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

 

Part Two: Lack of clarity of intention

On June 24, I left this comment on the ICD-11 Beta drafting platform:

One of the problems with this publicly viewable version of the Beta drafting platform is that no “Change history” or “Discussion Notes” display that record TAG MH’s rationales for proposed changes to parent category names or for adding proposed new categories or child categories.

What is TAG Mental Health’s rationale for the proposed change of name for this section of Chapter 5 and for proposing to add three new terms (Mild, Moderate and Severe “Bodily distress disorder”) to this section?

What is TAG Mental Health’s understanding of the term “Bodily Distress Disorders” and what disorders(s) does TAG Mental Health propose these three new category terms would define?

How do these three proposed new category terms relate to the existing ICD-10 “Somatoform Disorders” categories that remain classified under “Bodily Distress Disorders” that was “Somatoform Disorders” in ICD-10?

How is the public to submit meaningful input when TAG MH has yet to clarify its understanding of the term “Bodily Distress Disorders” and what disorder(s) TAG MH proposes these three new terms would capture?

Will TAG MH please clarify?

No clarification was forthcoming, but on July 2, I noted the three changes to this section of the Beta draft:

Foundation view:

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

Linearization view:

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


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1] The parent term Somatoform Disorders that had been proposed to be renamed Bodily Distress Disorders now reads:

BODILY DISTRESS DISORDERS, AND PSYCHOLOGICAL AND BEHAVIOURAL FACTORS ASSOCIATED WITH DISORDERS OR DISEASES CLASSIFIED ELSEWHERE

2] The three proposed new terms, 9F0 Mild bodily distress disorder; 9F1 Moderate bodily distress disorder; 9F2 Severe bodily distress disorder remain but Psychological and behavioural factors associated with disorders or diseases classified elsewhere, a category term classified at F54 in ICD-10, has been relocated to 9F3.

3] The ICD-10 terms below were no longer listed in either the ICD-11 Beta draft Foundation or Linearization view:

Somatization disorder
Undifferentiated somatoform disorder
Somatoform autonomic dysfunction
Persistent somatoform pain disorder
   ›  Persistent somatoform pain disorder
   ›  Chronic pain disorder with somatic and psychological factors [not in ICD-10]
Other somatoform disorders
Somatoform disorder, unspecified

There are no Definitions or other “ICD-11 Content Model” parameters populated yet for the three proposed new terms:

9F0 Mild bodily distress disorder; 9F1 Moderate bodily distress disorder; 9F2 Severe bodily distress disorder

Psychological and behavioural factors associated with disorders or diseases classified elsewhere category is the ICD-10 F54 category here:

http://apps.who.int/classifications/icd10/browse/2010/en#/F54

which, in ICD-10, sits under parent category:

http://apps.who.int/classifications/icd10/browse/2010/en#/F50-F59

Behavioural syndromes associated with physiological disturbances and physical factors
(F50-F59)

The textual content in ICD-11 Beta draft for Psychological and behavioural factors associated with disorders or diseases classified elsewhere currently reads:

http://apps.who.int/classifications/icd11/browse/l-m/en#/http%3a%2f%2fwho.int%2ficd%23F54

ID : http://who.int/icd#F54

Psychological and behavioural factors associated with disorders or diseases classified elsewhere

Parent(s)
BODILY DISTRESS DISORDERS, AND PSYCHOLOGICAL AND BEHAVIOURAL FACTORS ASSOCIATED WITH DISORDERS OR DISEASES CLASSIFIED ELSEWHERE

Definition
This category should be used to record the presence of psychological or behavioural influences thought to have played a major part in the etiology of physical disorders which can be classified to other chapters. Any resulting mental disturbances are usually mild, and often prolonged (such as worry, emotional conflict, apprehension) and do not of themselves justify the use of any of the categories in this chapter.

Narrower Terms
Psychological factors affecting physical conditions *
Examples of the use of this category are: asthma F54 and J45.- *
Examples of the use of this category are: dermatitis F54 and L23-L25 *
Examples of the use of this category are: gastric ulcer F54 and K25.- *
Examples of the use of this category are: mucous colitis F54 and K58.- *
Examples of the use of this category are: ulcerative colitis F54 and K51.- *
Examples of the use of this category are: urticaria F54 and L50.- *
nervous gastritis
psychic factors associated with diseases classified elsewhere
psychic; factor, associated with diseases classified elsewhere

Exclusions
tension-type headache

* Hover text over asterisks reads: “This term is an inclusion term in the linearization”

What ICD-11 proposes to do with these eight categories that are no longer listed under parent class:

BODILY DISTRESS DISORDERS, AND PSYCHOLOGICAL AND BEHAVIOURAL FACTORS ASSOCIATED WITH DISORDERS OR DISEASES CLASSIFIED ELSEWHERE

remains unclarified since no “Change history” displays in the public version of the Beta drafting platform.

The “Printable” version of Chapter 05 Mental and behavioural disorders, which is available to download in PDF format for those registered for interaction with the Beta drafting platform was subsequently updated to reflect this change:

Pages 18-19: PDF

http://apps.who.int/classifications/icd11/browse/l-m/en/Printables

Print Versions for the ICD11 Beta Morbidity Linearization

PDF: 05 Mental and behavioural disorders:

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Neurasthenia

Updated at July 5:

Prior to July 3, Neurasthenia (which is not classified in DSM-IV) had been listed in the Beta draft under parents Neurotic, stress-related and somatoform disorders > Other neurotic disorders.

Since July 4, Neurasthenia is no longer displaying in the ICD-11 Beta draft Foundation view or Linearization view or in the PDF print version.

It isn’t possible to determine whether the omission of Neurasthenia, Fatigue Syndrome and a number of other ICD-10 legacy categories [Depersonalization-derealization syndrome; Other specified neurotic disorders; Neurotic disorder, unspecified] is due to the temporary disappearance of the parent classes under which these categories sit while these are being rearranged for ICD-11, or whether the proposal is to retire the Neurasthenia,  Fatigue Syndrome category and possibly also all or selected of the other category terms that sit under Other neurotic disorders in ICD-1o, or whether these categories are destined to be subsumed under Bodily distress disorders.

According to the Goldberg February 2011 report, terms included in the ICD11-PHC version of ICD-11 must have an equivalent disorder in the main classification. In February 2011, it was proposed not to include Neurasthenia in the ICD11-PHC version but to replace it with 13 Distress disorder (replaces F42.2 Mixed anxiety and depression, F43 Adjustment disorder, F48 Neurasthenia).

In Chapter 2 “Comparison Between ICD and DSM Diagnostic Systems for Mental Disorders” by David Goldberg, again, there is no Neurasthenia listed for proposals for ICD11-PHC but it is not implicit from the text or the tables which of the revised categories grouped under Dysphoric disorders and Body Distress Disorders might now be proposed to subsume Neurasthenia.

At July 24, the sorting codes assigned to the four proposed categories currently listed under BODILY DISTRESS DISORDERS, AND PSYCHOLOGICAL AND BEHAVIOURAL FACTORS ASSOCIATED WITH DISORDERS OR DISEASES CLASSIFIED ELSEWHERE were 9F5 thru 9F8. Sorting codes are reassigned as chapters are reorganized and these codes are in a state of flux.

I shall continue to monitor this section of ICD-11 Beta draft.

In Post #193, I’ll be reporting on recent changes to the ICD-11 Beta drafting platform to proposals for the revision of ICD-10’s Neurasthenia, PVFS, (Benign) ME, Chronic fatigue syndrome, Fibromyalgia and IBS.

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References and related material:

1] Patients with medically unexplained symptoms and somatisation – a challenge for European health care systems: A white paper of the EACLPP Medically Unexplained Symptoms study group by Peter Henningsen and Francis Creed: http://www.eaclpp.org/working_groups.html
http://www.eaclpp.org/documents/Patientswithmedicallyunexplainedsymptomsandsomatisation_000.doc

2] Creed F, Guthrie E, Fink P, Henningsen P, Rief W, Sharpe M and White . Is there a better term than “Medically unexplained symptoms”? J Psychosom Res: Volume 68, Issue 1, Pages 5-8 January 2010) discusses the deliberations of the EACLPP MUS study group. Editorial also includes references to the DSM and ICD revision processes: http://www.ncbi.nlm.nih.gov/pubmed/20004295

3] 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. The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8000 Aarhus, Denmark:
http://www.ncbi.nlm.nih.gov/pubmed/20403500

Fink P, Toft T, Hansen MS, Ørnbøl E, Olesen F. Symptoms and syndromes of bodily distress: an exploratory study of 978 internal medical, neurological, and primary care patients. Psychosom Med. 2007 Jan;69(1):30-9.
http://www.ncbi.nlm.nih.gov/pubmed/17244846
Full text: http://www.psychosomaticmedicine.org/content/69/1/30.full

Fink P, Rosendal, M. Recent developments in the understanding and management of functional somatic symptoms in primary care. Current Opinion in Psychiatry 2008, 21:182–188

Rosendal M, Fink P, Falkoe E, Schou Hansen H, Olesen F. Improving the Classification of Medically Unexplained Symptoms in Primary Care. Eur. J. Psychiat. v.21 n.1 Zaragoza ene.-mar. 2007
Text: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632007000100004
PDF: http://scielo.isciii.es/pdf/ejpen/v21n1/improv3.pdf

4] EURASMUS  http://eurasmus.net/
The multidisciplinary European Research Association for Somatisation and Medically Unexplained Symptoms(EURASMUS) was formed to study the genetic, psychological and physiological mechanisms underlying bodily distress. Co-convenors: Francis Creed, Peter Henningsen

5] 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.”

6] Article: ‘Heartsinks’ and weird symptoms by Tony Dowell, June 15, 2011.

Article Table: Functional somatic syndromes according to medical speciality:
http://www.nzdoctor.co.nz/media/671495/heartsinks.pdf

Pages: 1 2 3 4

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