DSM-5 SSD work group

This page is awaiting revision.

Somatic Symptom Disorders

The DSM-5 Work Group which this site is monitoring and which has the most relevance for “Chronic fatigue syndrome”, CFS, “CFS/ME”, IBS, FM, Chemical Sensitivity (CS), Chemical Injury (CI), EI, GWS and chronic Lyme disease patient communities is the Somatic Symptom Disorders Work Group (SSD WG), at one point also known as the Somatic Distress Disorders Work Group, which has responsibilty for the revision of categories currently classified under Somatoform Disorders in DSM-IV.

Chronic fatigue syndrome is not categorized in DSM-IV and neither is Neurasthenia (ICD-10: Chapter V at F48.0). (Note that for the forthcoming US specific, Clinical Modification of ICD-10, ICD-10-CM, Neurasthenia is coded at F48.8.)

Many professionals within the field of liaison psychiatry and psychosomatics bundle CFS, “CFS/ME”, IBS, FM, CS, CI, EI, GWS and other disorders under the umbrella of the so-called “Functional Somatic Syndromes” (FSS) and “Medically Unexplained Syndromes” (MUS).

According to some psychiatrists, these so-called “functional syndromes” would “fall into the [DSM-IV] somatoform disorders category given their phenomenology, unknown physical causes, absence of reliable markers, and the frequent coexistence of somatic and psychiatric symptoms.” [1]

Somatic Symptom Disorders Work Group

The page above includes biosketches and disclosure information for each Work Group member. The group is chaired by Joel E Dimsdale, MD, who is also a member of the DSM-5 Task Force.

[1] Special Report: August 1, 2008: Humberto Marin, MD and Javier I. Escobar, MD Unexplained Physical Symptoms What’s a Psychiatrist to Do? Psychiatric Times. Vol. 25 No. 9

2006 Research Planning Conference: Somatic Presentations of Mental Disorders Symposium

In September 2006, in collaboration with WHO and NIH, the APA convened a diagnosis-related research planning conference focusing on “Somatic presentations of mental disorders”. Twenty-eight international researchers were invited to participate – the eighth in a series of thirteen conferences convened by the APA between 2004 and 2008.

Amongst those presenting at the Beijing Symposium were:

Ricardo Araya (Bristol, UK); Simon Wessely (KCL, London, UK); *Javier Escobar (New Jersey, US); *Richard Mayou (Oxford, UK); *Michael Sharpe (Edinburgh, UK); *Winfried Rief (Marburg, Germany), Norman Sartorius (WHO, Geneva, Switzerland) and *Kurt Kroenke (Indianapolis, US).

At the time, the five asterisked presenters were also members of the international CISSD (Conceptual Issues in Somatoform and Similar Disorders Project workgroup, co-ordinated by Dr Richard Sykes, PhD, between 2003 and 2007, Principal administrator: Action for M.E., Principal collaborator: Professor Rachel Jenkins, Director, WHO Collaborating Center, Institute of Psychiatry, London. (Dr Sykes is now engaged in the “MUPSS Project”, administered by the Institute of Psychiatry.)

Professor Kurt Kroenke and Professor Michael Sharpe served as the CISSD Project’s international and UK chairs. Javier Escobar is now a member of the DSM Revision Task Force; Professor Michael Sharpe is now a member of the Somatic Symptom Disorders Work Group.

Javier Escobar, MD, Director of the University of Medicine and Dentistry of New Jersey (UMDNJ) – Robert Wood Johnson Medical School (RWJMS) Medically Unexplained Physical Symptoms (MUPS) Research Center, which has been supported with over $4M in funding by the US National Institute of Mental Health (NIMH), is also a member of the DSM-5 Task Force. Dr Escobar serves as a Task Force liaison to the Somatic Symptom Disorders Work Group.

In November 2007, an Editorial and selected papers based on the Beijing Symposium presentations were published in: Psychosom Med 2007 69: 827-900. These are subscription papers, but summaries of the presentations and recommendations can be read on the APA’s DSM-5 Development pages. The Journal Editorial is free.

The monograph Somatic Presentations of Mental Disorders Refining the Research Agenda for DSM-V published by American Psychiatric Publishing Inc., summarises the proceedings of the 2006 Beijing Symposium and provides “a research landscape and literature resource for researchers and clinicians”. Edited by Joel E Dimsdale, MD, Yu Xin, MD, Arthur Kleinman, MD, Vikram Patel, PhD, William E Narrow, MD, MPH, Paul J Sirovatka, MS, and Darrel A Regier, MD, MPH. 2009 206 pages ISBN 9780890423424 Paperback.

This Google Books “Somatic Presentations of Mental Disorders Refining the Research Agenda for DSM-V” preview provides access to some chapters, including the papers by Professors Simon Wessely (Chapter 2, Page 9) and Javier Escobar and (Chapter 4, Page 41) resulting out of the Beijing Symposium presentations.

The revision process towards DSM-5 has spawned dozens of journal papers, editorials and conference presentations around the so-called “Somatoform Disorders”, and around the so-called “Functional Somatic Syndromes” and “Medically Unexplained Symptoms and Syndromes”.

Somatic Symptom Disorders Work Group

The 28 member DSM-5 Task Force set up 13 Work Groups which have been meeting since late 2007 to undertake the revision of DSM-IV. According to a November ’09 DSM-5 Work Group presentation, there are now 16 Work Groups, four study groups, a General Medical Interface Study Group and ad hoc subcommittees. Work Groups also draw on external advisers whose names are not being disclosed by the APA.

Within the field of liaison psychiatry and psychosomatics, CFS, IBS, FM, CI, CS, EI and a number of other conditions, for example, chronic Lyme disease, are bundled under the so-called “Functional Somatic Syndromes” (FSS) and “Medically Unexplained Syndromes” (MUS) umbrellas.

According to some psychiatrists, these so-called “functional syndromes” would “fall into the [DSM-IV] somatoform disorders category given their phenomenology, unknown physical causes, absence of reliable markers, and the frequent coexistence of somatic and psychiatric symptoms.” [1]

The DSM-5 Work Group which this site is monitoring and that has the most relevance for the CFS, IBS, FM, EI, CS and CI patient communities is the Somatic Symptom Disorders Work Group (SSD WG), also known as the Somatic Distress Disorders Work Group, which has responsibilty for the revision of the DSM-IV categories currently classified under Somatoform Disorders.

Chronic fatigue syndrome is not categorized in DSM-IV and neither is Neurasthenia (ICD-10: Chapter V at F48.0) http://www.psychnet-uk.com/dsm_iv/dsm_iv_index.htm

The equivalent section in ICD-10 is Somatoform Disorders classified in ICD-10 Chapter V: Mental and Behavioural Disorders between codes F45 – F48.0.

This DSM-5 Development website page Somatic Symptom Disorders Work Group links to biosketches and CIO disclosure information for each Somatic Symptom Disorders Work Group member. Under the chairmanship of Joel E Dimsdale, MD, the nine Work Group members are:

Somatic Symptom Disorders Work Group

Dimsdale, Joel E., M.D.
Barsky III, Arthur J., M.D. *
Creed, Francis, M.D. *
Frasure-Smith, Nancy, Ph.D.
Irwin, Michael R., M.D.
Keefe, Francis J., Ph.D.
Lee, Sing, M.D.
Levenson, James L., M.D. *
Sharpe, Michael, M.D . *
Wulsin, Lawson R., M.D.

Four members of the Somatic Symptom Disorders Work Group (asterisked) were also members of the CISSD Project workgroup. Professor Michael Sharpe had served as the CISSD Project’s UK Chair.*

Javier Escobar, MD, Director of the University of Medicine and Dentistry of New Jersey (UMDNJ) – Robert Wood Johnson Medical School (RWJMS) Medically Unexplained Physical Symptoms (MUPS) Research Center, which has been supported with over $4M in funding by the US National Institute of Mental Health (NIMH), was also a member of the CISSD Project workgroup.

Dr Escobar serves as a Task Force liaison to the DSM-5 Somatic Symptom Disorders Work Group and is said to work closely with this group.

*Conceptual Issues in Somatoform and Similar Disorders Project (CISSD), was an unofficial private project undertaken between 2003 and 2007, initiated and co-ordinated by Dr Richard Sykes, PhD, former Director of Westcare UK; Principal Administrators, Action for M.E. Four members of the CISSD Project workgroup, Michael Sharpe, Arthur Barsky, Francis Creed and James Levenson have served on the DSM-5 Somatic Symptoms Disorders Work Group since 2007. A fifth member, Javier Escobar, is a member of the DSM-5 Task Force, the DSM-5 Psychiatric/General Medical Interface Study Group and serves as Task Force liaison to the DSM-5 SSD Work Group.

Study Groups

“As development on DSM-5 progressed, the importance of addressing cross-cutting issues relevant to all of the disorder work groups became increasingly evident. As a result, six DSM-5 Study Groups were formed to address these universal topic areas. Please click on the links below to learn more about the study groups and their members.”

Psychiatric/General Medical Interface Study Group

“The Psychiatric/General Medical Interface Study Group is chaired by Lawson R. Wulsin, M.D. The study group is examining the link between general medical disorders and psychiatric disorders. Given that most patients with mental illnesses are seen by primary care physicians, the study group aims to ensure that DSM-5 meets the needs of general medical practitioners and not just specialty mental health clinicians. The group is also developing revision strategies for the forthcoming DSM-5-PC, which is intended to be used in primary care settings. The members of the Psychiatric/General Medical Interface Study Group are listed below.”

Psychiatric/General Medical Interface Study Group Members

Wulsin, Lawson R., M.D. [Ed: Member, Somatic Symptoms Disorders Work Group]
Dahl, Ronald E., M.D.
Dimsdale, Joel E., M.D. [Ed: Chair, Somatic Symptoms Disorders Work Group]
Escobar, Javier I., M.D. [Ed: Member, Task Force and Liaison to SSD WG]
Jeste, Dilip V., M.D.
Kaufmann, Walter E., M.D.
Kreipe, Richard E., M.D.
Petersen, Ronald, Ph.D., M.D.
Reynolds, Charles F., M.D.
Segraves, Taylor R., M.D., Ph.D.
Walsh, Timothy B., M.D.

Professionals within the field and some of those who had served on previous Task Forces have criticised the APA for the infrequency of updates on the progress of the various Work Groups and for the lack of detail in the few reports that have been issued.

To date, the Somatic Symptom Disorders group has published just two brief progress reports on the APA’s DSM-5 webpages. There has been some information around the Work Group’s deliberations published in journals and elsewhere, if you know where to look.

To read these two reports and for information around the deliberations of the Somatic Symptom Disorders Work Group published via journal papers, editorials and workshop presentations, go to this Dx Revision Watch page:

DSM-5 Somatic Symptoms Disorders Work Group proposals

Current proposals by the Work Group can be read here on the DSM-5 Development site:

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

There are two key documents associated with the current proposals:

Key PDF documents as they stood in May 2011 [these are revisions of the January 2010 versions]

     Disorder Descriptions:  Disorder Descriptions   May 04, 2011

     Rationale/Validity:  Rationale Document   May 04, 2011

The third and final public review is expected to take place no later than May 2012.

[1] Special Report: August 1, 2008: Humberto Marin, MD and Javier I. Escobar, MD “Unexplained Physical Symptoms What’s a Psychiatrist to Do?” Psychiatric Times. Vol. 25 No. 9


Related material:

In the January 2010, Volume 16, Issue 1 edition of Advances in Psychiatric Treatment there were two editorials and an article around ICD-11 and DSM-V (DSM-5) revision classificatory issues. Read Abstract for the Sartorius Editorial here

Adv. Psychiatr. Treat., Jan 2010; 16: 1.

FROM THE EDITOR
Joe Bouch: Classification

Advances in Psychiatric Treatment (2010) 16: 2-9. doi:10.1192/apt.bp.109.007138

Editorial: Norman Sartorius
Revision of the classification of mental disorders in ICD-11 and DSM-V: work in progress

«Back to DSM-5 drafts page

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