Final day: Submissions to third DSM-5 stakeholder review

Page 2 Suzy Chapman J 00  Somatic Symptom Disorder

“The B-type criteria are crucial for a diagnosis of CSSD. These criteria in essence reflect disturbance in thoughts, feelings, and/or behaviors in conjunction with long standing distressing somatic symptoms. Whilst an exact threshold is perhaps arbitrary, considerable work suggests that the degree of functional impairment is associated with the number of such criteria. Using a threshold of 2 or more such criteria results in prevalence estimates of XXXX in the general population, XXXX in patients with known medical illnesses, and XXXX in patients who may previously have been considered to suffer from a somatoform illness. {text in development concerning impact of different thresholds for criteria B- from Francis}…”

An article by Woolfolk RL, Allen LA. Cognitive Behavioral Therapy for Somatoform Disorders. Standard and Innovative Strategies in Cognitive Behavior Therapy states:

“…To receive a diagnosis of complex somatic symptom disorder, patients must complain of at least one somatic symptom that is distressing and/or disruptive of their daily lives. Also, patients must have at least two [SC: now reduced to “at least one from the B type criteria” since evaluation of the CSSD field trials] of the following emotional/cognitive/behavioral disturbances: high levels of health anxiety, disproportionate and persistent concerns about the medical seriousness of the symptom(s), and an excessive amount of time and energy devoted to the symptoms and health concerns. Finally, the symptoms and related concerns must have lasted for at least six months.

“Future research will examine the epidemiology, clinical characteristics, or treatment of complex somatic symptom disorder as there is no published research on this diagnostic category.”

“…Just as for complex somatic symptom disorder, there is no published research on the epidemiology, clinical characteristics, or treatment of simple somatic symptom disorder.”

The following major changes to proposals are noted for the third draft for the “Somatic Symptom Disorder” category: to merge CSSD and SSSD; to drop the adjective “Complex”; to reduce the threshold for the B type cognitions from “at least two” from the B type criteria to “at least one”; to include three new optional Severity Specifiers: Mild; Moderate; Severe. 

That the “B type” criteria are considered highly subjective and problematic has been discussed in previous submissions. There are now particular concerns that the Work Group is proposing to lower the B type threshold.

  • Whilst it is welcomed that the SSD Chronicity criteria of > one month has been removed with the merging of SSSD with CSSD, it is of considerable concern that in order to accommodate SSSD within the CSSD criteria the B type threshold has been reduced from “at least two” to “at least one,” thereby potentially increasing prevalence.
  • It is of considerable concern that no data on prevalence estimates were available for the second review; that no data on impact of different thresholds for the B type criteria and prevalence estimates has been published with the third review; that there is no published research on the epidemiology, clinical characteristics or treatment of this new construct “somatic symptom disorder.”

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