Update on ICD-11 Beta drafting: Bodily Distress Disorder: emerging proposals: Part One

Emerging proposals from the WHO Primary Care Consultation Group (PCCG)

I have previously reported that for the primary care version of ICD-11 a new disorder group called Body distress disorders has been proposed, under which would sit several disorders, including a new primary care category, tentatively defined as Bodily stress syndrome (BSS).

(Note that for the ICD-11 core version, the current proposal is for a new ICD entity called Bodily distress disorder. The two groups appeared not to have reached consensus, last year, over a name for this proposed new ICD disorder, or how it should be defined and characterized.)

Proposed disorders for ICD-11-PHC [1]

Extract: Page 51, Table 2.5

Dysphoric disorders:

[…]
13 Health anxiety
14: PTSD

Body distress disorders:

15 Bodily stress syndrome [Replaces F45 Unexplained somatic symptoms]
16 Acute stress reaction
17 Dissociative disorder
18 Self-harm

[F48 Neurasthenia proposed to be eliminated for ICD11-PHC]

This new recommendation for ICD-11-PHC has been proposed to include “milder somatic symptom disorders” as well as “DSM-5’s complex somatic symptom disorder” and replace “medically unexplained somatic symptoms” (ICD10-PC F45 Unexplained somatic symptoms) [1].

The PCCG proposals were evidently supportive, last year, of accommodating (selective of) the defining characteristics of DSM-5’s Somatic Symptom Disorder within the framework of its own recommendations, despite the lack of a body of evidence for the validity of Somatic Symptom Disorder, as a construct, and for its safety of application in diverse primary health care settings, in both adults and children.

Extract: The World Organization of Family Physicians (WONCA) Classification Committee
http://www.ph3c.org/PH3C/docs/27/000113/0000118.pdf
Wonca International Classification Committee, 2010 Annual Meeting, Ghent, Belgium
11-15 October, 2010
MEETING SUMMARY
[Pages 17-18]
[…]
Chapter P and Z- Report of work of WHO Primary Care Consultation Group to ICD-11 Mental Health Classification.
Presentation and discussion led by Mike Klinkman.
The work of this 10-member group, composed of 5 GPs and 5 psychiatrists, was presented. The group is charged with recommending the list of mental health conditions to be included as the ICD-11-PC mental health classification. This list is to be integrated with the full ICD mental health classification. MK is deputy Chair of this group and MR is a member. The draft list of 28 terms was presented, and compared to the rubrics included in Chapter P of ICPC-2. Differences and similarities in the lists of conditions were highlighted. One important issue is how to address somatization, as there has been much work by Marianne Rosendal and her research colleagues* in defining the category of Body Distress Disorder (BDD) as an alternative to somatization/somatiform [sic] disorder. Another issue is the new formulation of anxiety – – depression – anxious depression – distress disorder.
General discussion.
[…]
General discussion on the topic of BDD and its main disorders, body distress syndrome and health preoccupation disorder – and the fact that these reflect the failure of ICD to accommodate symptom diagnoses.

*Marianne Rosendal is a member of Wonca’s International Classification Committee and of the Primary Care Consultation Group. See Part Two of Dx Revision Watch Post: ICD-11 Beta draft and BDD, Per Fink and Bodily Distress Syndrome for more information on Fink et al’s Bodily Distress Syndrome, which is already in use in Denmark in research studies and in specialised clinic settings.

Per Fink and colleagues are lobbying for the adoption of the BDS construct for diagnosis by primary care clinicians and for integration into forthcoming classification systems.

See also PDF slide presentation: Somatoform disorders – functional somatic syndromes – Bodily distress syndrome, EACLPP Lecture, Prof. Per Fink MD, Ph.D, Dr.Med.Sc.

Continued on Page 3

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