Final day: Submissions to third DSM-5 stakeholder review

Page 4 Suzy Chapman J 00  Somatic Symptom Disorder

The “Somatic Symptom Disorders” section is one section for which substantial changes to existing disorder criteria are being proposed.

The group reports that preliminary analysis of field trial results shows “good reliability between clinicians and good agreement between clinician rated and patient rated severity.” In the field trials for new category proposals, CSSD achieved mediocre Kappa values of .60 (.41-.78 Confidence Interval).

Kappa reliability reflects agreement in rating by two different clinicians corrected for chance agreement – it does not mean that what clinicians have agreed upon are valid constructs. Radical change to the status quo needs grounding in scientifically validated constructs and a body of rigorous studies.

  • It remains a considerable concern that there is no substantial body of independent research evidence to support the group’s proposals for this new construct.

 

During the Q & A session at the end of Dr Dimsdale’s APA Conference presentation, a questioner raised the issue that practitioners who are not clinicians or psychiatric professionals might have some difficulty interpreting the wording of the B type criteria to differentiate between negative and positive coping strategies.

Dr Dimsdale was asked to expand on how the B type criteria would be operationalized and by what means patients with chronic medical conditions who devote time and energy to health care strategies to try to improve their symptoms and their level of functioning would be evaluated in the field by a very wide range of DSM users and differentiated from patients considered to be spending “excessive time and energy devoted to symptoms or health concerns” or perceived as having become “absorbed” by their illness and whose preoccupations were felt to be “disproportionate.”

By what means will the practitioner reliably assess an individual’s response to illness within the social context of the patient’s life and determine what should be coded as “excessive preoccupation” or indicate that this patient’s life has become “subsumed” or “overwhelmed” by concerns about illness and “devotion” to symptoms? By what means would a practitioner determine how much of a patient’s time spent “searching the internet looking for data” (to quote an example provided by Dr Dimsdale) might be considered a reasonable response to chronic health concerns within the context of this patient’s experience?

I am not reassured from Dr Dimsdale’s responses that these B (1), (2) and (3) criteria can be safely applied outside the optimal conditions of field trials, in settings where practitioners may not necessarily have the time nor instruction for administration of diagnostic assessment tools, and where decisions to code or not to code may hang on arbitrary and subjective perceptions.

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