Final day: Submissions to third DSM-5 stakeholder review

Page 3 Suzy Chapman J 00  Somatic Symptom Disorder

The group is proposing to operationalize an entirely new construct of its own devising, using highly subjective criteria for which no significant body of research into reliability, validity and safety has been published, that will capture adults, children, adolescents and elderly people with diverse illnesses.

The SSD Work Group’s framework “…will allow a diagnosis of somatic symptom disorder in addition to a general medical condition, whether the latter is a well-recognized organic disease or a functional somatic syndrome such as irritable bowel syndrome or chronic fatigue syndrome.”

“…These disorders typically present first in non-psychiatric settings and somatic symptom disorders can accompany diverse general medical as well as psychiatric diagnoses. Having somatic symptoms of unclear etiology is not in itself sufficient to make this diagnosis. Some patients, for instance with irritable bowel syndrome or fibromyalgia would not necessarily qualify for a somatic symptom disorder diagnosis. Conversely, having somatic symptoms of an established disorder (e.g. diabetes) does not exclude these diagnoses if the criteria are otherwise met.” [1]

According to Dr Dimsdale’s presentation to APA Conference, May 2012, 15% of the “diagnosed illness” arm of the field trial study (cancer, malignancy and severe coronary disease) met the criteria for SSD when “one of the B type criteria” was required; if the threshold was increased to “two B type criteria” about 10% met criteria for dual-diagnosis of cancer + “Somatic Symptom Disorder.”

For the 94 “functional somatic” study group, said to comprise patients with irritable bowel and “chronic widespread pain” (a term used synonymously with fibromyalgia) about 26% were coded when one B type cognition was required; 13% coded with two cognitions required.

If these proposals are approved they have the potential for bringing millions of patients under a mental health banner and greatly increasing application of psychiatric services, anxiolytics, antidepressants and behavioural therapies like CBT, for the “modification of dysfunctional and maladaptive beliefs about symptoms and disease, and behavioral techniques to alter illness and sick role behaviors.”

  • In light of these field trial findings, it is of considerable concern that the SSD Work Group has yet to publish any projections for prevalence estimates and the potential increase in mental health diagnoses across the entire disease landscape.
  • It is also of concern that the Work Group has not published on the projected clinical and economic burden of providing CBT and similar therapies for patients for whom an additional diagnosis of “Somatic Symptom Disorder” has been coded across the entire disease landscape.

In a counterpoint response to Dr Allen Frances’ May 12 New York Times Op-Ed piece, APA has stated:

“…There are actually relatively few substantial changes to draft disorder criteria. Those that have been recommended are based on the scientific and clinical evidence amassed over the past 20 years and then are subject to multiple review processes within the APA.”

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