What is the focus for this site?

This site endeavours to provide timely updates and content of interest to consumer groups and professionals that are stakeholders in the forthcoming DSM-5 and ICD-11 classification systems.

One focus for this site is:

Monitoring the progress of the revision of ICD-10 Chapter VI: Diseases of the nervous system (the Neurological chapter) with specific reference to the classifications coded in ICD-10 Volume 1: The Tabular list at G93.3: Postviral fatigue syndrome; (Benign) myalgic encephalomyelitis, and indexed in Volume 3: The Alphabetical Index to G93.3, Chronic fatigue syndrome.

Monitoring the population of content to be included in ICD-11 for these three entities in accordance with the ICD-11 “Content Model”.

Monitoring the progress of the revision of the DSM category section currently called Somatoform Disorders being undertaken by the DSM-5 Somatic Symptom Disorders Work Group.

Monitoring the progress of the revision of the corresponding Somatoform Disorders section in ICD-10 Chapter V (Mental and Behavioural Disorders) towards ICD-11 with specific reference to the categories currently classified under Somatoform Disorders at F45 – F48.0.

Monitoring potential “harmonization” of the corresponding category sections in DSM-5 and ICD-11 currently known as Somatoform Disorders, and “retro-fitting” DSM-5 and ICD-11 codes with ICD-10-CM.

Monitoring the progress and outcome of a request for consideration of a change to current proposals for the forthcoming ICD-10-CM for the chapter placement and coding of Chronic fatigue syndrome to bring it in line with ICD-10 (tabled for discussion at the September 14, 2011 meeting of ICD-9-CM Coordination and Maintenance Committee and for which a decision is awaited).

Issues for ICD-11

There is the potential for considerably more textual content to be included for diseases, disorders and syndromes in ICD-11 than appears in ICD-10, including Definition, Inclusions and Causal Mechanisms.

In ICD-10, there are no textual definitions, descriptive characteristics, criteria or any other content associated with the three terms Postviral fatigue syndrome; (Benign) myalgic encephalomyelitis, Chronic fatigue syndrome; nor are the relationships between these three terms specified.

Content in ICD-11 will be populated in accordance with the ICD-11 Content Model Style Guide. The ICD-11 Content Model identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters (currently 13).

Although up to 13 parameters may potentially be populated, for some ICD-11 entities, not all parameters may be used. For further information on the ICD-11 Content Model see Post #62: ICD-11 Content Model Reference Guide: version for December 2010

Content will need to be monitored, as it is generated, as will any changes to the hierarchy between these three terms, as will specification of the relationships between these three terms.

Any proposals, either internal or external to change the current chapter location of any of these three terms are being monitored for.

Issues for DSM-5

Chronic fatigue syndrome is not categorized within DSM-IV and neither is Neurasthenia. In ICD-10, Neurasthenia is classified in Chapter V Mental and Behavioural Disorders at F48.0 (for the forthcoming ICD-10-CM, in Chapter 5 at F48.8).

According to DSM-5 Task Force Chair, David Kupfer, MD, the specific diagnostic categories that received the most feedback during the second public review and feedback exercise were sexual and gender identity disorders, followed closely by somatic symptom disorders and anxiety disorders.

Research and clinical professionals, interest groups and the media have been voicing concerns for several years that the introduction of new disorders and the lowering of thresholds for existing criteria for some DSM-5 categories would bring many more patients under a mental health diagnosis.

If current proposals by the Somatic Symptom Disorders Work Group were to be approved there may be medical, social and economic implications to the detriment of all patient populations – but especially those bundled by some psychiatrists and clinicians under the so-called Functional Somatic Syndromes (FSS) and Medically Unexplained Syndromes (MUS) umbrellas, under which many researchers and clinicans include CFS, ME, Fibromyalgia, IBS, CI, CS, chronic Lyme disease, GW illness and a number of others disorders and conditions.

In a presentation to The Academy of Psychosomatic Medicine, in November 2009, Somatic Symptom Disorders Work Group Chair, Joel E Dimsdale, reported that the group was considering a proposal for a new category (then, tentatively entitled, “Somatic Symptom Disorder”*) to replace the DSM-IV Somatoform and related disorders which would combine the existing categories: somatoform disorders (somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder), factitious disorders, and psychological factors affecting medical condition.

* “Somatic” means “bodily” or “of the body” .

The Work Group was exploring the potential for de-emphasizing “medically unexplained symptoms” as a diagnostic criterion as the group considered the term to be “divisive”, fostered “mind-body dualism” and contributed to “doctor-patient antagonism.” 

See Post #8, January 12, 2010: APM 2009 Annual Meeting Workshop: DSM-V for Psychosomatic Medicine: Current Progress and Controversies

Image source: Academy of Psychosomatic Medicine, Nevada, November 2009 Annual Meeting slide presentation, Francis Creed, MD, FRCP: Can We Now Explain Medically Unexplained Symptoms?

In the June 2009 Journal of Psychosomatic Research Editorial “The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report”, which expanded on the brief April 2009 Work Group progress report, Chair, Joel E Dimsdale, and fellow Work Group member, Francis Creed, reported that by doing away with the “controversial concept of medically unexplained”, their proposed classification might diminish the “dichotomy, inherent in the ‘Somatoform’ section of DSM-IV, between disorders based on medically unexplained symptoms and patients with organic disease.”

The conceptual framework the Work Group was proposing:

“…will allow a diagnosis of somatic symptom disorder in addition to a general medical condition, whether the latter is a well-recognized organic disease or a functional somatic syndrome such as irritable bowel syndrome or chronic fatigue syndrome.”

The Work Group states:

“Because the current terminology for somatoform disorders is confusing and because somatoform disorders, psychological factors affecting medical condition, and factitious disorders all involve presentation of physical symptoms and/or concern about medical illness, the work group suggests renaming this group of disorders Somatic Symptom Disorders.”

The Somatic Symptom Disorders Disorders description document (as published in May 2011 for the second stakeholder review but not updated to reflect revisions for the third draft) states:

“This group of disorders is characterized predominantly by somatic symptoms or concerns that are associated with significant distress and/or dysfunction…Such symptoms may be initiated, exacerbated or maintained by combinations of biological, psychological and social factors.”

“These disorders typically present first in non-psychiatric settings and somatic symptom disorders can accompany diverse general medical as well as psychiatric diagnoses. Having somatic symptoms of unclear etiology is not in itself sufficient to make this diagnosis. Some patients, for instance with irritable bowel syndrome or fibromyalgia would not necessarily qualify for a somatic symptom disorder diagnosis. Conversely, having somatic symptoms of an established disorder (e.g. diabetes) does not exclude these diagnoses if the criteria are otherwise met.”

“The symptoms may or may not be associated with a known medical condition. Symptoms may be specific (such as localized pain) or relatively non-specific (e.g. fatigue). The symptoms sometimes represent normal bodily sensations (e.g., orthostatic dizziness), or discomfort that does not generally signify serious disease.”

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