Brief update on DSM-5 ‘Somatic Symptom Disorder’
January 30, 2013
Brief update on DSM-5 ‘Somatic Symptom Disorder’
Post #221 Shortlink: http://wp.me/pKrrB-2Dd
As previously reported, all draft proposals for categories and criteria for DSM-5 were frozen on the DSM-5 Development website on June 15, 2012, immediately following the closure of the third and final stakeholder review and comment period.
Changes made to the draft after June 15, 2012 are embargoed and final disorder descriptions and criteria sets won’t be evident until DSM-5 is released, in May, this year, unless APA elects to release selected information.
The manual texts that expand on the various disorder sections and the categories that sit within them have not been made public at any stage in the development process. It is understood that for the ‘Somatic Symptom Disorders’ group, for example, the manual text that accompanies these new categories and criteria sets will run to five or six pages.
On November 15, 2012, APA removed the entire third draft from the DSM-5 Development website.
According to this APA Permissions, Licensing & Reprints page, because the most recently posted draft [the third draft that was released on May 2, 2012] has undergone revisions and is no longer current, the criteria texts have been removed from the website in order to avoid confusion or use of outdated categories and definitions. 
The page also states that although APA Board of Trustees approved all the proposed diagnoses [in December, 2012] there continue to be minor editorial and content changes as APA moves towards the final stages of the publication process.
Although the DSM-5 Development Timeline has “Final Revisions by the APA Task Force; Final Approval by APA Board of Trustees; Submission to American Psychiatric Publishing, Inc” scheduled for December 2012, according to my sources, the manual texts were now expected to be finalized for the publishers by end of January.
DSM-5 Table of Contents
As also previously reported, APA has created new pages for information and resources for DSM-5, where a number of new articles and documents are available to download. 
Documents include a DSM-5 Table of Contents which lists the disorder sections and the category terms that sit within them.
The DSM-5 Table of Contents reveals that changes to the overall section name for the ‘Somatic Symptom Disorders’ categories and to the category names that sit within this section have been made since closure of the third and final draft.
For the overall disorder section name, DSM-5 will now be using
‘Somatic Symptom and Related Disorders’
‘Somatic Symptom Disorders’ as per the first, second and third drafts.
For the third draft, the 6 disorders proposed to sit under this disorder section were:
Somatic Symptom Disorders (SSD)
J 00 Somatic Symptom Disorder
J 01 Illness Anxiety Disorder
J 02 Conversion Disorder (Functional Neurological Symptom Disorder)
J 03 Psychological Factors Affecting Medical Condition
J 04 Factitious Disorder
J 05 Somatic Symptom Disorder Not Elsewhere Classified
7 categories are now listed (on Page 3) of the DSM-5 Table of Contents as follows:
Somatic Symptom and Related Disorders
Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder (Functional Neurological Symptom Disorder)
Psychological Factors Affecting Other Medical Conditions
Other Specified Somatic Symptom and Related Disorder
Unspecified Somatic Symptom and Related Disorder
Other than these revisions to the SSD disorder section name and category names, there are no other texts disclosed within the DSM-5 Table of Contents. So whatever text is included for the latter two categories, ‘Other Specified Somatic Symptom and Related Disorder’ and ‘Unspecified Somatic Symptom and Related Disorder,’ isn’t known.
Whether any revisions have been made to the disorder descriptions and criteria for the five other disorders since the third draft proposals were posted is also unknown because of the embargo on disclosure of changes to categories and criteria beyond June 15, last year.
SSD Work Group asked to reconsider
In December, Allen Frances, MD, who had chaired the Task Force that had oversight of the development of DSM-IV, asked the SSD Work Group, key APA Board of Trustees members and Task Force Chairs to reconsider the proposals for specifically the ‘Somatic Symptom Disorder’ category. 
These representations were made in response to Dr Frances’ own considerable concerns, and those of lay and professional stakeholders, for the looseness of the SSD definition and criteria set, as it had stood at the third draft, and the absence of a body of robust evidence for the validity and safety of ‘SSD’ as a construct, and data on likely prevalence rates.
Dr Frances also proffered suggestions for revisions that he considered would tighten up the criteria and reduce the potential for misapplication.
The response on behalf of the work group was that although Dr Frances’ suggestions were discussed, the work group would not be revising their recommendations. 
It is not known whether the concerns raised by Dr Frances in December were discussed beyond the SSD Work Group with the DSM-5 Task Force or with the APA Board of Trustees, who are responsible for approving proposals and therefore accountable for the content of the forthcoming manual.
ICD-11 and DSM-5
In a January 18 article for Psychiatric News, organ of the APA, Mark Moran reports:
“Kupfer [DSM-5 Task Force Chair] said the classification of disorders is largely harmonized with the World Health Organization’s International Classification of Diseases (ICD) so that the DSM criteria sets are more parallel with the proposed ICD-11. In DSM-5 both the current ICD-9-CM and the future standard ICD-10-CM codes (scheduled for 2014) are attached to the relevant disorders in the classification.” 
As reported in my Dx Revision Watch post of January 6, at the time of writing, current proposals in the ICD-11 Beta draft have ICD-10’s ‘Somatoform Disorders’ replaced with ‘Bodily Distress Disorders, and Psychological and behavioural factors associated with disorders or diseases classified elsewhere,’ with three, as yet undefined, Severities of ‘Bodily Distress Disorder.’ 
It remains to be clarified whether ICD-11’s Beta draft proposals for three Severities of ‘Bodily Distress Disorder’ to replace six ICD-10 ‘Somatoform Disorders’ proposes to mirror Per Fink’s definition and criteria for ‘Bodily Distress Syndrome’ or are more closely aligned with DSM-5‘s ‘Somatic Symptom Disorder,’ in keeping with the APA and WHO’s joint commitment to strive, where possible, for harmonization between the category names, glossary descriptions and criteria across the two systems. 
(I shall be addressing this issue in a future post.)
I have previously reported that for ICD-11-PHC, the abridged, Primary Health Care version of ICD-11, the proposal, last year, was for a disorder section called ‘Bodily distress disorders,’ under which would sit ‘Bodily stress [sic] syndrome.’ 
According to Professor, Sir David Goldberg, this category is proposed for ICD-11 Primary Health Care version to include “milder somatic symptom disorders” as well as “DSM-5′s Complex somatic symptom disorder” and would replace “medically unexplained somatic symptoms.” These proposals are subject to rejection or modification following ICD-11 Field Trials. 
DSM-5 is scheduled for release at the APA’s 166th Annual Meeting (San Francisco, May 18-22).
References and related reports
4] Mislabeling Medical Illness As Mental Disorder: The Eleventh DSM-5 Mistake, Psychology Today, DSM5 in Distress, Allen Frances, MD, December 8, 2012
5] Bad News: DSM 5 Refuses to Correct Somatic Symptom Disorder, Psychology Today, DSM5 in Distress, Allen Frances, MD, January 16, 2012
6] Continuity and Changes Mark New Text of DSM-5, Psychiatric News, Volume 48, Number 2, January 18, 2013: pp. 1-6
7] ICD-11 Beta Draft Public Version: Bodily Distress Disorders
8] Fink P, Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture ten diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res 2010;68:415-26
9] Lam TP, Goldberg DP, Dowell AC, Fortes S, Mbatia JK, Minhas FA, Klinkman MS. Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study. Fam Pract 2012
10] Goldberg DP. Comparison Between ICD and DSM Diagnostic Systems for Mental Disorders. In: Sorel E, (Ed.) 21st Century Global Mental Health. Jones & Bartlett Learning, 2012: 37-53 [Free PDF Sample Chapter 2]
11] Somatic Symptom Disorder could capture millions more under mental health diagnosis, Suzy Chapman for Dx Revision Watch, May 26, 2012