Changes to ICD-11 Beta drafting platform: Bodily Distress Disorders (1)

 

What does ICD-11 Revision understand by the term “Bodily Distress Disorders”?

ICD-11 Revision Steering Group and the various ICD-11 Topic Advisory Groups are drafting the revision of ICD-10 on a separate, more complex platform where category and hierarchy change histories are recorded.

Since no “Category and Discussion Notes” or “Change history” records, rationales or “Retired” terms display in the public version of the Beta drafting browser it wasn’t possible, at June 2, to determine whether ICD-11 was proposing to introduce three new proposed categories

9R0 Mild bodily distress disorder
9R1 Moderate bodily distress disorder
9R2 Severe bodily distress disorder

in addition to retaining the existing ICD-10 categories listed at 9R3 thru 9R8.

Or, whether the ICD-10 categories listed at 9R3 thru 9R8 were destined to be subsumed under these three new Bodily distress disorder terms.

(Compare with the DSM-5 Somatic Symptom Disorders Work Group proposal to eliminate four existing DSM-IV categories and replace them with an entirely new category [Complex] Somatic Symptom Disorder, with new criteria and three optional severity specifiers, Mild, Moderate and Severe Somatic Symptom Disorder.)

Nor was it clear whether these ICD-10 categories were proposed to be retired for ICD-11 but retained in the hierarchical listings in order that coding data from ICD-10 legacy terms would not be lost.

None of the three proposed new categories had any definitions or other textual content displaying for them in the disorder descriptions frame on the right hand side of the Beta Browser pages.

In the absence of any explanation, there is insufficient information to determine what ICD-11 Topic Advisory Group for Mental Health understands by the term Bodily Distress Disorders; what disorder(s) these three proposed new category terms were intended to capture; how they would be defined or what their relationship would be to the ICD-10 category terms that remained listed in this section of Chapter 5, at that point.

Nor was it evident whether these three proposed new categories might be intended to mirror proposals for DSM-5, as they had stood for the second draft in May 2011 or following revisions to proposed categories and criteria as published on May 2, 2012, for the third and final stakeholder review.

Nor was it evident whether the ICD-11 term Bodily Distress Disorders mirrors the Bodily Distress Syndrome construct of Danish researchers, Per Fink et al.

The Definition text and Exclusions that displayed in the disorder description frame for the proposed new parent term BODILY DISTRESS DISORDERS remained unmodified from the imported ICD-10 Somatoform Disorder text:

http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%23F45

Definition

The main feature is repeated presentation of physical symptoms together with persistent requests for medical investigations, in spite of repeated negative findings and reassurances by doctors that the symptoms have no physical basis. If any physical disorders are present, they do not explain the nature and extent of the symptoms or the distress and preoccupation of the patient…

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Fink et al and Bodily Distress Syndrome (BDS)

According to Fink and colleagues, Bodily Distress Disorder/Bodily Distress Syndrome is a unifying diagnosis that encompasses somatization disorder, so-called “medically unexplained symptoms” (MUS), fibromyalgia, irritable bowel syndrome and chronic fatigue syndrome and some other conditions which they consider to be closely related, with a likely shared underlying aetiology.

See paper: Fink P, Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders J Psychosom Res. 2010 May;68(5):415-26.

See article: Per Fink,a Marianne Rosendal b Understanding and Management of Functional Somatic Symptoms in Primary Care: The Concept of Functional Somatic Symptoms

aResearch Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
bResearch Unit for General Practice, University of Aarhus, Denmark

See Per Fink’s clinical trial for BDS: http://clinicaltrials.gov/ct2/show/NCT01518647

See BDS clinician/patient manual: Specialised Treatment for Severe Bodily Distress Syndromes (STreSS)

According to a June 2012 EACLPP Conference Abstract, the concept of Bodily Distress Syndrome (BDS) “is expected to be integrated into the upcoming versions of classification systems.”

The potential for inclusion of Bodily Distress Disorder/Syndrome within ICD-11 could have significant implications for patients, globally, who are diagnosed with one of the so-called “functional somatic syndromes.” These proposals require very close monitoring by patient organizations in those countries that will be implementing ICD-11, post 2015.

Research and clinical professionals, patient organizations and their professional advisors can register now with ICD Revision for input into the ongoing drafting process and urge organizations and professionals to engage in this process.

Abstracts, oral presentations, EACLPP Conference: 27 – 30 June 2012, Aarhus University Campus, Aarhus – Denmark

http://www.eaclpp-ecpr2012.dk/Home/DownloadOral

Extract:

Page 17 Budtz-Lilly A

The Research Unit for General Practice, School of Public Health, Aarhus University, Denmark

Bodily Distress Syndrome: A new diagnosis for functional disorders in primary care

Aim: Medically unexplained or functional symptoms and disorders are common in primary care. Empirical research has proposed specific criteria for a new unifying diagnosis for functional disorders and syndromes: Bodily Distress Syndrome (BDS). This new concept is expected to be integrated into the upcoming versions of classification systems.

And from Page 31 of the Conference Abstracts:

Fjorback L

Aarhus University Hospital, Research Clinic for Functional Disorders and Psychosomatics

Mindfulness Therapy for Bodily Distress Syndrome – randomized trial, one-year follow-up, active control

Objective: To conduct a feasibility and efficacy trial of mindfulness therapy in somatization disorder and functional somatic syndromes such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome, defined as bodily distress syndrome (BDS)…

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Professor Francis Creed is a member of the DSM-5 Somatic Symptom Disorders Work Group and also a member of the ICD-11 Revision working group for Somatoform Disorders/Bodily Distress Disorders. Like Per Fink and colleagues, Prof Creed already uses the term Bodily Distress Disorders. 

See Pages 5 and 19: MHRN 2011 National Scientific Meeting

See also: Medically Unexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services. Creed, Francis; Henningsen, Peter; Fink, Per, Cambridge University Press, 14 July 2011

Some pages of the above publication, a book which resulted out of the EACLPP MUS Study Group White Paper [1] which had been led by Prof Creed, can be read on Google Books at:

http://books.google.com/books?id=UQjdZrkyWkoC&pg=PA1#v=onepage&q&f=false

See also: Notes from EACLPP Workgroup meeting in Budapest July 2011:

http://www.eaclpp.org/working-groups.html

Report from Working group meeting on MUS/somatisation/bodily distress, Budapest July 1st 2011

 “…We should find out whether the WHO group for classification of somatic distress and dissociative disorders will provide a better diagnostic system for these disorders.”

Continued on Page Three

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