Psychologists’ perspectives on the diagnostic classification of mental disorders: Results from the WHO-IUPsyS Global Survey

Post #263 Shortlink: http://wp.me/pKrrB-3dj

Psychologists’ perspectives on the diagnostic classification of mental disorders: Results from the WHO-IUPsyS Global Survey

Int J Psychol. 2013 Jun 10. [Epub ahead of print]

Psychologists’ perspectives on the diagnostic classification of mental disorders: Results from the WHO-IUPsyS Global Survey.

Evans SC, Reed GM, Roberts MC, Esparza P, Watts AD, Correia JM, Ritchie P, Maj M, Saxena S.
Source
a Clinical Child Psychology Program, University of Kansas, Lawrence , KS, USA.

Abstract

This study examined psychologists’ views and practices regarding diagnostic classification systems for mental and behavioral disorders so as to inform the development of the ICD-11 by the World Health Organization (WHO). WHO and the International Union of Psychological Science (IUPsyS) conducted a multilingual survey of 2155 psychologists from 23 countries, recruited through their national psychological associations. Sixty percent of global psychologists routinely used a formal classification system, with ICD-10 used most frequently by 51% and DSM-IV by 44%. Psychologists viewed informing treatment decisions and facilitating communication as the most important purposes of classification, and preferred flexible diagnostic guidelines to strict criteria. Clinicians favorably evaluated most diagnostic categories, but identified a number of problematic diagnoses. Substantial percentages reported problems with crosscultural applicability and cultural bias, especially among psychologists outside the USA and Europe. Findings underscore the priority of clinical utility and professional and cultural differences in international psychology. Implications for ICD-11 development and dissemination are discussed.

PMID: 23750927

[PubMed – as supplied by publisher]

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Slide Presentation: Aug 3, 2012

The WHO-IUPsyS Global Survey of Psychologists’ Attitudes Toward Mental Disorders Classification.

Download PDF WHO-IUPsyS Global Survey slides

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More information on this WHO study can be found on Page 7 (3.) of this report:

http://www.apa.org/international/outreach/icd-report-2012.pdf

2012 Annual Report of the International Union of Psychological Science to the American Psychological Association

Revision of World Health Organization’s ICD-10 Mental and Behavioural Disorders

Pierre L.-J. Ritchie, Ph.D., Main Representative to the World Health Organization, International Union of Psychological Science, January, 2013

Click link for PDF document    WHO-IUPsyS ICD Survey Report Report 2012

This report also sets out the responsibilities of ICD Revision working groups, on Page 3 (1.1), and gives some information on the field studies for ICD-11 and ICD11-PHC, on Page 8 (4.)

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The earlier study: WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification can be downloaded here: 

The WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification

World Psychiatry 2011;10:118-131

Research report

Geoffrey M Reed, João Mendonça Correia, Patricia Esparza, Shekhar Saxena, Mario Maj

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DSM-5 released: professional and campaigning reaction: Round up #7

Post #262 Shortlink: http://wp.me/pKrrB-3cF

DSM-5 released: professional and campaigning reaction: Round up #7

A considerable amount of media coverage and commentary on DSM-5 has been published since posting Round up #6, on May 24. Occupied with other matters, I shall likely not catch-up. The world will continue to turn.

Here, though, are some recent commentaries from psychiatry and psychology professionals; a report from Prof Sir Simon Wessely on last week’s Institute of Psychiatry’s two day DSM-5 Conference; below that, new Online Assessment Measures documents from the APA’s DSM-5 Resource pages, including Somatic Symptom assessment instruments for 6-17 year olds, and a clarification from CMS on HIPAA and the status of the DSM-5 code sets.

Via Patrick Landman

Pédopsychiatre, Psychiatre, Président d’Initiative Pour une Clinique du Sujet Stop-Dsm, Psychanalyste Membre d’Espace Analytiquea

A statement written and signed by prominent French psychiatrists in response to recent comments by APA President-Elect, Jeffrey Lieberman, was issued, yesterday:

Full text on the STOP-DSM campaign website:

To oppose the DSM-5 is not to oppose psychiatry

Recently, some of the DSM-5 supporters have been trying to portray the opposition against the fifth edition of this manual of the American Psychiatric Association as an opposition to psychiatry and a form of antipsychiatry. This political argument aims to discredit the movement and to subsume it in its entirety, including its numerous variations, under a single label, one that can easily be identified and connected with a certain history, the sixties. Such specious rhetoric allows its authors not to have to respond to serious and well-documented arguments of the DSM-5 critics. In reality, its many opponents from Europe, Australia, South America and even the United States include a great number of psychiatrists, clinical psychologists, social workers and other mental health practitioners… Read on


Report on the website of South London and Maudsely NHS Foundation Trust from Prof Sir Simon Wessely on the Institute of Psychiatry’s recent DSM-5 Conference.

Prof Wessely is Head of the Department of Psychological Medicine and Vice Dean, Institute of Psychiatry, King’s College London. 

DSM-5 at the IoP

Monday June 10, 2013

The latest and fifth version of the Diagnostic and Statistical Manual of the American Psychiatric Association (APA), invariably known as the DSM, was published on 18 May 2013. To mark the occasion, we hosted an international conference at the Institute of Psychiatry from 3-4 June. This was the first such meeting since the launch and the first platform for Professor David Kupfer, Chair of Psychiatry at the Western Psychiatric Institute in Pittsburgh, but more importantly for us, the man who has directed the compilation and development of DSM-5, and who is justly regarded as its architect…

…I used the somatoform disorders as an example of where “DSM feared to tread”. The latest attempt to come up with something that is both empirically rigorous but also suitable for real world use in this particular area represents a small step forward, at least in simplifying an area of previous mind numbing complexity, but I suggested, was unlikely to represent real progress. This is because the DSM (and for that matter the ICD) are both diagnostic systems that are written by psychiatrists but which in this area need to be used by physicians, who ignore them, and concern patients who don’t like them, often fiercely so… Full Text


Essay by Sarah Kamens MA on the Dx Summit platform

DSM-5′s Somatic Symptom Disorder: From Medical Enigma to Psychiatric Sphinx

Sarah Kamens is a Ph.D. candidate in clinical psychology at Fordham University and in media & communications at the European Graduate School (EGS). Her work focuses on diagnostic discourse and sociopolitics in the psy disciplines.


Spiked Review of Books

‘This manual is, frankly, a disaster for children’

Christopher Lane talks to spiked about the new edition of the bible of psychiatry – ‘a legal document facilitating the medication of millions’.

by Helene Guldberg


http://www.psychiatry.org/dsm5

DSM-5 Online Assessment Measures

APA is inviting clinicians and researchers to provide feedback on the instruments’ usefulness in characterizing patient status and improving patient care. There are a large number of documents that can be downloaded from the link above, including:

For Adults

LEVEL 2–Somatic Symptom–Adult (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])

For Parents of Children Ages 6–17

LEVEL 2—Somatic Symptom—Parent/Guardian of Child Age 6-17 (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])

For Children Ages 11–17

LEVEL 2—Somatic Symptom—Parent/Guardian of Child Age 11-17 (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])

Clinician-Rated

Clinician-Rated Severity of Somatic Symptom Disorder


Finally, a note on the FAQ pages of the CMS.gov website which clarifies the non official status of DSM-5 code sets:

Frequently Asked Questions

(FAQ1817)

[Q] In current practice by the mental health field, many clinicians use the DSM-IV in diagnosing mental disorders. As of May 19, 2013, the DSM-5 was released. Can these clinicians continue current practice and use the DSM-IV and DSM-5 diagnostic criteria?

[A] Yes. The Introductory material to the DSM-IV and DSM-5 code set indicates that the DSM-IV and DSM-5 are “compatible” with the ICD-9-CM diagnosis codes. The updated DSM-5 codes are crosswalked to both ICD-9-CM and ICD-10-CM. As of October 1, 2014, the ICD-10-CM code set is the HIPAA adopted standard and required for reporting diagnosis for dates of service on and after October 1, 2014.

Neither the DSM-IV nor DSM-5 is a HIPAA adopted code set and may not be used in HIPAA standard transactions. It is expected that clinicians may continue to base their diagnostic decisions on the DSM-IV/DSM-5 criteria, and, if so, to crosswalk those decisions to the appropriate ICD-9-CM and, as of October 1, 2014, ICD-10 CM codes. In addition, it is still perfectly permissible for providers and others to use the DSM-IV and DSM-5 codes, descriptors and diagnostic criteria for other purposes, including medical records, quality assessment, medical review, consultation and patient communications.

Dates when the DSM-IV may no longer be used by mental health providers will be determined by the maintainer of the DSM-IV/DSM-5 code set, the American Psychiatric Association, http://www.dsm5.org

(FAQ1817)

Somatic Symptom Disorder in recent journal papers

Post #261 Shortlink: http://wp.me/pKrrB-3ah

Somatic Symptom Disorder in recent journal papers

Somatic Symptom Disorder is also included in Saving Normal: An Insider’s Revolt Against Out-Of-Control Psychiatric Diagnosis, Dsm-5, Big Pharma, and the Medicalization of Ordinary Life (pp. 193-6): Allen Frances, William Morrow & Company (20 May 2013).

Also in Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 (Chapter 16): Allen Frances, Guilford Press (14 June 2013).

In the June edition of Journal of Nervous and Mental Disorders, Allen Frances, MD, who chaired the Task Force for DSM-IV, discusses his concerns for the loosely defined DSM-5 category, Somatic Symptom Disorder, sets out his suggestions for revising the criteria prior to finalization, as presented to the SSD Work Group chair, in December, and advises clinicians against using the new SSD diagnosis.

http://www.ncbi.nlm.nih.gov/pubmed/23719325

DSM-5 Somatic Symptom Disorder.

Frances A.

Department of Psychiatry, Duke University, Durham, NC.

J Nerv Ment Dis. 2013 Jun;201(6):530-1. doi: 10.1097/NMD.0b013e318294827c. No abstract available.

PMID: 23719325

[PubMed – in process]

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Commentary by Allen Frances, MD, and Suzy Chapman in the May issue of Australian and New Zealand Journal of Psychiatry. The paper discusses the over-inclusive DSM-5 Somatic Symptom Disorder criteria and the potential implications for diverse patient groups. The paper concludes by advising clinicians not to use the new SSD diagnosis.

http://www.ncbi.nlm.nih.gov/pubmed/23653063

DSM-5 somatic symptom disorder mislabels medical illness as mental disorder.

Allen Frances¹, Suzy Chapman²

1 Department of Psychiatry, Duke University 2 DxRevisionWatch.com

Aust N Z J Psychiatry. 2013 May;47(5):483-4. doi: 10.1177/0004867413484525. No abstract available.

PMID: 23653063

[PubMed – in process]

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The April 22 edition of Current Biology published a feature article on DSM-5 by science writer, Michael Gross, Ph.D. The article includes quotes from Allen Frances, MD, and Suzy Chapman on the implications for patients for the application of the new DSM-5 Somatic Symptom Disorder. The article includes concerns for the influence of Somatic Symptom Disorder on proposals for a new ICD category – Bodily Distress Disorder – being field tested for ICD-11 and ICD-11-PHC.

Current Biology 22 April, 2013 Volume 23, Issue 8

Copyright 2013 All rights reserved. Current Biology, Volume  23, Issue  8, R295-R298, 22 April 2013

doi:10.1016/j.cub.2013.04.009

Feature

Has the manual gone mental?

Michael Gross

Full text: http://www.cell.com/current-biology/fulltext/S0960-9822(13)00417-X

PDF: http://download.cell.com/current-biology/pdf/PIIS096098221300417X.pdf

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In this opinion piece, published in the BMJ, March 18, Allen Frances, MD, strongly opposes the new Somatic Symptom Disorder, discusses its lack of specificity, data from the field trials and advises clinicians to ignore this new category.

http://www.ncbi.nlm.nih.gov/pubmed/23511949

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

Frances A.

Allen Frances, chair of the DSM-IV task force

BMJ. 2013 Mar 18;346:f1580. doi: 10.1136/bmj.f1580. No abstract available.

PMID: 23511949

[PubMed – indexed for MEDLINE]

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Further reading

APA Somatic Symptom Disorder Fact Sheet APA DSM-5 Resources

Somatic Chapter Drops Centrality Of Unexplained Medical Symptoms Psychiatric News, Mark Moran, March 1, 2013

Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care David J Kupfer, MD, Chair, DSM-5 Task Force, defends the SSD construct, Huffington Post, February 8, 2013

The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill Allen Frances, MD, BMJ 2013;346:f1580 BMJ Press Release

Somatic Symptom Disorder could capture millions more under mental health diagnosis Suzy Chapman, May 26, 2012

Mislabeling Medical Illness As Mental Disorder Allen Frances, MD, Psychology Today, DSM 5 in Distress, December 8, 2012

Why Did DSM 5 Botch Somatic Symptom Disorder? Allen Frances, MD, Psychology Today, Saving Normal, February 6, 2013

New Psych Disorder Could Mislabel Sick as Mentally Ill Susan Donaldson James, ABC News, February 27, 2013

Dimsdale JE. Medically unexplained symptoms: a treacherous foundation for somatoform disorders? Psychiatr Clin North Am 2011;34:511-3. [PMID: 21889675]

Karina Hansen initiatives: A clarification

Post #260 Shortlink: http://wp.me/pKrrB-38n

Karina Hansen initiatives: Clarification notice

I have now published three posts on my site in relation to the Hansen family’s situation:

Something rotten in the state of Denmark: Karina Hansen’s story: http://wp.me/pKrrB-2Xc

(In English)

Human Rights denied: Something rotten in the state of Denmark: Karina Hansen’s story: Update 1: http://wp.me/pKrrB-35o

(Update in English)

Menneskerettighederne nægtet: Noget råddent i staten Danmark: Karina Hansen: Opdater 1: http://wp.me/pKrrB-36e

(Update in English and Danish)

Clarification

Reports and updates on Dx Revision Watch site on the Hansen family’s situation are being published as provided by, and in consultation with, Rebecca Hansen, Chairman, ME Foreningen, Danmark (ME Association, Denmark), or edited from reports as provided.

Dx Revision Watch site has no connection with any petitions or initiatives, or with any social media platforms or other platforms set up to promote petitions or initiatives, or to otherwise raise awareness of the Hansen family’s situation.

All enquiries in relation to any petitions or other initiatives, or social media platforms, or any other platforms associated with them should be addressed directly to the organizers, sponsors or owners responsible for them.

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The official petition launched and sponsored by ME Foreningen, Danmark and approved by the Hansen family can be found here: http://www.ipetitions.com/petition/postcardtokarina/

For more information on the ME Foreningen, Danmark petition go here on Facebook

Website:

ME Foreningen, Danmark
www.me-foreningen.dk

For first report (in English) see: Something rotten in the state of Denmark: Karina Hansen’s story: http://wp.me/pKrrB-2Xc

For more information on the ME Association of Denmark’s postcard campaign go here on Facebook
For information on Bodily Distress Syndrome see Part Two of Dx Revision Watch Post: ICD-11 Beta draft and BDD, Per Fink and Bodily Distress Syndrome
Menneskerettighederne nægtet: Noget råddent i staten Danmark: Karina Hansen: Opdater 1: http://wp.me/pKrrB-36e
Human Rights denied: Something rotten in the state of Denmark: Karina Hansen’s story: Update 1: http://wp.me/pKrrB-35o
Ontkenning van mensenrechten: Iets verrot in de staat van Denemarken: Het verhaal van Karina Hansen: Update 1: http://wp.me/pKrrB-35o
Menschenrechtsverstoß: Etwas ist faul in Dänemark: Karina Hansens Geschichte: Update 1: http://wp.me/pKrrB-35o
Droits de l’Homme: Il y a quelque chose de pourri au royaume du Danemark: l’histoire de Karina Hansen: Update 1: http://wp.me/pKrrB-35o

New Danish and German guidelines for “Bodily distress” and functional disorders published

Post #259 Shortlink: http://wp.me/pKrrB-36F

New Danish and German guidelines for “Bodily distress” and “functional disorders”

Update:

Slide presentation [23 slides in PDF format]

http://www.regionsyddanmark.dk/dwn225587

Or open on Dx Revision Watch site:

Session 4 – Medicinsk uforklarede symptomer – Marianne Rosendal

Medicinsk uforklarede symptomer og funktionelle lidelser

“Medically unexplained symptoms and functional disorders”

Marianne Rosendal, Research Unit for General Practice, Institute of Public Health, Aarhus University

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Related information:

Trygfonden invites applications for funding for research on functional disorders
http://www.kronisktraethedssyndrom.dk/Diverse/Trygfonden.pdf
Trygfonden has allocated 48 million for research on functional disorders. The application deadline for the last 28 million kroner is 6 April 2010.
Lene Toscano får 3,3 mio. kr. til formidling af viden om funktionelle lidelser
Lene Toscano gets 3.3 million kr. for dissemination of knowledge about functional disorders
Specialist in General Medicine Lene Toscano, Aarhus University Hospital, has received 3,336,458 kr. from TrygFonden to examine how best to communicate and share knowledge about functional disorders.

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As previously posted:

In February, I published information on the status of current proposals for revision of ICD-10 “Somatoform Disorders” for the ICD-11 core version, as displayed in the ICD-11 Beta drafting platform, and on proposals for ICD-11-PHC, the abridged primary care version of ICD.

In Part Two of that post, I compiled information on “Bodily Distress Syndrome,” a disorder construct developed by Per Fink and colleagues initially for research studies, now used in clinical practice at The Research Clinic for Functional Disorders and Psychosomatics, Aarhus.

See post #222 ICD-11 Beta draft and Bodily Distress Disorders; Per Fink and Bodily Distress Syndrome Parts One and Two

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Today, I have three new “Bodily Distress Disorders” related items to bring to your attention:

1. The World Psychiatric Association (WPA) is holding its 2013 International Congress in October, in Vienna. Four topics relating to “Bodily Distress Disorders” are being presented:

Bodily Distress Disorders and the new classifications

Bodily Distress Disorders at the work place: prevention and treatment

A stepped care approach for bodily distress disorders: the new interdisciplinary German guideline

Raising the awareness for the health political relevance of Bodily Distress Disorders – a European agenda

Symposia presenters include:

Francis Creed (member of the DSM-5 Somatic Symptom Disorders Work; member of the WHO Working Group on Somatic Distress and Dissociative Disorders, reporting to the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders; co-author book [1], paper [2]).

Per Fink (The Research Clinic for Functional Disorders and Psychosomatics, Aarhus, Denmark, co-author book [1], paper [3]).

Peter Henningsen (Co-author book [1]).


2] A new German guideline has been published, with summary texts in German and English language:

Neue Leitlinien zu funktionellen und somatoformen Störungen

CLINICAL PRACTICE GUIDELINE Non-Specific, Functional, and Somatoform Bodily Complaints

Rainer Schaefert, Constanze Hausteiner-Wiehle, Winfried Häuser, Joram Ronel, Markus Herrmann, Peter Henningsen. Dtsch Arztebl Int 2012; 109(47): 803−13 [PMID 23341111]

Abstract [in English] here:

New guidelines on functional and somatoform disorders

The S3 guideline “Dealing with patients with non-specific, functional and somatoform bodily symptoms” emphasizes the similarities in the management of the manifold manifestations of so called “medically unexplained symptoms” and gives recommendations for a stepped and collaborative diagnostic and therapeutic approach in all subspecialties and all levels of health care. It has a special focus on recommendations regarding attitude, physician-patient-relationship, communication, the parallelization of somatic and psychosocial diagnostics and a stepped therapeutic approach. The “Evidence-based guideline psychotherapy in somatoform disorders and associated syndromes” provides a differentiated analysis of the current evidence regarding the effectiveness of various psychotherapeutic interventions for the most relevant manifestations of functional and somatoform disorders. In combination, both guidelines pose important advances for treatment quality in Germany, but also illustrate remarkable structural and research deficits.

Abstract [in German] here:

Neue Leitlinien zu funktionellen und somatoformen Störungen

Official summary version texts:

English language version:
S3 Clinical Practice Guideline: Non-specific, Functional, and Somatoform Bodily Complaints” (NFS)
or open PDF on Dx Revision Watch:
S3 Non-specific, Functional and Somatoform Bodily Complaints 2013-01

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German language version:

http://www.aerzteblatt.de/archiv/132847
MEDIZIN: Klinische Leitlinie Nicht-spezifische, funktionelle und somatoforme Körperbeschwerden
Clinical Practice Guideline: Non-specific, functional and somatoform bodily complaints
Dtsch Arztebl Int 2012; 109(47): 803-13; DOI: 10.3238/arztebl.2012.0803
or open PDF on Dx Revision Watch:
Nicht-spezifische, funktionelle und somatoforme Körperbeschwerden

Correspondence in response to summary version:

Letter: Iatrogenic Chronification as a Result of Pseudo Diagnosis
Dr. med. Rainer Hakimi, Stuttgart
In Reply:
Dr. med. Rainer Schaefert
Klinik für Allgemeine Innere Medizin und Psychosomatik, Universitätsklinikum Heidelberg

3] New Danish Association for General Practitioners (DSMA) guide for general practice on functional disorders:

Funktionelle lidelser for Almen Praksis

Ny vejledning sætter fokus på funktionelle lidelser Practicus | April 2013

“New guide focuses on functional disorders”

[Article in Danish]

This article introduces the new Danish Association for General Practitioners (DSMA) guide for general practitioners, published this May. The Working Group for the guide, which included Per Fink, was chaired by Marianne Rosendal.

Access document here in PDF [in Danish]:

Funktionelle lidelser Dansk Selskab for Almen Medicin 2013

or open PDF on Dx Revision Watch: Funktionelle lidelser 2013

Related information:
Lene Toscano får 3,3 mio. kr. til formidling af viden om funktionelle lidelser
Lene Toscano gets 3.3 million kr. for dissemination of knowledge about functional disorders
Specialist in General Medicine Lene Toscano, Aarhus University Hospital, has received 3,336,458 kr. from TrygFonden to examine how best to communicate and share knowledge about functional disorders.

Notes:

ICD-11 Beta drafting platform Bodily Distress Disorder: Mild; Moderate; Severe

“Bodily distress disorder” (BDD) is being proposed as a new category for ICD-11 to replace a number of existing ICD-10 “Somatoform Disorders.”

An alternative construct, called Bodily stress syndrome (BSS), has been put out for international primary care focus group evaluation by the working group for the revision of ICD-10-PHC (the abridged primary care version of ICD-10), and will be undergoing ICD-11 field testing and analysis. There is no public domain information available on where BSS will be field tested or on field trial study design, patient selection, criteria etc.

Although ICD-11 is at the Beta drafting stage and scheduled for WHA approval in 2015, the public version of the Beta drafting platform has yet to define this proposed new BDD category, characterize its three, proposed severities: Mild; Moderate; Severe, or populate any of its “Content Model” parameters.

It has sat there since February 2012, a tabula rasa.

At the time of writing, it remains unspecified which disorders BDD is proposed to capture.

It isn’t clear whether its criteria are proposed to be based on unspecified somatic symptoms, symptom counts or specific constellations of symptoms (eg gastrointestinal, musculoskeletal); whether psychological or behavioural responses are central to its definition; whether it is intended to be inclusive of selected of the so-called “functional somatic syndromes”; whether, like DSM-5’s SSD, its reach would be extended to include patients with somatic symptoms in association with diagnosed diseases, such as cancer or diabetes.

It is not possible to determine from what little information displays in the public version of the drafting platform whether ICD-11 proposes that BDD would mirror or incorporate Per Fink’s construct of “Bodily Distress Syndrome” for definition, criteria, severity specifiers, inclusions, exclusions etc; or whether it intends BDD to also incorporate DSM-5’s “Somatic Symptom Disorder” (and if so, how might this be achieved, since BDS and SSD lack congruency); or whether a unique definition for BDD is being developed and tested specifically for ICD-11.

Until ICD-11 defines BDD, it presents barriers to professional and lay stakeholders inputting meaningful comment on this proposal, which has remained undefined for over a year.

If the working groups advising ICD-11 Revision are putting forward a Per Fink “BDS” model for BDD, or an adaptation of Per Fink’s model, it is not known how WHO classification experts view any proposal that might seek to shift several, discrete, ICD-10 categories with long-standing classification locations outside the Mental and behavioural disorders chapter of ICD, into Chapter 5, and subsume them under a new disorder construct, for which there is no body of evidence for its validity as a construct and safety of application outside research settings.

Note that the ICD-11 Beta draft is a work in progress: proposals for new disorders for ICD-11 are subject to field trial evaluation and approval by Topic Advisory Group Managing Editors, the ICD-11 Revision Steering Group and WHO classification experts.

These two papers and a book chapter discuss emerging proposals for ICD-11 and ICD-11-PHC:

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 [PMID: 22843638]*
Creed F, Gureje O. Emerging themes in the revision of the classification of somatoform disorders. Int Rev Psychiatry 2012;24:556-67. [PMID: 23244611]
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 Two: http://samples.jbpub.com/9781449627874/Chapter2.pdf]
*SHORT REPORT Kuruvilla, A, Jacob KS. Perceptions about anxiety, depression and somatization in general medical settings: A qualitative study. National Medical Journal of India, vol. 25, no. 6, pp. 332–335, 2012

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What is “Bodily Distress Syndrome”?

The Per Fink et al construct of BDS is a unifying diagnosis that encompasses a group of what are considered to be closely related conditions such as somatization disorder, fibromyalgia, chronic pain disorder, irritable bowel syndrome, chronic fatigue syndrome and ME, multiple chemical sensitivity (MCS) and whiplash associated disorder. On some BDS presentation slides, “Stress and burn out…and many more…” are added to the list.

From the Aarhus Research Clinic website:

“…recent research suggests that the different diagnoses are all subcategories of one single illness, namely BDS…

“…BDS is a new research diagnosis and therefore unfamiliar to many doctors. Most doctors do know the different diagnoses mentioned in the above box, but they are unaware that they can be viewed as one single illness…”

In May 2010, Per Fink and Andreas Schröder, PhD, MD, Aarhus Universitetshospital, Denmark, published the paper, “One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders.” [Abstract: PMID: 20403500].

According to the authors of this 2012 EACLPP Conference Abstract: Bodily Distress Syndrome: A new diagnosis for functional disorders in primary care, the concept of “Bodily Distress Syndrome”

is expected to be integrated into the upcoming versions of classification systems.

This 2010 Danish journal article sets out proposals by Fink et al for a new classification:

Journal article: Fink P, Rosendal, M et al. Ny fælles diagnose for de funktionelle sygdomme. [PDF, in Danish]

Note: This proposal by Fink, Rosendal et al has three hitherto discrete ICD-10 classifications, Fibromyalgia (M79.7), IBS (K58) and Chronic Fatigue Syndrome (indexed to G93.3 in ICD-10; classified in ICD-11 Beta draft as an ICD Title term within ICD-11 Chapter 6: Diseases of the nervous system) proposed to be relocated under the ICD-11 mental and behavioural disorders chapter (Chapter 5) and subsumed under a single new disorder classification, “Bodily Distress Syndrome,” along with Neurasthenia (F48.0), Hypochondriasis and some other ICD-10/DSM-IV Somatoform Disorders.

Page 1837

Proposed new classification on left;  Current classifications on right:

Danish Journal paper Fink P

Here, the same proposal set out in English, from a Danish presentation:

(Note: MS type = Musculoskeletal)

Slide Presentation Two [PDF, in Danish; some slides in English]

Bodily Distress Syndrome (BDS), og helbredsangst  Udvikling af diagnoserne, assessment og forskning på området, Oplæg ved Sundhedspsykologisk, Årsmøde 2011

Slide #11 of 97

Fink: Proposed New Classification

For further information on proposals for “Bodily Distress Disorder” for ICD-11 and on Per Fink’s “Bodily Distress Syndrome” see Dx Revision Watch post #222: ICD-11 Beta draft and Bodily Distress Disorders; Per Fink and Bodily Distress Syndrome Parts One and Two

References

1. Medically Unexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services. Creed, Francis; Henningsen, Peter; Fink, Per, Cambridge University Press, 2011. Sample pages on Google Books
2. Creed F, Gureje O. Emerging themes in the revision of the classification of somatoform disorders. Int Rev Psychiatry 2012;24:556-67. [Abstract: PMID: 23244611]
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. [Abstract: PMID: 20403500]
4. ICD-11 Beta drafting platform: Bodily Distress Disorder: Mild; Moderate; Severe. Proposed revision to ICD-10 Somatoform Disorders

Menneskerettighederne nægtet: Noget råddent i staten Danmark: Karina Hansen: Opdater 1

Post #258 Shortlink: http://wp.me/pKrrB-36e

Clarification

Reports and updates on Dx Revision Watch site on the Hansen family’s situation are being published as provided by, and in consultation with, Rebecca Hansen, Chairman, ME Foreningen, Danmark (ME Association, Denmark), or edited from reports as provided by Ms Hansen.
Dx Revision Watch site has no connection with any petitions or initiatives, or with any social media platforms or other platforms set up to promote petitions or initiatives, or to otherwise raise awareness of the Hansen family’s situation. The use of any links to content on Dx Revision Watch does not imply endorsement of, or association with any initiatives other than the ME Foreningen, Danmark (ME Association, Denmark) Postcard to Karina Campaign.
All enquiries in relation to petitions or other initiatives, social media platforms, or any other platforms associated with them should be addressed directly to the organizers, sponsors or owners responsible for them.

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”Har ME-patienter ikke ret til at vælge, hvilken behandling vi ønsker at modtage? Har vi ikke ret til besøgende, når vi er på hospitalet?”

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Karina HansenOpdater 1: Menneskerettighederne nægtet

On May 11, on the eve of ME Awareness week, I published an account, of the plight of the Hansen family, in Denmark.

Karina Hansen is 24. She has been bedridden with severe ME since 2009.

In February, this year, Karina was forcibly removed from her bedroom and committed to Hammel Neurocenter.

Her parents have not seen Karina for over three months.

The Hansen family and their lawyer are still waiting for legal documentation and answers to their questions:

Which authority gave the order to remove Karina from her home against her will and by whom was it authorized?

What legislation was used to detain her as an involuntary patient in a hospital?

Why are the parents being denied visits?

Two updates on the case have been released, this week. These are being published, as provided, and with permission of the Hansen family and their lawyer.

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Første rapport:
Noget råddent i staten Danmark: Karina Hansen: http://wp.me/pKrrB-2Xc

Verdenserklæringen om Menneskerettighederne: http://www.unric.org/da/information-om-fn/15

Status på Karinas sag – 24.5.13

Af Rebecca Hansen

Følgende tekst er godkendt af familien.

Karina er forsat indlagt på Hammel Neurocenter. Lægen Jens Gyring har givet mundtlig besked til familien om, at indlæggelsen vil forsætte i lang tid – måske et år. Vi har ikke set noget bevis for, at Karina har fået det bedre.

Karinas forældre har en fuldmagt, som giver dem ret til at træffe beslutninger for Karina, også omkring hendes behandling. Denne fuldmagt ignoreres.

Fuldmagten blev oprettet i maj 2012. Karinas praktiserende læge erklærede hende psykisk rask 2 gange i maj 2012.

Sundhedsstyrelsen (SST) påstår, at Karinas advokat ikke er hendes advokat, da de nu mener, at hun ikke var habil, da hun antog advokaten i maj 2012. Advokaten har repræsenteret Karina siden maj 2012 og fik aktindsigt i Karinas sag på dette grundlag. Dernæst oplyser SST, at advokaten havde fuldmagt i 2012 ved første mislykkede forsøg på at få Karina tvangsindlagt (03.05.12) men at fuldmagten ikke er gældende for episoden med hendes endelige tvangsfjernelse og indlæggelse i februar 2013.

Psykiater Nils Balle Christensen skriver, at Karina er voksen og myndig til at træffe ”her og nu beslutninger”, og at de på Hammel Neurocenter ikke gør noget imod hendes vilje. Men samtidig, mener Holstebro Kommune at Karina har brug for en værge og Statsforfatningen Midtjylland har fået til opgave at udpege en værge til hende og hermed umyndiggøre hende.

ME Foreningen kontaktede Patientkontoret den 29. april 2013 for at få navn på Karinas patientrådgiver, idet Foreningen ønsker at bidrage med viden om sygdommen og vil herudover forsøge at skaffe en udenlandsk ME ekspert til landet, der kan tilse Karina. Svaret var at ”sagen er overgivet til Juridisk kontor i Region Midtjylland.”

Karinas forældre og jeg prøvede at besøge Karina den 12. maj, men blev nægtet adgang. Du kan læse om dette på ME Foreningens facebook under noter.

Nils Balle Christensen skriver, at der ikke er besøgsforbud, men Karinas forældre må alligevel fortsat ikke besøge hende. Der gives en mundlig besked til forældrene, at ”juristerne” vil oprette et ”dokument” omkring ”besøgsrestriktionerne”. Denne kan Karinas forældre forvente at få fremsendt i løbet af 7-14 dage.

Vi har ringet til Karinas mobil som hun har med på hospitalet mange gange, men den går direkte på voicemail.

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Et besøg hos Karina – et spørgsmål om menneskerettigheder

Af Rebecca Hansen
ME-patient
icerebel62@hotmail.com

Den 12. maj besluttede Karinas forældre og jeg igen at prøve at besøge Karina på Hammel Neurocenter. Karina er en alvorligt syg dansk ME-patient, som er blevet tilbageholdt på Hammel Neurocenter siden den 12. februar 2013, og i denne periode har hendes forældre ikke fået lov til at besøge eller tale med hende.

Karinas advokat har for nylig fået en meget begrænset adgang til nogle af dokumenterne i Karinas sag ved hjælp af offentlig aktindsigt. Af dette materiale fremgik det, at det faktisk ikke er tilladt i Danmark at forhindre pårørende i at besøge deres familie på hospitalet, og at menneskerettighederne har høj prioritet.

Karina forældre var blevet fortalt, at de skulle mødes med Nils Balle Christensen (NBC), en psykiater fra Forskningsklinikken for Funktionelle Lidelser, for at tale om betingelserne for besøg, før de kunne se deres datter. Da Karinas søster, Janni, besøgte Karina i april, fik Janni instruktioner om, hvad hun måtte sige og ikke sige til Karina. Forældrene fik slet ikke lov at komme ind, fordi de fik at vide, at de først skulle mødes med NBC for at afgøre betingelserne for besøg.

Men nu vidste vi, at det ikke er legalt at have sådanne restriktioner på besøg, så vi besluttede at prøve at se Karina søndag den 12. maj – på Mors Dag og den internationale mærkedag for ME.

Før jeg fortæller om besøget, vil jeg fortælle om den kontakt, som NBC har haft med Karina og hendes familie.

Nils Balle Christensen blev involveret i Karinas sag i maj 2012, efter Karinas advokat havde forhindret hendes fjernelse efter psykiatrisk lovgivning. Han blev præsenteret for familien, og hans opgave var at udarbejde en behandlingsplan til Karina. I løbet af sommeren 2012 besøgte NBC Karinas forældre adskillige gange med henblik på at etablere en behandlingsplan. I denne periode ønskede NBC ikke at samarbejde med Karinas advokat, og NBC leverede ikke en skriftlig behandlingsplan. Karinas forældre har aldrig modtaget nogen skriftlige instrukser for Karinas pleje og der var ingen kritik af den pleje, de gav Karina. Jeg var til et møde med NBC og Karinas forældre i 2012, hvor NBC fortalte moderen, at hun gjorde et godt stykke arbejde. NBC kom med et tilbud om at indlægge Karina, men ikke med en plan om hvad der ville ske, når hun blev indlagt. De fik heller ikke nogen forklaring på, hvorfor man ikke kunne behandle Karina i hjemmet. Karinas forældre turde ikke acceptere en ukendt behandling fra en læge, der aldrig før har behandlet (eller set) en alvorlig syg ME-patient. Af mange årsager stolede Karinas forældre ikke på NBC, og kontakten med NBC blev afbrudt i starten af efteråret 2012. Karinas forældre valgte at betale for en privat læge og en diætist til at hjælpe Karina.

Karinas forældre troede, at NBCs involvering med Karina nu var afsluttet. Men den begrænsede adgang, som Karinas advokat nu har opnået ved offentlig aktindsigt afslører, at NBCs engagement langt fra var overstået.

Dokumenterne viser, at der var aktivitet i Karinas sag imellem Sundhedsstyrelsen og henholdsvis Holstebro Kommune, Holstebro politi samt til NBC, efter at hans kontakt til forældrene var stoppet.

Desuden afslører disse papirer, at der var en forespørgsel til Ministeriet for Sundhed og Forebyggelse om retten til at forhindre pårørende i at besøge familiemedlemmer på et hospital. Den 21. december 2012 sendte ministersekretæren for Ministeriet for Sundhed og Forebyggelse et 5-siders svar, der forklarer, at menneskerettighederne har høj prioritet (vejer meget tungt).

Men i NBCs skrivelse af 12. februar 2013 til Karinas forældre står der:

”Det er besluttet, at Karina, pga. sin tilstand, ikke må have besøg de første 14 dage. Det vil herefter blive vurderet, om hun er i stand til at modtage besøg.”

Med disse nye oplysninger om menneskerettighederne i hånden, besluttede Karinas forældre og jeg os den 12. maj for at se, om der stadig var et forbud imod eller begrænsninger på at besøge Karina på Hammel Neurocenter.

Vi ønskede ikke, at personalet skulle føle sig truet af os på nogen måde, så vi havde på forhånd aftalt, at hvis vi fik at vide, vi ikke kunne besøge Karina, ville vi respektere dette, men vi ville stille en masse spørgsmål om, hvorfor dette forbud / denne begrænsning var oprettet.

På Hammel præsenterede Karinas forældre sig for personalet og bad om tilladelse til at se deres datter. Der blev svaret ”nej”, og at det skulle have været aftalt telefonisk med lægen. Jeg spurgte, om der var et besøgsforbud. Det blev der svaret ”nej” til. Så spurgte jeg, om der var restriktioner, men det blev ikke besvaret. I stedet svarede medarbejderen, at hun ville ringe til Jens Gyring, som er overlægen på stedet. De bad os om at vente. Medarbejderne på Hammel Neurocenter var høflige og venlige, men det var tydeligt, at de var beklemte ved vores tilstedeværelse.

Et øjeblik senere vendte sygeplejersken tilbage med svar fra Jens Gyring, at forældrene først skulle have et møde med NBC, inden de kunne se deres datter. Vi diskuterede denne begrænsning, og Karinas forældre bad om en skriftlig forklaring på, hvorfor de skulle have et møde med NBC, før de kunne se deres datter, og hvad hensigten med mødet ville være.

Jeg understregede, at det ikke er lovligt at forhindre forældre i at besøge sit barn og prøvede at vise dem udtalelsen fra Ministeriet for Sundhed og Forebyggelse. En anden medarbejder brød ind og sagde, at denne diskussion skulle tages med lægerne og ikke med dem.

I mellemtiden var Jens Gyring blevet kontaktet igen og havde sagt, at man skulle spørge Karina om hun vil have besøg. En ny sygeplejerske deltog i vores diskussion og sagde: ”Jeg har lige været inde ved Karina og fortalt, at I er her og spurgt om hun vil have besøg, og hun rystede bare på hovedet.”

Meget interessant, at der pludselig ikke var noget besøgsforbud, men at det nu var op til Karina…

Til det svarede jeg, at vi gerne ville have en hel sætning fra Karina for at sikre, at hun forstod spørgsmålet. Vi ønskede at høre hende sige, at hun ikke ville se sin mor og far. Vi kunne ikke rigtig vide, om hun forstod spørgsmålet, eller om hun virkelig troede på, at de var her efter 3 måneder. Desuden bærer Karina normalt ørepropper, så måske hørte hun ikke engang spørgsmålet.

Karinas mor sagde, at hun gerne vil høre ordene fra Karinas egen mund. At hun gerne ville se Karina og høre hendes svar. Og hvis Karina bad hende om at gå, ville hun straks gå igen.

Personalet insisterede på, at Karina havde svaret.

Her skal man huske på, at det sidste Karina sagde til sin mor den 13. februar var, da hun ringede til sin mor og sagde: ”Hvordan kommer jeg ud herfra. Jeg kan ikke klare det.” – Hvad er der sket de sidste 3 måneder? Ønsker Karina virkelig ikke at se sine forældre? Hvis dette er tilfældet, hvad er så årsagen? Hvilken begrundelse har lægerne givet Karina for, at forældrene ikke besøger hende? Vi er overladt til at gætte svarene på disse spørgsmål.

Det var tydeligt, at forældrene ikke ville få lov til at se Karina og selv høre, at Karina ikke ønskede et besøg. Men vi fik de ansatte til at love at få NBC til at sende forældrene en skriftlig erklæring om, hvorfor de skulle have et møde med ham, før de kunne se deres datter, og hvad mødet ville handle om. De lovede også at oplade Karinas mobiltelefon og give den til hende. Så forlod vi Neurocenteret. Karinas mor havde tårer i øjnene og sagde: ”Jeg troede virkelig, at jeg ville få hende at se i dag.”

Efter hjemkomsten skrev Karinas forældre en mail til Nils Balle Christensen og bad igen om på skrift at få at vide, hvorfor de ikke må se Karina, og hvad dagsordenen er for det møde, han kræver, før de kan se hende.

Til dette svarede NBC, at der ikke er besøgsforbud. Og siden Karinas forældre ikke ønsker at mødes med NBC, kan de i stedet mødes med overlæge Jens Gyring: ”hvor der kan laves skriftlige aftaler om fremtidige besøg og telefonkontakt med mere”.

Er det ikke stadig et besøgsforbud, indtil deres betingelser er opfyldt? Hvordan er det forskelligt fra et besøgsforbud, indtil forældrene mødes med NBC? Hvilken ret har de til at stille disse betingelser?

Få dage senere fik Karinas forældre at vide af Jens Gyring, at det ville være op til advokaterne at lave en skriftlig aftale om besøg. Dette kunne tage 2 uger.

I mellemtiden kan vi tænke over, hvad denne situation betyder for andre ME-patienter og deres pårørende i Danmark. En alvorligt syg ME-patient får tilkendt en psykiater, som aldrig før har behandlet en alvorligt syg ME-patient. Psykiateren kommer fra en klinik, der har fravalgt at samarbejde med internationale ME eksperter (brev fra september 2012 og referat fra mødet den 8. oktober 2012). Psykiateren ønsker ikke at samarbejde med patientens advokat eller oplyse noget på skrift om den behandling, han vil give.

Når ME-patienten og de pårørende beslutter, at de ikke ønsker den behandling, som denne psykiater tilbyder, så samarbejder de danske myndigheder for at fjerne ME-patienten fra hjemmet – tydeligt imod hendes vilje – og isolere hende fra hendes pårørende og advokat.

Psykiateren, der har ansvaret for Karina, er også ansvarlig for alle ME-patienter i Danmark – så er det fremtiden for alle ME-patienter og deres familier i Danmark?

Har ME-patienter ikke ret til at vælge, hvilken behandling vi ønsker at modtage? Har vi ikke ret til besøgende, når vi er på hospitalet?

Ja, der er virkelig noget råddent i Danmarks rige.

Hvis jeg har misforstået noget i denne historie, så vil jeg være glad for at høre en forklaring fra de involverede parter.

Rebecca Hansen
ME-patient
Icerebel62@hotmail.com

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For first report (in English) see:

Something rotten in the state of Denmark: Karina Hansen’s story: http://wp.me/pKrrB-2Xc

For more information on the ME Association of Denmark’s postcard campaign go here on Facebook
For information on Bodily Distress Syndrome see Part Two of Dx Revision Watch Post: ICD-11 Beta draft and BDD, Per Fink and Bodily Distress Syndrome
Menneskerettighederne nægtet: Noget råddent i staten Danmark: Karina Hansen: Opdater 1: http://wp.me/pKrrB-36e
Human Rights denied: Something rotten in the state of Denmark: Karina Hansen’s story: Update 1: http://wp.me/pKrrB-35o
Ontkenning van mensenrechten: Iets verrot in de staat van Denemarken: Het verhaal van Karina Hansen: Update 1: http://wp.me/pKrrB-35o
Menschenrechtsverstoß: Etwas ist faul in Dänemark: Karina Hansens Geschichte: Update 1: http://wp.me/pKrrB-35o
Droits de l’Homme: Il y a quelque chose de pourri au royaume du Danemark: l’histoire de Karina Hansen: Update 1: http://wp.me/pKrrB-35o