‘Somatic Symptom Disorder’ – the most ubiquitous mental health diagnosis you never heard of

‘Somatic Symptom Disorder’ – the most ubiquitous mental health diagnosis you never heard of

Lead psychiatrist for DSM-IV voices opposition to DSM-5’s new ‘catch-all’ criteria in BMJ, today

Post #229 Shortlink: http://wp.me/pKrrB-2GI

Update: Rapid Responses to the BMJ article can be read here:

http://www.bmj.com/content/346/bmj.f1580?tab=responses

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The opinion piece published under BMJ’s “Personal View” section, on Wednesday, is now featured in this week’s “Editor’s Choice”:

http://www.bmj.com/content/346/bmj.f1918

Editor’s Choice
US Editor’s Choice

DSM-5 and the rough ride from approval to publication

BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f1918 (Published 22 March 2013)

Edward Davies, US news and features editor, BMJ

Update: Media coverage for BMJ article:

Times of India

Eat or surf a lot? You risk being labelled mentally ill

Malathy Iyer, TNN | Mar 24, 2013

…Earlier this week, American psychiatrist Allen Frances, who helped devise the fourth edition of the manual (DSM-IV), lashed out against the new installment in the British Medical Journal. “It risks mislabelling a sizeable number of population as mentally ill,” Frances wrote.

He is disturbed about a new introduction called ‘somatic symptom disorder’ that will need only one bodily symptom distressing or disrupting daily life for about six months. “This new category will extend the scope of mental disorder classification by eliminating the requirement that somatic symptoms must be medically unexplained,” he wrote. In a field trial study to check for somatic symptom disorder, the results included 15% of patients with cancer or heart disease and 26% with irritable bowel syndrome or fibromyalgia. “The rate of psychiatric disorder among medically ill patients is unknown, but these rates seem high,” added Frances.

Doctors in India are not too supportive of the somatic symptom disorder…

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Medscape Medical News > Psychiatry

DSM-5 Somatic Symptom Disorder Debate Rages On

Deborah Brauser | March 21, 2013

The inclusion of the new somatic symptom disorder category in the soon-to-be-released Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) continues to spark heated debate in the field of psychiatry.

In a “Personal View” published online March 19 in BMJ, Allen Frances, MD, writes that the new disorder could result in “inappropriate diagnoses of mental disorder and inappropriate medical decision making” and urged clinicians to ignore the category completely…

…”The proposed diagnosis is unsupported by any substantial evidence on its likely validity and safety and was strongly opposed by patients, families, caregivers, and advocacy organizations,” he writes.

“Every diagnostic decision is a delicate balancing act between definitions that will result in too much versus too little diagnosis — the DSM-5 work group chose a remarkably sensitive definition that is also remarkably non-specific.”

He adds that clinicians should just ignore this classification altogether…

(Free registration for access to full article.)

Rheumatology Update

New ‘somatic symptom disorder’ captures fibromyalgia

Tony James | March 22, 2013

The new diagnosis of ‘somatic symptom disorder’ due for inclusion in the American Psychiatric Association’s updated diagnostic manual will capture up to a quarter of fibromyalgia patients…

Psychiatry Update (Australia)

Clinicians urged to ignore DSM-5 ‘somatic symptom disorder’

Tony James | March 20, 2013

The chair of the DSM-IV task force has told clinicians to ignore the new diagnosis of ‘somatic symptom disorder’ in DSM-5.

In a strongly-worded critique in this week’s BMJ, Professor Frances said that every diagnostic decision was a delicate balancing act between over-diagnosis and under-diagnosis…

“…The diagnosis of somatic symptom disorder is based on subjective and difficult to measure cognitions that will enable a ‘bolt-on’ diagnosis of mental disorder to be applied to all medical conditions, irrespective of cause.”

Field trials had shown that the new definition captured 15% of patients with cancer or heart disease and 26% with irritable bowel syndrome or fibromyalgia.

(Registered Medical Practitioner site; registration required for access to full article.)

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Inform 21

Un nuevo trastorno podría clasificar a millones de personas como enfermos mentales

March 21, 2013

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UK Times

The Times Mental Health

Psychologists to fight new list of mental illnesses

Martin Barrow, Health Editor | March 21, 2013

Everyday Health

Why Obsessing Over Physical Symptoms Could Equal Mental Illness

A psychiatrist argues in a new paper that a change in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) could lead to misdiagnosis of people with cancer and heart disease as mentally ill.

Jaimie Dalessio | Everyday Health Staff Writer | March 20, 2013

Come May, everyone with chronic medical illness or long-term pain – from cancer to coronary disease, MS to myalgia, becomes a potential candidate for a new mental health label.

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On Wednesday, BMJ publishes a commentary on the DSM-5 ‘Somatic Symptom Disorder’ by Allen Frances, MD, who chaired the Task Force for DSM-IV, with contribution from Dx Revision Watch:

http://www.bmj.com/uk/comment

Full article available without subscription, here:

http://www.bmj.com/content/346/bmj.f1580

PDF here:

http://www.bmj.com/highwire/filestream/636761/field_highwire_article_pdf/0/bmj.f1580.full.pdf

PERSONAL VIEW

The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill

This new condition suggested in the bible of mental health diagnoses lacks specificity, says Allen Frances

Allen Frances chair of the DSM-IV task force

The fuzzy boundary between psychiatry and general medicine is about to experience a seismic shift. The next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is scheduled for release this May amid controversy about many of its new disorders. Among these, DSM-5 introduces a poorly tested diagnosis—somatic symptom disorder—which risks mislabeling a sizeable proportion of the population as mentally ill…

BMJ Media release will be available here:

http://group.bmj.com/group/media/latest-news

Psychiatric creep

For DSM-5, the somatoform disorders section is being dismantled and four rarely used disorders are being replaced by a single new diagnosis, ‘Somatic Symptom Disorder.’

Out go DSM-IV’s rigorous criteria sets and the requirement for multiple symptoms to be medically unexplained; in comes a far looser definition that doesn’t distinguish between ‘medically unexplained’ symptoms or somatic symptoms in association with diagnosed medical illness.

From May, patients with common diseases like cancer, angina, diabetes or multiple sclerosis; with long-term pain, chronic illnesses like irritable bowel syndrome, fibromyalgia or CFS, or with unexplained conditions that have so far presented with somatic (bodily) symptoms of unclear cause may qualify for an additional mental disorder diagnosis of ‘Somatic Symptom Disorder’ if the clinician considers they also meet the criteria for ‘Somatic Symptom Disorder,’ and may benefit from treatment.

The SSD criteria set focuses on the psychological impact of persistent, distressing bodily symptoms on the patient’s thoughts, feelings and behaviors and the degree to which their response is considered ‘disproportionate’ or ‘excessive.’

As the criteria stand, this new disorder will potentially result in a ‘bolt-on’ mental health diagnosis being applied to all chronic illnesses and medical conditions if the clinician decides the patient’s response to distressing symptoms is ‘excessive’ or their coping strategies are ‘maladaptive,’ or that they are ‘catastrophising’ or displaying ‘fear avoidance.’ Or if the practitioner feels the patient is spending too much time on the internet researching data, symptoms and treatments, or that their lives have become ‘dominated’ by ‘illness worries,’ they may be vulnerable to an additional diagnosis of SSD.

Patients with chronic, multiple bodily symptoms due to rare conditions or multi-system diseases like Behçet’s syndrome or Systemic lupus, which may take several years to diagnose, will also be vulnerable to misdiagnosis with a mental disorder.

There is no substantial body of research to support the validity, reliability or safety of the ‘Somatic Symptom Disorder’ diagnosis.

During the second public review of draft criteria for DSM-5, the ‘Somatic Symptom Disorder’ section received more submissions from advocacy organizations, patients, and professionals than almost any other disorder category. But rather than tighten up the criteria or subject the entire disorder section to independent scientific review, the SSD Work Group’s response has been to lower the threshold even further – potentially pulling even more patients under a mental disorder label.

The ‘Somatic Symptom Disorder’ Work Group rejected eleventh hour calls from professionals and patients to review its criteria before going to print.

APA says there will be opportunities to reassess and revise DSM-5s new disorders, post publication, and that it intends to start work on a ‘DSM-5.1′ release. Patient groups, advocates and professionals are not reassured by a ‘publish first – patch later’ approach to science.

Notes for media, websites, bloggers:

1. The next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will be published by American Psychiatric Publishing Inc. in May 2013. It will be known as ‘DSM-5′ and has been under development since 1999.
http://www.dsm5.org/Pages/Default.aspx
http://www.dsm5.org/Documents/DSM%205%20development%20factsheet%201-16-13.pdf

2. The American Psychiatric Association (APA) has spent $25 million on the development of DSM-5.

3. The Diagnostic and Statistical Manual of Mental Disorders is used by mental health and medical professionals for diagnosing and coding mental disorders. It is used by psychiatrists, psychologists, therapists, counselors, primary health care physicians, nurses, social workers, occupational and rehabilitation therapists and allied health professionals.

The DSM is also used for medical insurance reimbursement and informs government, public health policy, courts and legal specialists, education, forensic science, prisons, drug regulation agencies, pharmaceutical companies and researchers. Diagnostic criteria defined within DSM determine what is considered a mental disorder and what is not, which treatments and therapies health insurers will authorise funding for, and for how long.

4. Four existing disorder categories in the DSM-IV ‘Somatoform Disorders’ section: somatization disorder [300.81], hypochondriasis [300.7], pain disorder, and undifferentiated somatoform disorder [300.82] will be eliminated and replaced with a single new category – ‘Somatic Symptom Disorder’ for DSM-5.

5. APA has held three stakeholder comment periods during which professional and public stakeholders have been invited to submit comment on the proposals for the revision of DSM-IV categories and criteria (in February-April 2010; May-June 2011; May-June 2012).

6. DSM-5 is slated for release at the American Psychiatric Association’s 166th Annual Meeting, San Francisco (May 18-22, 2013). The new manual is available for pre-order and will cost $199: http://www.psychiatry.org/dsm5

7. Allen Frances, MD, was chair of the DSM-IV Task Force and of the Department of Psychiatry at Duke University School of Medicine, Durham, NC; Dr Frances is currently professor emeritus, Duke.

8. Dr Frances blogs at DSM 5 in Distress, and Saving Normal at Psychology Today.

Mislabeling Medical Illness As Mental Disorder was published on December 8, 2012

Bad News DSM-5 Refuses To Correct Somatic Symptom Disorder was published on January 16, 2013

For additional information on ‘Somatic Symptom Disorder’:

Somatic Symptom Disorder could capture millions more under mental health diagnosis by Suzy Chapman for Dx Revision Watch, May 26, 2012

Suzy Chapman

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