerns, and those of lay and professional stakeholders, for the looseness of the SSD definition and criteria set, as it had stood at the third draft, and the absence of a body of robust evidence for the validity and safety of ‘SSD’ as a construct, and data on likely prevalence rates.

Dr Frances also proffered suggestions for revisions that he considered would tighten up the criteria and reduce the potential for misapplication.

The response on behalf of the work group was that although Dr Frances’ suggestions were discussed, the work group would not be revising their recommendations. [5]

It is not known whether the concerns raised by Dr Frances in December were discussed beyond the SSD Work Group with the DSM-5 Task Force or with the APA Board of Trustees, who are responsible for approving proposals and therefore accountable for the content of the forthcoming manual.

 

ICD-11 and DSM-5

In a January 18 article for Psychiatric News, organ of the APA, Mark Moran reports:

“Kupfer [DSM-5 Task Force Chair] said the classification of disorders is largely harmonized with the World Health Organization’s International Classification of Diseases (ICD) so that the DSM criteria sets are more parallel with the proposed ICD-11. In DSM-5 both the current ICD-9-CM and the future standard ICD-10-CM codes (scheduled for 2014) are attached to the relevant disorders in the classification.” [6]

As reported in my Dx Revision Watch post of January 6, at the time of writing, current proposals in the ICD-11 Beta draft have ICD-10′s ‘Somatoform Disorders’ replaced with ‘Bodily Distress Disorders, and Psychological and behavioural factors associated with disorders or diseases classified elsewhere,’ with three, as yet undefined, Severities of ‘Bodily Distress Disorder.’ [7]

It remains to be clarified whether ICD-11′s Beta draft proposals for three Severities of ‘Bodily Distress Disorder’ to replace six ICD-10 ‘Somatoform Disorders’ proposes to mirror Per Fink’s definition and criteria for ‘Bodily Distress Syndrome’ or are more closely aligned with DSM-5‘s ‘Somatic Symptom Disorder,’ in keeping with the APA and WHO’s joint commitment to strive, where possible, for harmonization between the category names, glossary descriptions and criteria across the two systems. [8]

(I shall be addressing this issue in a future post.)

I have previously reported that for ICD-11-PHC, the abridged, Primary Health Care version of ICD-11, the proposal, last year, was for a disorder section called ‘Bodily distress disorders,’ under which would sit ‘Bodily stress [sic] syndrome.’ [9]

According to Professor, Sir David Goldberg, this category is proposed for ICD-11 Primary Health Care version to include “milder somatic symptom disorders” as well as “DSM-5′s Complex somatic symptom disorder” and would replace “medically unexplained somatic symptoms.” These proposals are subject to rejection or modification following ICD-11 Field Trials. [10]

DSM-5 is scheduled for release at the APA’s 166th Annual Meeting (San Francisco, May 18-22).

 

References and related reports

1] American Psychiatric Publishing Permissions, Licensing & Reprints

2] New DSM-5 webpages

3] DSM-5 Table of Contents

4] Mislabeling Medical Illness As Mental Disorder: The Eleventh DSM-5 Mistake, Psychology Today, DSM5 in Distress, Allen Frances, MD, December 8, 2012

5] Bad News: DSM 5 Refuses to Correct Somatic Symptom Disorder, Psychology Today, DSM5 in Distress, Allen Frances, MD, January 16, 2012

6] Continuity and Changes Mark New Text of DSM-5, Psychiatric News, Volume 48, Number 2, January 18, 2013: pp. 1-6 

7] ICD-11 Beta Draft Public Version: Bodily Distress Disorders
http://apps.who.int/classifications/icd11/browse/l-m/en#/http%3a%2f%2fwho.int%2ficd%23F45

8] Fink P, Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture ten diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res 2010;68:415-26
http://www.ncbi.nlm.nih.gov/pubmed/20403500

9] Lam TP, Goldberg DP, Dowell AC, Fortes S, Mbatia JK, Minhas FA, Klinkman MS. Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study. Fam Pract 2012
http://www.ncbi.nlm.nih.gov/pubmed/22843638

10] Goldberg DP. Comparison Between ICD and DSM Diagnostic Systems for Mental Disorders. In: Sorel E, (Ed.) 21st Century Global Mental Health. Jones & Bartlett Learning, 2012: 37-53 [Free PDF Sample Chapter 2]

11] Somatic Symptom Disorder could capture millions more under mental health diagnosis, Suzy Chapman for Dx Revision Watch, May 26, 2012

American Psychiatric Association launches new pages for DSM-5 – DSM-5 to cost $199

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American Psychiatric Association (APA) launches new pages for DSM-5 – DSM-5 to cost $199

Post #220 Shortlink: http://wp.me/pKrrB-2CD

Unless you’ve had your head stuck in a bucket this last three years, you’ll be aware that the next edition of the American Psychiatric Association’s diagnostic manual is slated for release this May.

APA has spent $25 million on the development of DSM-5.

DSM-5 will be published by American Psychiatric Publishing Inc. and planned for release at the APA’s 166th Annual Meeting in San Francisco (May 18-22).

A hardback copy is going to set you back $199, though paid up members of the American Psychiatric Association are being offered a discount.

Psychiatrists, psychologists, primary health care physicians, therapists, counselors, social workers and allied health professionals don’t have to use DSM-5.

Instead, when codes are required they can use the codes in Chapter 5 of ICD-9-CM (Mental Disorders) and Chapter 5 of ICD-10-CM (Mental, Behavioral and Neurodevelopmental disorders), when ICD-10-CM is implemented*.

*Effective implementation date for ICD-10-CM (and ICD-10-PCS) is currently October 1, 2014. Until that time the codes in ICD-10-CM are not valid for any purpose or use.

Image Copyright Dx Revision Watch 2013

Don’t like it? Don’t use it. Use ICD codes instead.

Since 2003, ICD-9-CM diagnostic codes have been mandated for third-party billing and reporting by HIPAA for all electronic transactions for billing and reimbursement. The codes in DSM are crosswalked to ICD codes.

So you can use ICD-9-CM codes.

And when ICD-10-CM is implemented, it isn’t going to cost you a cent – it will be freely available on the internet.

The ICD-10-CM draft, currently subject to partial code freeze, and its associated documentation can be accessed here on the CDC site; so you can already have a poke around:

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)

On January 23, Allen Frances, MD, who had oversight of the Task Force that developed DSM-IV had this to say about the $199 manual:

Price Gouging: Why Will DSM-5 Cost $199 a Copy?

 

APA launches new pages for DSM-5

Last week the APA launched new pages to promote DSM-5.

Report by John Gever for Medpage Today:

Psych Group Posts Glimpses of Final DSM-5

John Gever, Senior Editor, MedPage Today | January 21, 2013

Peeks into the final DSM-5, the controversial new edition of the American Psychiatric Association’s diagnostic manual, are now available from the group prior to the guide’s official May 22 debut…

PR piece by Mark Moran for Psychiatric News, organ of the American Psychiatric Association:

Psychiatric News | January 18, 2013
Volume 48 Number 2 page 1-6
10.1176/appi.pn.2013.1b10
American Psychiatric Association
Professional News

Continuity and Changes Mark New Text of DSM-5

Mark Moran

The DSM-5 Task Force chair discusses conceptual themes driving changes to the new manual. This is the first in a series continuing through May that will summarize the diagnostic and organizational differences between DSM-IV and DSM-5.

DSM-5, approved by the APA Board of Trustees in December, reflects the “state of the clinical science” in psychiatric diagnosis, incorporating important findings from genetic, neurobiological, and treatment research, while also maintaining substantial continuity for maximum clinical utility…

Go here for the DSM-5 Collection.

Psychiatric News Alert, where those not intending to boycott DSM-5 are encouraged to explore and pre-order a copy ($199):

Psychiatric News Alert

Tuesday, January 22, 2013

New DSM-5 Series Includes Supplementary Information; Order Your Manual Now!

The new DSM-5 pages can be found here, with articles, fact sheets and videos:

http://www.psychiatry.org/dsm5

Documents include:

DSM-5 Table of Contents  [Lists disorder sections and the categories that sit under them.]

Changes to DSM-5

Continuity and Changes Mark New Text of DSM-5, Psychiatric News, January 18, 2013

Highlights of Changes from DSM-IV-TR to DSM-5
DSM-5 Provides New Take on Developmental Disorders, Psychiatric News, January 18, 2013

DSM-5 Fact Sheets

From Planning to Publication: Developing DSM-5
The People Behind DSM-5
The Organization of DSM-5

Making a Case for New Disorders
Autism Spectrum Disorder
Specific Learning Disorder
Intellectual Disability
Social Communication Disorder
Attention-Deficit/Hyperactivity Disorder

DSM-5 Video Series

How and why was DSM-5 developed?
What has been the goal for revising DSM-5?

What are the changes to autism spectrum disorder in DSM-5?
What will be the impact of DSM-5 changes to autism spectrum disorder?
What are the changes to learning disorder in DSM-5?
What will be the impact of the revised specific learning disorder diagnosis?

The APA’s DSM-5 Development site can still be found here DSM-5 Development.

Proposals for changes to DSM-IV categories and criteria, as they had stood at the third draft, were frozen on June 15, 2012.

Any revisions made to criteria sets following closure of the third and final comment period are subject to embargo and the DSM-5 Development site has not been updated to reflect changes made to categories and criteria beyond June 15.

The entire third draft of proposals was removed from the DSM-5 Development site on November 15.

You can read APA’s rationale for removing the draft on an updated Permissions, Licensing & Reprints page.

DSM-5 rejects call for urgent reconsideration of new “Somatic Symptom Disorder” category

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DSM-5 rejects call from lead psychiatrist for DSM-IV Task Force for urgent reconsideration of new “Somatic Symptom Disorder” category 

Post #219 Shortlink: http://wp.me/pKrrB-2C0

Today, Allen Frances, M.D., publishes a follow-up to our December 8 commentary in which we set out the implications for all chronic illness patient populations of misdiagnosis with “Somatic Symptom Disorder (SSD)” or misapplication of an additional diagnosis of “SSD.”

In the second of three commentaries, Dr Frances reports on the outcome of his representations to the DSM-5 Somatic Symptom Disorder Work Group, key APA Board of Trustees office holders and DSM-5′s Task Force chair and vice-chair, for urgent reconsideration of this new “catch-all” mental health disorder.

The texts for DSM-5 are expected to be finalized for the publishers by the end of this month.

Dr Frances’ first commentary on SSD is approaching 20,000 views and has received over 300 comments on Psychology Today, alone. It is also published at Huffington Post and at Education Update and widely circulated on other platforms.

There has been an overwhelming response to our concerns with comments pouring in from patients with diverse chronic illnesses and medical conditions including Ehlers-Danlos Syndrome, Interstitial Cystitis, Behcet’s disease, Endometriosis, Lupus, Hashimotos thyroid disorder, Hughes Syndrome, Pancreatitis and Chronic Lyme disease –patients whose symptoms had been dismissed for years before finally receiving a diagnosis or who are still struggling to obtain a diagnosis, many of whom had been mislabelled with a somatoform disorder.

We’ve also received many emails from patients and international patient organizations.

Please circulate this follow-up commentary. I am particularly keen to reach platforms for patients with common chronic diseases and conditions – cancer, heart disease, diabetes, COPD, MS, RA, chronic pain; also Lyme disease, chemical injury and rare diseases, IBS and Fibromyalgia, ME and CFS.

Allen Frances, M.D., was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.

Psychology Today

DSM5 in Distress

The DSM’s impact on mental health practice and research
by Allen Frances, M.D.

Published on January 16, 2013 by Allen J. Frances, M.D., in DSM5 in Distress

Bad News: DSM 5 Refuses To Correct Somatic Symptom Disorder
Medical Illness Will Be Mislabeled Mental Disorder

“Many of you will have read a previous blog prepared by Suzy Chapman and me that contained alarming information about the new DSM 5 diagnosis ‘Somatic Symptom Disorder.’

“SSD is defined so over inclusively by DSM 5 that it will mislabel 1 in 6 people with cancer and heart disease; 1 in 4 with irritable bowel and fibromyalgia; and 1 in 14 who are not even medically ill.

“I hoped to be able to influence the DSM 5 work group to correct this in 2 ways: 1) by suggesting improvements in the wording of the SSD criteria set that would reduce mislabeling; and 2) by letting them know how much opposition they would face from concerned professionals and an outraged public if DSM 5 failed to slam on the brakes while there was still time…”

Read on here:

Bad News: DSM 5 Refuses To Correct Somatic Symptom Disorder
Medical Illness Will Be Mislabeled Mental Disorder

 

The most recent proposals for new category “J 00 Somatic Symptom Disorder”

IASP and the Classification of Pain in ICD-11  Prof. Dr. Winfried Rief, University of Marburg, Germany

Slide 9

Ed: Note that the requirement for “at least two from the B type criteria” was reduced to “at least one from the B type criteria” for the third iteration of draft proposals. This lowering of the threshold is presumably in order to accommodate the merging of the previously proposed “Simple Somatic Symptom Disorder” category into the “Complex Somatic Symptom Disorder” category, a conflation now proposed to be renamed to “Somatic Symptom Disorder,” also the disorder section name. A revised “Rationale/Validity” PDF document was not issued for the third and final draft. A brief, revised “Rationale” text was published on a Tab Page for the Somatic Symptom Disorder proposal and criteria but is no longer accessible.

Proposals, criteria and rationales, as posted for the third draft in May 2012, were removed from the DSM-5 Development website on November 15, 2012 and placed behind a non public log in. Criteria as they had stood for the third draft can no longer be viewed but are set out on Slide 9 in this presentation, which note, does not include three, optional Severity Specifiers that were included with the third draft criteria.

 

Related material

Mislabeling Medical Illness As Mental Disorder: The Eleventh DSM-5 Mistake, Psychology Today, DSM5 in Distress, Allen Frances, MD, December 8, 2012

Somatic Symptom Disorder could capture millions more under mental health diagnosis, Suzy Chapman

Submission to Somatic Symptom Disorder Work Group in response to third draft proposals, Suzy Chapman

Additional commentary

Oak Park Behavioral Medicine, Mind Your Body blog

Moving in the Wrong Direction

Dr Tiffany Taft, Ph.D., Northwestern University, December 13, 2012

IBS Impact IBS Impact blog

Proposed DSM-5 Criteria May Unfairly Label Physical Conditions as Psychological Disorders

11th hour call: “Mislabeling Medical Illness As Mental Disorder” by Allen J. Frances, MD.

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11th hour call: “Mislabeling Medical Illness As Mental Disorder” by Allen J. Frances, MD.

Post #217 Shortlink: http://wp.me/pKrrB-2AL

Image Copyright Dx Revision Watch 2012On December 8, Allen J. Frances, MD, blogged at Psychology Today on our shared concerns for the new DSM-5 category – Somatic Symptom Disorder. Dr Frances was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus, Duke.

One in six people suffering from cancer, heart and other serious diseases risks being saddled with a psychiatric diagnosis if they are considered to be “excessively” worried about their illness or spending more time on the internet researching their symptoms than the American Psychiatric Association (APA) thinks good for them.

But many illness groups – particularly the so-called “functional somatic syndromes” – stand to be captured by these new criteria and assigned an additional mental health diagnosis, or placed at risk of misdiagnosis.

The DSM-5 manual texts are still being finalized and the Somatic Symptom Disorder Work Group has been asked to reconsider its criteria and tighten them up before the next edition of DSM is sent to the publishers.

Please demonstrate to the APA and the Somatic Symptom Disorder Work Group the level of concern amongst clinicians and allied health professionals, patients, caregivers and advocacy organizations by visiting Dr Frances’ blog post and leaving a comment. You can read the commentary at the link, below.

If you share our concerns that these catch-all criteria will see thousands more patients tagged with a mental health label please forward the link to your colleagues and contacts and post on Twitter, blogs and social media platforms.

Thank you,

Suzy Chapman for Dx Revision Watch

Mislabeling Medical Illness As Mental Disorder: The Eleventh DSM-5 Mistake

Psychology Today, DSM5 in Distress, Allen Frances, MD, December 8, 2012

Additional commentary

Oak Park Behavioral Medicine, Mind Your Body blog

Moving in the Wrong Direction

Dr Tiffany Taft, Ph.D., Northwestern University, December 13, 2012

IBS Impact IBS Impact blog

Proposed DSM-5 Criteria May Unfairly Label Physical Conditions as Psychological Disorders

The most recent proposals for new category “J 00 Somatic Symptom Disorder”

Ed: Proposals, criteria and rationales, as posted for the third stakeholder review and comment period, in May 2012, were removed from the DSM-5 Development website on November 15, 2012 and placed behind a non public log in. Criteria as they had stood for the third draft can no longer be viewed but are set out on Slide 9 in this presentation, which note, does not include the three, optional Severity Specifiers that were included in the third iteration.

Note that the requirement for “at least two from the B type criteria” was reduced to “at least one from the B type criteria” between the second and third set of draft proposals.

IASP and the Classification of Pain in ICD-11  Prof. Dr. Winfried Rief, University of Marburg,

Slide 9

Related material

Somatic Symptom Disorder could capture millions more under mental health diagnosis

Submission to Somatic Symptom Disorder Work Group in response to third draft proposals