US, UK and international patient organisation submissions to DSM-5 draft proposals

US, UK and international patient organisation submissions to DSM-5 draft proposals

Post #29 Shortlink: http://wp.me/pKrrB-Ex

The DSM-5 public review period closes on 20 April – that’s less than four weeks away.

Patient representation organisations, clinicians, researchers, allied health professionals, patient advocates and other stakeholders can register online at www.dsm5.org to submit responses.

US patient organisation submissions:

CFSIDS: The March issue of CFIDSLink-e-News reports that the CFIDS Association of America is seeking input from outside experts into the DSM-5 public review process. Their notice can be read here:
http://www.cfids.org/archives/2006-2010-cfidslink/march-2010.asp#advocacy

WPI: The Whittemore Peterson Institute has announced on its Facebook site that it intends to submit a response:
http://www.facebook.com/pages/Whittemore-Peterson-Institute/154801179671

International patient organisation submissions:

IACFSME: The IACFSME has issued an alert for international CFS and ME clinicians, researchers and professionals and has published a copy of the organisation’s own submission in the DSM-5 public review process. Their notice and submission can be read here: http://www.iacfsme.org/Home/tabid/36/Default.aspx

ESME: ESME (International Society for ME) has stated on its Facebook site that its Think Tank panel members will submit a response which will be posted on ESME’s website and on ESME’s Facebook page:
http://www.facebook.com/pages/ESME-European-Society-for-ME/326113349124

If readers are aware of other US organisations, international organisations or professionals who have stated that they intend to submit responses, please let me know as I am collating these on my site.

UK patient organisation submissions:

On 4 March, I contacted senior personnel of seven national UK patient and research organisations. All were sent key links and documents relevant to the DSM-5 Somatic Symptom Disorders Work Group proposals. (These organisations had also been sent selected DSM revision related material during the course of the past twelve months so all will have been aware of the impending release of draft proposals for DSM-5.)

They were all asked if they would clarify whether they intended to submit a response to the DSM-5 draft proposals for revision of DSM-IV categories currently classified under “Somatoform Disorders” and if so, whether they intended to publish their submission.

Those organisations which had not responded by 22 March were contacted again. These are the replies so far to my enquiries:

The Young ME Sufferers Trust: No reply received.

AYME: No reply received.

Invest in ME: Invest in ME has confirmed that it does intend to submit a response and that it will be publishing its response.

ME Research UK: Neil Abbott has said that it is uncertain whether resources will run to producing a response, but if a response is put together on behalf of MERUK, then this would be made publicly available.

Action for M.E.: On 25 March, in a telephone conversation, Action for M.E.’s Policy Officer was unable to confirm what Action for M.E.’s intentions are. The Policy Officer was asked to follow this up with Sir Peter Spencer (CEO) and Heather Walker (Communications Manager) since neither had responded to my email enquiries.

Later in the day, Action for M.E. posted a holding statement from its CEO, Sir Peter Spencer, on its Facebook Wall ( http://www.facebook.com/actionforme ) stating that:

“Action for M.E. will respond to the American consultation exercise before the 20th April.

“We will publish our considered response on our website when it has been submitted to the DSM-5 Task force.

“Action for M.E ‘s position is that M.E./CFS is a long-term and disabling physical illness. We accept the WHO classification in ICD 10 G93.3 that M.E. is a neurological disorder.

“We will oppose any attempt to classify CFS/M.E. as a psychiatric disorder either explicitly or implicitly.”

25% ME Group: The 25% ME Group has published a 12 page “Submission re: DSM-V and ME/CFS”, compiled by Professor Malcolm Hooper and Margaret Williams for submission by The 25% ME Group, dated 20 March 2010:
http://www.25megroup.org/News/DSM-V%20submission.doc

The ME Association: Neil Riley, Chair of the ME Association Board of Trustees, provided me with the following information:

That a response had already been submitted to the DSM-5 on 11 February.
That the response was submitted not by the ME Association but by Dr Ellen Goudsmit, PhD.
That the ME Association endorses Dr Goudsmit’s submission.
That the ME Association “had not thought of publishing it and wanted to see what the final proposals for the revision of the DSM categories will be but [Mr Riley] can confirm that the main argument put forward was that CFS should be an exclusion.”

In response to a request for further clarification, Mr Riley wrote:

“As you are aware the DSM-5 draft proposals relate to proposed psychiatric categories and this is a specialised field for which professional advice was best sought. As you know CFS and ME are not in the current draft for DSM-5. A comment was submitted related to another disorder (CSSD) which may be considered by some clinicians as an additional diagnosis on the axis e.g. affecting outcome of CFS. This was not a response to the text on CFS but challenged the robustness of a proposed psychiatric disorder.”

“The current text in the draft ‘clarifies that a diagnosis of CSSD is inappropriate in the presence of only unexplained medical symptoms. Similarly, in conditions such as irritable bowel syndrome, CSSD should not be coded unless the other criterion (criterion B-attributions, etc) is present.’ Without diagnostic tests to determine whether attributions are correct (cf criterion B), our recommendation is that to avoid confusion, CFS should be an exclusion.”

Mr Riley added:

“If a future draft mentions CFS, a formal response on behalf of the MEA is justified and will be published in full online.”

Other than the comments contained in Mr Riley’s responses to me earlier this month, the ME Association has been silent on the DSM-5 revision process and its position on the proposals of the Somatic Symptom Disorders Work Group and whether it had intended to submit a response, as an organisation, on behalf of its members.

Mr Riley’s response indicates that the ME Association does not plan to publish a copy of the response which it says it is endorsing, in order to fully inform its membership and the wider ME community of its position on the DSM-5 proposals.

If you find this unacceptable, please advise the Board of Trustees.

In June 2009, the ME Association published, on its website only, a “Summary Report” on the CISSD Project* which had been co-ordinated by Dr Richard Sykes, PhD. between 2003 and 2007. This report drew on the content of the December 2007 Final Report on the CISSD Project handed to the project’s Administrators, Action for M.E. on completion of the project.

The ME Association has published no comment or opinion on the aims and objectives of the project, itself, the membership of its workgroup, the content and recommendations contained in the Review paper published by the project’s leads, Kroenke, Sharpe and Sykes in mid 2007, or on the “Summary Report” provided to it by Dr Sykes, either at the time that it placed this document on its website, last June, nor since.

The project’s UK chair was Professor Michael Sharpe.

I will update when I have heard from the remaining two organisations.

If readers are aware of other UK organisations and professionals who are intending to make a submission, please let me know.

 

Related material:

The DSM-5 proposal is that Somatoform Disorders, Psychological Factors Affecting Medical Condition (PFAMC) and Factitious Disorders should be combined under a common rubric entitled “Somatic Symptom Disorders” and for a new disorder – “Complex Somatic Symptom Disorder (CSSD)”.

The DSM-5 public review period runs from 10 February to 20 April. Members of the public, patient representation organisations, professionals and other end users can submit responses, online.

Please take this opportunity to comment and to alert and encourage professionals and international patient organisations to participate.

Proposed Draft Revisions to DSM Disorders and Criteria are published here on the APA’s relaunched DSM5.org website: http://www.dsm5.org/Pages/Default.aspx

Somatoform Disorders:
http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx

Proposed new DSM-5 category: Complex Somatic Symptom Disorder:
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=368

Two Key PDF documents are associated with proposals:

PDF A] Somatic Symptom Disorders Introduction DRAFT 1/29/10
http://www.dsm5.org/Documents/Somatic/APA%20Somatic%20Symptom%20Disorders%20description%20January29%202010.pdf

PDF B] Justification of Criteria – Somatic Symptoms DRAFT 1/29/10
http://www.dsm5.org/Documents/Somatic/APA%20DSM%20Validity%20Propositions%201-29-2010.pdf

*Review paper: CISSD Project leads Kroenke K, Sharpe M, Sykes R: Revising the Classification of Somatoform Disorders: Key Questions and Preliminary Recommendations. Psychosomatics 2007 Jul Aug;48(4):277-85. FREE Full Text: http://psy.psychiatryonline.org/cgi/content/full/48/4/277

18 Proposals submitted by Dr Richard Sykes to WHO ICD Update and Revision Platform, Topical Advisory Group – Mental Health (TAGMH): https://extranet.who.int/icdrevision/GroupPage.aspx?gcode=104

The paper: Kroenke K: Somatoform disorders and recent diagnostic controversies. Psychiatr Clin North Am 2007 Dec;30(4):593-619: http://www.ncbi.nlm.nih.gov/pubmed/17938036  contains the caveat:

“Although the CISSD is an ad hoc group that includes many international experts on somatoform disorders, it was neither appointed nor sanctioned by the APA or WHO, the organizations authorized to approve revisions of DSM and ICD, respectively. As such, the CISSD recommendations should be considered advisory rather than official. Also, there were some suggestions for which the CISSD achieved near consensus but other issues where opinions diverged considerably.”

——————

Note: An unpublished paper refered to on the DSM-5 site at this URL under “Rationale”

Complex Somatic Symptom Disorder [Rationale Tab]
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=368

“A key issue is whether the guidelines for CSSD describe a valid construct and can be used reliably. A recent systematic review (Lowe, submitted for publication) shows that of all diagnostic proposals, only Somatic Symptom Disorder reflects all dimensions of current biopsychosocial models of somatization (construct validity) and goes beyond somatic symptom counts by including psychological and behavioral symptoms that are specific to somatization (descriptive validity). Predictive validity of most of the diagnostic proposals has not yet been investigated.”

is thought to be this paper currently “In Press” on the Journal of Psychosomatic Research, for which DSM-5 SDD Work Group member, Frances Creed, is a co-editor. Access to full paper requires subscription or pay per paper:

Articles in Press
http://www.jpsychores.com/inpress

Towards positive diagnostic criteria: A systematic review of somatoform disorder diagnoses and suggestions for future classification
In Press Corrected Proof , Available online 15 March 2010
Katharina Voigt, Annabel Nagel, Björn Meyer, Gernot Langs, Christoph Braukhaus, Bernd Löwe
Journal of Psychosomatic Research
DOI: 10.1016/j.jpsychores.2010.01.015
Abstract | Full Text | Full-Text PDF (183 KB)

Abstract
http://www.jpsychores.com/article/S0022-3999(10)00020-6/abstract

Towards positive diagnostic criteria: A systematic review of somatoform disorder diagnoses and suggestions for future classification

Katharina Voigta 1, Annabel Nagel a1, Björn Meyer a, Gernot Langs b, Christoph Braukhaus b, Bernd Löwe a
Received 1 November 2009; received in revised form 12 January 2010; accepted 14 January 2010. published online 15 March 2010. Corrected Proof

Abstract

Objectives
The classification of somatoform disorders is currently being revised in order to improve its validity for the DSM-V and ICD-11. In this article, we compare the validity and clinical utility of current and several new diagnostic proposals of those somatoform disorders that focus on medically unexplained somatic symptoms.

Methods
We searched the Medline, PsycInfo, and Cochrane databases, as well as relevant reference lists. We included review papers and original articles on the subject of somatoform classification in general, subtypes of validity of the diagnoses, or single diagnostic criteria.

Results
Of all diagnostic proposals, only complex somatic symptom disorder and the Conceptual Issues in Somatoform and Similar Disorders (CISSD) example criteria reflect all dimensions of current biopsychosocial models of somatization (construct validity) and go beyond somatic symptom counts by including psychological and behavioral symptoms that are specific to somatization (descriptive validity). Predictive validity of most of the diagnostic proposals has not yet been investigated. However, the number of somatic symptoms has been found to be a strong predictor of disability. Some evidence indicates that psychological symptoms can predict disease course and treatment outcome (e.g., therapeutic modification of catastrophizing is associated with positive outcome). Lengthy symptom lists, the requirement of lifetime symptom report (as in abridged somatization), complicated symptom patterns (as in current somatization disorder), and imprecise definitions of diagnostic procedures (e.g., missing symptom threshold in complex somatic symptom disorder) reduce clinical utility.

Conclusion
Results from the reviewed studies suggest that, of all current and new diagnostic suggestions, complex somatic symptom disorder and the CISSD definition appear to have advantages regarding validity and clinical utility. The integration of psychological and behavioral criteria could enhance construct and descriptive validity, and confers prospectively relevant treatment implications. The incorporation of a dimensional approach that reflects both somatic and psychological symptom severity also has the potential to improve predictive validity and clinical utility.

Keywords: Classification, Diagnosis, Diagnostic and Statistical Manual of Mental Disorders, International Classification of Diseases, Somatoform disorders, Validation studies as topic

a Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany
b Medical and Psychosomatic Hospital Bad Bramstedt, Bad Bramstedt, Germany
Corresponding author. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Tel.: +49 40 7410 59733; fax: +49 40 7410 54975.
1 Both authors contributed equally to this paper.
PII: S0022-3999(10)00020-6
doi:10.1016/j.jpsychores.2010.01.015

Compiled by Suzy Chapman

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Notice from IACFSME: DSM-5 May Include CFS as a Psychiatric Diagnosis

Notice from IACFSME: DSM-5 May Include CFS as a Psychiatric Diagnosis and submission in DSM-5 public review process

Post #28 Shortlink: http://wp.me/pKrrB-En

Notice From IACFSME   http://www.iacfsme.org/

International Association for Chronic Fatigue Syndrome

DSM-5 May Include CFS as a Psychiatric Diagnosis

March 25, 2010

Important Alert to the CFS/ME Community:

The DSM-5 Task Force of the American Psychiatric Association is asking for public comment to their proposed DSM-5 manual of psychiatric diagnoses scheduled for release in 2013. We are concerned about the possibility of CFS/ME being classified as a psychiatric disorder, based on comments made in their Work Group on somatoform disorders (see letter below). Of course, such an action would be a major setback in our ongoing efforts to legitimize and increase recognition of the illness.

We urge you to submit your comments about this disturbing possibility to the DSM-5 Task Force ( www.dsm5.org ). You only need to register on this website to submit your comments. (Once you have a login, click on Proposed Revisions, and then Complex Somatic Symptom Disorder. At the bottom of page is a section for public comments.) Comments written from the perspective of a working professional (researcher, clinician, educator) will have the most influence.

Comments must be submitted by April 20 th.

Thank you.

Fred

Fred Friedberg, PhD
President
IACFS/ME

Letter To the DSM-5 Task Force:

On behalf of the board of directors and the membership of the International Association for Chronic Fatigue Syndrome (IACSF/ME), I would like to express my deep concern about the possible reclassification of CFS as a somatoform disorder in DSM-5. Although the proposed new category of Complex Somatic Symptom Disorder (CSSD) appears reasonable, we are concerned about CFS, a complex illness condition, becoming a subtype of CSSD or a distinct stand alone psychiatric diagnosis. We base our concern on comments by Dr Simon Wessely (DSM-5 Work Group; September 6-8, 2006) who concluded that “we should accept the existence …of functional somatic symptoms/ syndromes …[apart from depression and anxiety] and respect the integrity of fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, and their cultural variants.” This comment suggests the possibility of a new DSM-5 somatoform diagnosis that subsumes CFS as one manifestation or subcategory.

It is the position of the IACFS/ME that placing CFS in the new category of CSSD would not be reasonable based upon the body of scientific evidence and the current understanding of this disease.

The classification of CFS as a psychiatric disorder in the DSM-5 ignores the accumulating biomedical evidence for the underpinnings of CFS in the domains of immunology, virology, genetics, and neuroendocrinology. Over the past 25 years, 2,000 peer review CFS studies have been published. The data support a multifactorial condition characterized by disturbances in HPA function, upregulated antiviral pathways in the immune system, and genetic abnormalities. Unlike clinical anxiety and depression, psychotropics are generally ineffective for CFS and standard medical advice to exercise and rest or resume activities often leads to symptom worsening. In contrast to clinical depression, motivation is much less affected in CFS and the desire to be active remains intact. Furthermore, large differences in gene expression have been recently found between CFS and endogenous depression (Zhang et al., 2009)

Although biomedical research to elucidate the mechanisms of CFS is a work in progress, the medical uncertainties surrounding CFS should not be used as justification to classify it as a psychiatric illness. As stated by Ricardo Araya MD: “The absence of a medical explanation [for an illness] should not confer automatic psychiatric labeling (Sept.6-8, 2006; Somatic Presentations of Mental Disorders; DSM-5 Work Group).”

With respect to DSM-5, we support a recent editorial in the British Medical Journal by Dr. Allen Francis (2010), chair of the DSM-IV task force, who stated that any new DSM diagnosis should be based on “a careful risk-benefit analysis that includes ….a consideration of all the potential unintended consequences (p. 492)”. The likely unintended consequences of a CFS diagnosis in the new DSM will be increased stigmatization and even lower levels of recognition by primary care physicians and the medical community in general. As a result, we believe such an action would be counterproductive to our ongoing efforts to educate physicians about the assessment and clinical care of these patients.

The IACFS/ME is an organization of more than 500 biomedical and behavioral professionals whose mission is to promote, stimulate, and coordinate the exchange of ideas related to CFS research, patient care, and treatment. We support scientific advocacy efforts for increased research funding. We also support public health policy initiatives to increase the recognition and reduce the stigmatization that continues to plague these debilitated and medically underserved patients.

Thank you for your attention.

Sincerely,

Fred Friedberg, PhD
President
IACFS/ME
www.iacfsme.org  

 

Submissions by US patient organisations

The March issue of CFIDSLink-e-News reports that the CFIDS Association of America is seeking input from outside experts into the DSM-5 public review process.

The Whittemore Peterson Institute has announced on its Facebook site that it intends to submit a response.

Submissions by UK patient organisations

On 4 March, I contacted seven national UK organisations.  I will update on responses received, so far, in the next couple of days. The following UK patient representative and research organisations have been contacted:

Action for M.E.
ME Association
AYME
The Young ME Sufferers Trust
Invest in ME
The 25% ME Group
ME Research UK

The DSM-5 public review period runs from 10 February to 20 April 2010. Members of the public, patient representation organisations, professionals and other end users can submit responses, online.

Please take this opportunity to comment and to alert and encourage professionals and international patient organisations to participate in the DSM-5 public review process. 

If the proposals of the “Somatic Symptom Disorders” Work Group were to be approved there will be medical, social and economic implications to the detriment of all patient populations – especially those bundled by many psychiatrists under the so-called “Functional Somatic Syndromes” (FSS) and “Medically Unexplained Syndromes” (MUS) umbrellas, under which they include CFS, ME, FM, IBS, CI, CS, chronic Lyme disease, GWS and others.

Register here: http://www.dsm5.org/Pages/Registration.aspx

Related information:

[1] APA’s new DSM-5 Development webpages: http://www.dsm5.org/Pages/Default.aspx

[2] Somatoform Disorders: http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx

[3] Complex Somatic Symptom Disorder (CSSD):
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=368

[4] Key documents:

     PDF Somatic Symptom Disorders Introduction DRAFT 1/29/10

     PDF Justification of Criteria – Somatic Symptoms DRAFT 1/29/10

New papers: Journal of Psychosomatic Research March 10 edition and In Press

New papers: Journal of Psychosomatic Research March 10 edition and In Press

Post #27 Shortlink: http://wp.me/pKrrB-Dv

At the time of writing, the co-editor of Journal of Psychosomatic Research is Francis Creed.  Professor Creed is a member of the APA’s DSM-5 Somatic Symptom Disorder Work Group and had been a member of the Conceptual Issues in Somatoform and Similar Disorders (CISSD) Project. (See Footnotes [1] and [2])

There are currently a number of new papers and In Press papers on the website of Journal of Psychosomatic Research on “Chronic fatigue syndrome” and the so-called “functional somatic syndromes (FSS)”; fibromyalgia (which is referred to in the paper as “chronic widespread pain”); irritable bowel syndrome; so-called “medically unexplained somatic symptoms”; somatoform disorders; the proposed new DSM-5 category Complex Somatic Symptom Disorder and the Conceptual Issues in Somatoform and Similar Disorders (CISSD) example criteria (Table 2).

Image Source: Academy of Psychosomatic Medicine, Nevada, November ‘09 Annual Meeting slide presentation, Francis Creed, MD, FRCP: Can We Now Explain Medically Unexplained Symptoms? See this posting for slide presentation

There is a new MUS paper by Hilbert, Rief et al published in the March ’10 edition.

There are also In Press papers by White (CFS: One discrete syndrome or many? FSSs); Knoop, Prins, Moss-Morris, Bleijenberg (Central role of cognitive processes in the perpetuation of chronic fatigue syndrome); Voigt, Löwe et al (Systematic review of somatoform disorder diagnoses and suggestions for future classification, DSM-5 and proposed new category CSSD, CISSD Project: Kroenke, Sharpe, Sykes: example criteria); Escobar et al (3 or more concurrent somatic symptoms predict psychopathology and service use); Ladwig, Henningsen, Creed et al (Screening for multiple somatic complaints); Cella and Chalder (Measuring fatigue) .

Journal of Psychosomatic Research
Volume 68, Issue 3, Pages 219-316 (March 2010)

http://www.jpsychores.com/home

March 2010 issue

Patients with medically unexplained symptoms and their significant others: Illness attributions and behaviors as predictors of patient functioning over time, 10 December 2009
Anja Hilbert, Alexandra Martin, Thomas Zech, Elisabeth Rauh, Winfried Rief
pages 253-262
Abstract | Full Text | Full-Text PDF (161 KB)

http://www.jpsychores.com/article/S0022-3999(09)00375-4/abstract

———————-

Articles in Press
http://www.jpsychores.com/inpress

Chronic fatigue syndrome: Is it one discrete syndrome or many? Implications for the “one vs. many” functional somatic syndromes debate
In Press Corrected Proof, Available online 18 March 2010
Peter D. White
Journal of Psychosomatic Research
DOI: 10.1016/j.jpsychores.2010.01.008
Abstract | Full Text | Full-Text PDF (110 KB)

http://www.jpsychores.com/article/S0022-3999(10)00013-9/abstract

Chronic fatigue syndrome: Is it one discrete syndrome or many? Implications for the “one vs. many” functional somatic syndromes debate
Peter D. White

Received 10 November 2009; received in revised form 12 January 2010; accepted 14 January 2010. published online 18 March 2010.
Corrected Proof

Abstract
There is a current debate as to whether “functional somatic syndromes” (FSSs) are more similar to or different from each other. While at the same time, there is evidence of heterogeneity within single syndromes. So, it could be that these syndromes are all part of one big process/illness, are discrete in their own right, or that they are heterogeneous collections of different illnesses lumped together by common symptoms but separated by uncommon pathophysiologies. The example of chronic fatigue syndrome (CFS) is instructive. There is evidence to support all three models of understanding. Three recent large studies have suggested that FSSs are both similar and dissimilar at the same time. The solution to the debate is that we need to both “lump” and “split.” We need to study both the similarities between syndromes and their dissimilarities to better understand what we currently call the FSSs.

Keywords: Functional somatic syndromes, Chronic fatigue syndrome, heterogeneity, homogeneity, risk markers

Wolfson Institute of Preventive Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Department of Psychological Medicine, St Bartholomew’s Hospital, London,
EC1A 7BE, UK. Tel.: +44 207 601 8108; fax: +44 207 601 7097.
PII: S0022-3999(10)00013-9
doi:10.1016/j.jpsychores.2010.01.008

———————-

Articles in Press
http://www.jpsychores.com/inpress

The central role of cognitive processes in the perpetuation of chronic fatigue syndrome
In Press Corrected Proof , Available online 17 March 2010
Hans Knoop, Judith B. Prins, Rona Moss-Morris, Gijs Bleijenberg
Journal of Psychosomatic Research
DOI: 10.1016/j.jpsychores.2010.01.022
Abstract | Full Text | Full-Text PDF (122 KB)

http://www.jpsychores.com/article/S0022-3999(10)00063-2/abstract

The central role of cognitive processes in the perpetuation of chronic fatigue syndrome
Hans Knoop a, Judith B. Prins b, Rona Moss-Morris c, Gijs Bleijenberg d

Received 8 November 2009; received in revised form 26 January 2010; accepted 26 January 2010. published online 17 March 2010.
Corrected Proof

Abstract

Objective
Chronic fatigue syndrome (CFS) is considered to be one of the functional somatic syndromes (FSS). Cognitions and behavior are thought to perpetuate the symptoms of CFS. Behavioral interventions based on the existing models of perpetuating factors are quite successful in reducing fatigue and disabilities. The evidence is reviewed that cognitive processes, particularly those that determine the perception of fatigue and its effect on behavior, play a central role in the maintenance of symptoms.

Method
Narrative review.

Results
Findings from treatment studies suggest that cognitive factors mediate the positive effect of behavioral interventions on fatigue. Increased fitness or increased physical activity does not seem to mediate the treatment response. Additional evidence for the role of cognitive processes is found in studies comparing the subjective beliefs patients have of their functioning with their actual performance and in neurobiological research.

Conclusion
Three different cognitive processes may play a role in the perpetuation of CFS symptoms. The first is a general cognitive representation in which fatigue is perceived as something negative and aversive and CFS is seen as an illness that is difficult to influence. The second process involved is the focusing on fatigue. The third element is formed by specific dysfunctional beliefs about activity and fatigue.

Keywords: Chronic fatigue syndrome, Functional somatic syndromes, Perpetuating factors, Treatment studies, Cognitive processes, Perception

a Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
b Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
c School of Psychology, University of Southampton, Southampton, United Kingdom
d Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

Corresponding author. Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Postbox 9011 , 6500 HB Nijmegen, The Netherlands.
Tel.: +31 24 3610042; fax: +31 24 3610041.

This article was written while the first author was a visiting staff member of the School of Psychology at the University of Southampton. The working visit was made possible by a grant of the Dutch MSresearch fund (Stichting MSresearch).

PII: S0022-3999(10)00063-2
doi:10.1016/j.jpsychores.2010.01.022

———————-

Articles in Press
http://www.jpsychores.com/inpress

Towards positive diagnostic criteria: A systematic review of somatoform disorder diagnoses and suggestions for future classification
In Press Corrected Proof , Available online 15 March 2010
Katharina Voigt, Annabel Nagel, Björn Meyer, Gernot Langs, Christoph Braukhaus, Bernd Löwe
Journal of Psychosomatic Research
DOI: 10.1016/j.jpsychores.2010.01.015
Abstract | Full Text | Full-Text PDF (183 KB)

Abstract
http://www.jpsychores.com/article/S0022-3999(10)00020-6/abstract

Towards positive diagnostic criteria: A systematic review of somatoform disorder diagnoses and suggestions for future classification
Katharina Voigta 1, Annabel Nagel a1, Björn Meyer a, Gernot Langs b, Christoph Braukhaus b, Bernd Löwe a
Received 1 November 2009; received in revised form 12 January 2010; accepted 14 January 2010. published online 15 March 2010.
Corrected Proof

Abstract

Objectives
The classification of somatoform disorders is currently being revised in order to improve its validity for the DSM-V and ICD-11. In this article, we compare the validity and clinical utility of current and several new diagnostic proposals of those somatoform disorders that focus on medically unexplained somatic symptoms.

Methods
We searched the Medline, PsycInfo, and Cochrane databases, as well as relevant reference lists. We included review papers and original articles on the subject of somatoform classification in general, subtypes of validity of the diagnoses, or single diagnostic criteria.

Results
Of all diagnostic proposals, only complex somatic symptom disorder and the Conceptual Issues in Somatoform and Similar Disorders (CISSD) example criteria reflect all dimensions of current biopsychosocial models of somatization (construct validity) and go beyond somatic symptom counts by including psychological and behavioral symptoms that are specific to somatization (descriptive validity). Predictive validity of most of the diagnostic proposals has not yet been investigated. However, the number of somatic symptoms has been found to be a strong predictor of disability. Some evidence indicates that psychological symptoms can predict disease course and treatment outcome (e.g., therapeutic modification of catastrophizing is associated with positive outcome). Lengthy symptom lists, the requirement of lifetime symptom report (as in abridged somatization), complicated symptom patterns (as in current somatization disorder), and imprecise definitions of diagnostic procedures (e.g., missing symptom threshold in complex somatic symptom disorder) reduce clinical utility.

Conclusion
Results from the reviewed studies suggest that, of all current and new diagnostic suggestions, complex somatic symptom disorder and the CISSD definition appear to have advantages regarding validity and clinical utility. The integration of psychological and behavioral criteria could enhance construct and descriptive validity, and confers prospectively relevant treatment implications. The incorporation of a dimensional approach that reflects both somatic and psychological symptom severity also has the potential to improve predictive validity and clinical utility.

Keywords: Classification, Diagnosis, Diagnostic and Statistical Manual of Mental Disorders, International Classification of Diseases, Somatoform disorders, Validation studies as topic

a Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany
b Medical and Psychosomatic Hospital Bad Bramstedt, Bad Bramstedt, Germany
Corresponding author. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Tel.: +49 40 7410 59733; fax: +49 40 7410 54975.
1 Both authors contributed equally to this paper.
PII: S0022-3999(10)00020-6
doi:10.1016/j.jpsychores.2010.01.015
———————-

Articles in Press
http://www.jpsychores.com/inpress

Whether medically unexplained or not, three or more concurrent somatic symptoms predict psychopathology and service use in community populations
In Press Corrected Proof , Available online 17 February 2010
Javier I. Escobar, Benjamin Cook, Chi-Nan Chen, Michael A. Gara, Margarita Alegría, Alejandro Interian, Esperanza Diaz
Journal of Psychosomatic Research
DOI: 10.1016/j.jpsychores.2010.01.001
Abstract | Full Text | Full-Text PDF (129 KB)

http://www.jpsychores.com/article/S0022-3999(10)00006-1/abstract

Whether medically unexplained or not, three or more concurrent somatic symptoms predict psychopathology and service use in community populations

Javier I. Escobar, MD ab, Benjamin Cook, PhD c, Chi-Nan Chen, PhD c, Michael A. Gara, PhD abd, Margarita Alegría, PhD c, Alejandro Interian, PhD ab, Esperanza Diaz, MD e

Received 6 May 2009; received in revised form 20 December 2009; accepted 5 January 2010. published online 17 February 2010.
Corrected Proof

Abstract

Objectives
To examine the frequency of somatic symptoms in a community population of various ethnic backgrounds and to identify correlates of these symptoms such as psychopathology, use of services, and personal distress.

Methods
Using a 14-symptom inventory with interviewer probes for somatic symptoms, we determined the presence of general physical symptoms (GPS) in a sample of 4864 white, Latino, and Asian US community respondents. Medically “edited” verbatim interview responses were used to decide whether or not physical symptoms would qualify as medically unexplained physical symptoms (MUPS). We then assessed the association between GPS and MUPS and psychiatric disorders, psychological distress, and use of services, in both unadjusted and multivariate regression analyses.

Results
One-third (33.6%) of the respondents reported at least one GPS and 11.1% reported at least one MUPS within the last year. 10.7% of respondents had three or more GPS and 1.5% had three or more MUPS. Three or more GPS and MUPS were positively associated with depressive, anxiety, and substance use disorders; service use; and psychological distress in unadjusted comparisons. In multivariate regressions, GPS persisted as a significant predictor, but there was no significant independent effect of MUPS, after controlling for GPS and other covariates.

Conclusions
Regardless of the presence or absence of medical explanations, physical symptoms are an important component of common mental disorders such as depression and anxiety and predict service use in community populations. These results suggest that three or more current GPS can be used to designate a “case” and that detailed probes and procedures aimed at determining whether or not physical symptoms are medically unexplained may not be necessary for classification purposes.

Keywords: Somatoform disorders, Epidemiology

a Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

b Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

c Center for Multicultural Health Research, Cambridge Health Alliance-Harvard Medical School, Somerville, MA, USA

d UMDNJ-University Behavioral Health Care (UBHC) Piscataway, NJ, USA

e Department of Psychiatry, Yale University School of Medicine, New Haven CT, USA

Corresponding author.
PII: S0022-3999(10)00006-1
doi:10.1016/j.jpsychores.2010.01.001

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Articles in Press
http://www.jpsychores.com/inpress

Screening for multiple somatic complaints in a population-based survey: Does excessive symptom reporting capture the concept of somatic symptom disorders? Findings from the MONICA-KORA Cohort Study
In Press Corrected Proof , Available online 02 March 2010
Karl Heinz Ladwig, Birgitt Marten-Mittag, Maria Elena Lacruz, Peter
Henningsen, Francis Creed, for the MONICA KORA Investigators
Journal of Psychosomatic Research
DOI: 10.1016/j.jpsychores.2010.01.009
Abstract | Full Text | Full-Text PDF (544 KB)

http://www.jpsychores.com/article/S0022-3999(10)00014-0/abstract

———————-

Articles in Press
http://www.jpsychores.com/inpress

Measuring fatigue in clinical and community settings
In Press Corrected Proof , Available online 11 December 2009
Matteo Cella, Trudie Chalder
Journal of Psychosomatic Research
DOI: 10.1016/j.jpsychores.2009.10.007
Abstract | Full Text | Full-Text PDF (135 KB)

http://www.jpsychores.com/article/S0022-3999(09)00417-6/abstract

Footnotes:

[1] The DSM-5 Somatic Symptom Disorders Work Group proposal is that Somatoform Disorders, Psychological Factors Affecting Medical Condition (PFAMC), and Factitious Disorders should be combined under a common rubric entitled “Somatic Symptom Disorders” and for a new classification “Complex Somatic Symptom Disorder (CSSD).”

The DSM-5 public review period runs from 10 February to 20 April 2010. Members of the public, patient representation organisations, professionals and other end users can submit responses, online.

Please take this opportunity to comment and to alert and encourage professionals and international patient organisations to participate. If the proposals of 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 – especially those bundled by many psychiatrists under the so-called “Functional Somatic Syndromes” (FSS) and “Medically Unexplained Syndromes” (MUS) umbrella, under which some include CFS, ME, FM, IBS, CI, CS, chronic Lyme disease, GWS and others.

Proposed Draft Revisions to DSM Disorders and Criteria are published here on the APA’s relaunched DSM5.org website: http://www.dsm5.org/Pages/Default.aspx

Somatic Symptom Disorders

Proposed new DSM-5 category: Complex Somatic Symptom Disorder

Two key PDF documents are associated with these proposals:

      Somatic Symptom Disorders Introduction  DRAFT January 29, 2010

      Justification of Criteria – Somatic Symptoms  DRAFT January 29, 2010

[2] Review paper: CISSD Project leads Kroenke K, Sharpe M, Sykes R: Revising the Classification of Somatoform Disorders: Key Questions and Preliminary Recommendations. Psychosomatics 2007 Jul-Aug;48(4):277-85. FREE Full Text: http://psy.psychiatryonline.org/cgi/content/full/48/4/277

18 Proposals submitted by Dr Richard Sykes to WHO ICD Update and Revision Platform, Topical Advisory Group – Mental Health (TAGMH) https://extranet.who.int/icdrevision/GroupPage.aspx?gcode=104

The paper: Kroenke K: Somatoform disorders and recent diagnostic controversies. Psychiatr Clin North Am 2007 Dec;30(4):593-619:  http://www.ncbi.nlm.nih.gov/pubmed/17938036  contains the following caveat:

“Although the CISSD is an ad hoc group that includes many international experts on somatoform disorders, it was neither appointed nor sanctioned by the APA or WHO, the organizations authorized to approve revisions of DSM and ICD, respectively. As such, the CISSD recommendations should be considered advisory rather than official. Also, there were some suggestions for which the CISSD achieved near consensus but other issues where opinions diverged considerably.”

Two key DSM-5 draft proposal documents (Somatic Symptom Disorders)

Two key DSM-5 draft proposal documents (Somatic Symptom Disorders)

Post #20 Shortlink: http://wp.me/pKrrB-zN

On 10 February, I posted information on the DSM-5 Somatic Symptom Disorders Work Group’s proposal to rename DSM-IV category “Somatoform Disorders” to “Somatic Symptoms Disorders”.

I included information on the proposed new classification:

Complex Somatic Symptom Disorder (CSSD)

and proposals for combining Somatoform Disorders, Psychological Factors Affecting Medical Condition (PFAMC), and Factitious Disorders under a common rubric entitled Somatic Symptom Disorders.

Links and further information on this Dx Revision Watch page: DSM-5 drafts where draft proposals and revisions and are set out for two examples:

Example [1] Complex Somatic Symptom Disorder [Proposed new classification]

and

Example [2] 316 Psychological Factors Affecting Medical Condition [Proposed should be revised]

Two key PDF documents are associated with these proposals:

     PDF Somatic Symptom Disorders Introduction DRAFT 1/29/10 DRAFT January 29, 2010
     PDF Justification of Criteria – Somatic Symptoms DRAFT 1/29/10 DRAFT January 29, 2010

 

Source: Academy of Psychosomatic Medicine Annual Meeting, Nevada, November 2009 workshop presentation, Francis Creed, MD, FRCP: Can We Now Explain Medically Unexplained Symptoms? [4]

Related material

1] APA’s new DSM-5 Development pages 

2] DSM-5 and ICD-11 Watch page: DSM-5 drafts (links and information on proposed revisons to DSM-IV “Somatoform Disorders” and draft criteria for DSM-5 “Somatic Symptom Disorders” )

3] Submitting comments in the DSM-5 Draft Proposal review process  Post #21 (to follow)

4] Academy of Psychosomatic Medicine Annual Meeting, Nevada, November 2009.  Workshop presentations: DSM-V for Psychosomatic Medicine: Current Progress and Controversies

PRESENTERS’ SLIDES
Francis Creed, MD, FRCP: Can We Now Explain Medically Unexplained Symptoms? [Slides only]
Lawson Wulsin, MD, FAPM: DSM V for Psychosomatic Medicine: Current Progress and Controversies [Slides only]
Joel Dimsdale, MD, FAPM: Update on DSM V Somatic Symptoms Workgroup [Text only]

DSM-5 Psychiatric/General Medical Interface Study Group

DSM-5 Psychiatric/General Medical Interface Study Group and  Somatic Symptom Disorders Work Group  

Post #19 Shortlink: http://wp.me/pKrrB-zC

On 10 February, when the American Psychiatric Association (APA) published draft proposals for DSM-5 categories, it launched new DSM-5 Development web pages. Links on this site posted prior to 10 February will link to the old APA DSM-V pages. This will be attended to as soon as possible.

This new DSM-5 Development website page Somatic Symptom Disorders Work Group links to biosketches and COI disclosure information for each Somatic Symptom Disorders Work Group member. Under the chairmanship of Joel E Dimsdale, MD, the nine Work Group members are:  

Somatic Symptom Disorders Work Group

Dimsdale, Joel E., M.D.
Barsky III, Arthur J., M.D. *
Creed, Francis, M.D. *
Frasure-Smith, Nancy, Ph.D.
Irwin, Michael R., M.D.
Keefe, Francis J., Ph.D.
Lee, Sing, M.D.
Levenson, James L., M.D. *
Sharpe, Michael, M.D . *
Wulsin, Lawson R., M.D. 

*Four members of the Somatic Symptom Disorders Work Group, Arthur Barsky, MD, Francis Creed, MD, James Levinson, MD and Michael Sharpe, MD, had been members of the Conceptual Issues in Somatoform and Similar Disorders (CISSD) Project workgroup.  Professor Michael Sharpe had served as the CISSD Project’s UK Chair.  

**The CISSD Project was an unofficial project undertaken between 2003 and 2007, initiated and co-ordinated by Dr Richard Sykes, PhD, former Director of Westcare UK (engulfed by Action for M.E. in mid 2002). Action for M.E. acted as Principal Administrators for the project. The Principal Collaborator was Professor Rachel Jenkins, WHO Collaborating Centre, Institute of Psychiatry, London.

The 2007 paper: Kroenke K: Somatoform disorders and recent diagnostic controversies. Psychiatr Clin North Am 2007 Dec;30(4):593-619. http://www.ncbi.nlm.nih.gov/pubmed/17938036

contains the caveat:

“Although the CISSD is an ad hoc group that includes many international experts on somatoform disorders, it was neither appointed nor sanctioned by the APA or WHO, the organizations authorized to approve revisions of DSM and ICD, respectively. As such, the CISSD recommendations should be considered advisory rather than official. Also, there were some suggestions for which the CISSD achieved near consensus but other issues where opinions diverged considerably.”

**The Dx Revision Watch pages for the CISSD Project are under construction. 

Study Groups 

According the APA:

“As development on DSM-5 progressed, the importance of addressing cross-cutting issues relevant to all of the disorder work groups became increasingly evident. As a result, six DSM-5 Study Groups were formed to address these universal topic areas.”

Psychiatric/General Medical Interface Study Group  

“The Psychiatric/General Medical Interface Study Group is chaired by Lawson R. Wulsin, M.D. The study group is examining the link between general medical disorders and psychiatric disorders. Given that most patients with mental illnesses are seen by primary care physicians, the study group aims to ensure that DSM-5 meets the needs of general medical practitioners and not just specialty mental health clinicians. The group is also developing revision strategies for the forthcoming DSM-5-PC, which is intended to be used in primary care settings. The members of the Psychiatric/General Medical Interface Study Group are listed below.” 

Psychiatric/General Medical Interface Study Group Members 

Wulsin, Lawson R., M.D. [Member, Somatic Symptoms Disorders Work Group]
Dahl, Ronald E., M.D.
Dimsdale, Joel E., M.D. [Chair, Somatic Symptoms Disorders Work Group]
Escobar, Javier I., M.D. [Member, DSM-5 Task Force and Liaison to SSD Work Group]
Jeste, Dilip V., M.D.
Kaufmann, Walter E., M.D.
Kreipe, Richard E., M.D.
Petersen, Ronald, Ph.D., M.D.
Reynolds, Charles F., M.D.
Segraves, Taylor R., M.D., Ph.D.
Walsh, Timothy B., M.D. 

Javier Escobar, MD, Director of the University of Medicine and Dentistry of New Jersey (UMDNJ) – Robert Wood Johnson Medical School (RWJMS) Medically Unexplained Physical Symptoms (MUPS) Research Center, which has been supported with over $4M in funding by the US National Institute of Mental Health (NIMH), had also been a member of the CISSD Project workgroup. 

Dr Escobar is a member of the DSM-5 Task Force, serves as Task Force liaison to the DSM-5 Somatic Symptom Disorders Work Group and according to the Task Force, works closely with this work group.  

APA publishes proposed revisions and draft criteria for DSM-5 categories

APA publishes proposed revisions and draft criteria for DSM-5 (DSM-V) categories

Post #16 Shortlink: http://wp.me/pKrrB-xG

Today, 10 February, the American Psychiatric Association (APA) released draft proposals for revisions to DSM-IV and draft criteria for DSM-5.

American Psychiatric Association DSM-5 Development

Proposed Draft Revisions to DSM Disorders and Criteria are published here on the APA’s relaunched DSM-5 website  

http://www.dsm5.org/Pages/Default.aspx

Selected material for revision of “Somatoform Disorders” on this DSM-5 Watch page

Draft proposals DSM-5

The comment period runs from 10 February to 20 April.

Open APA News Release here in PDF format: Diag Criteria General FINAL 2.05

or text below

http://www.dsm5.org/Newsroom/Documents/Diag%20%20Criteria%20General%20FINAL%202.05.pdf

APA News Release: 

Public release date: 10-Feb-2010

Contact: Jaime Valora
jvalora@psych.org
703-907-8562
American Psychiatric Association

APA announces draft diagnostic criteria for DSM-5

New proposed changes posted for leading manual of mental disorders

ARLINGTON, Va. (Feb. 10, 2010) – The American Psychiatric Association today released the proposed draft diagnostic criteria for the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM). The draft criteria represent content changes under consideration for DSM, which is the standard classification of mental disorders used by mental health and other health professionals, and is used for diagnostic and research purposes.

“These draft criteria represent a decade of work by the APA in reviewing and revising DSM,” said APA President Alan Schatzberg, M.D. “But it is important to note that DSM-5 is still very much a work in progress – and these proposed revisions are by no means final.” The proposed diagnostic criteria will be available for public comment until April 20, and will be reviewed and refined over the next two years. During this time, the APA will conduct three phases of field trials to test some of the proposed diagnostic criteria in real-world clinical settings.

Proposed revisions

Members of 13 work groups, representing different categories of psychiatric diagnoses, have reviewed a wide body of scientific research in the field and consulted with a number of expert advisors to arrive at their proposed revisions to DSM. Among the draft revisions are the following:

• The recommendation of new categories for learning disorders and a single diagnostic category, “autism spectrum disorders” that will incorporate the current diagnoses of autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder (not otherwise specified). Work group members have also recommended that the diagnostic term “mental retardation” be changed to “intellectual disability,” bringing the DSM criteria into alignment with terminology used by other disciplines.

• Eliminating the current categories substance abuse and dependence, replacing them with the new category “addiction and related disorders.” This will include substance use disorders, with each drug identified in its own category.

• Eliminating the category of dependence will better differentiate between the compulsive drug-seeking behavior of addiction and normal responses of tolerance and withdrawal that some patients experience when using prescribed medications that affect the central nervous system.

• Creating a new category of “behavioral addictions,” in which gambling will be the sole disorder. Internet addiction was considered for this category, but work group members decided there was insufficient research data to do so, so they recommended it be included in the manual’s appendix instead, with a goal of encouraging additional study.

• New suicide scales for adults and adolescents to help clinicians identify those individuals most at risk, with a goal of enhancing interventions across a broad range of mental disorders; the scales include research-based criteria such as impulsive behavior and heavy drinking in teens.

• Consideration of a new “risk syndromes” category, with information to help clinicians identify earlier stages of some serious mental disorders, such as neurocognitive disorder (dementia) and psychosis.

• A proposed new diagnostic category, temper dysregulation with dysphoria (TDD), within the Mood Disorders section of the manual. The new criteria are based on a decade of research on severe mood dysregulation, and may help clinicians better differentiate children with these symptoms from those with bipolar disorder or oppositional defiant disorder.

• New recognition of binge eating disorder and improved criteria for anorexia nervosa and bulimia nervosa, as well as recommended changes in the definitions of some eating disorders now described as beginning in infancy and childhood to emphasize that they may also develop in older individuals.

The APA has prepared detailed press releases on each of these topics, which are available on the DSM-5 Web site.

Dimensional Assessments

In addition to proposed changes to specific diagnostic criteria, the APA is proposing that “dimensional assessments” be added to diagnostic evaluations of mental disorders. These would permit clinicians to evaluate the severity of symptoms, as well as take into account “cross-cutting” symptoms that exist across a number of different diagnoses (such as insomnia or anxiety).

“We know that anxiety is often associated with depression, for example, but the current DSM doesn’t have a good system for capturing symptoms that don’t fit neatly into a single diagnosis, said David Kupfer, M.D., chair of the DSM-5 Task Force. “Dimensional assessments represent an important benefit for clinicians evaluating and treating patients with mental illness. It may help them better evaluate how a patient is improving with treatment, help them address symptoms that affect a patient’s quality of life and better assess patients whose symptoms may not yet be severe – leading to earlier effective treatment.”

Careful Consideration of Gender, Race and Ethnicity

The process for developing the proposed diagnostic criteria for DSM-5 has included careful consideration of how gender, race and ethnicity may affect the diagnosis of mental illness. The team has sought significant involvement of women, members of diverse racial and ethnic groups, and international researchers and clinicians. The APA also designated a specific study group to review and research these issues, and ensure they were taken into account in the development of diagnostic criteria.

The Gender and Cross-Cultural Study Group reviewed epidemiological data sets from the United States and other countries to determine if there were significant differences in incidence of mental illness among different subgroups (e.g., gender, race and ethnicity) that might indicate a bias in currently-used diagnostic criteria, including conducting meta-analyses (additional analyses combining data from different studies). Group members reviewed the literature from a broad range of international researchers who have explored issues of gender, ethnic and racial differences for specific diagnostic categories of mental illness. The study group also considered whether there was widespread cultural bias in criteria for specific diagnoses.

As a result of this process, the study group has tried to determine whether the diagnostic categories of mental illness in DSM need changes in order to be sensitive to the various ways in which gender, race and culture affect the expression of symptoms.

Public Review of Proposed Revisions

The resulting recommendations for revisions to the current DSM are being posted on the APA’s Web site for the manual, www.DSM5.org, for public review and written comment. These comments will be reviewed and considered by the relevant DSM-5 Work Groups.

“The process for developing DSM-5 continues to be deliberative, thoughtful and inclusive,” explained Dr. Kupfer. “It is our job to review and consider the significant advances that have been made in neuroscience and behavioral science over the past two decades. The APA is committed to developing a manual that is both based on the best science available and useful to clinicians and researchers.”

Overview of DSM-5 Development Process

The last edition of DSM was published in 1994. Beginning in 2000, during the initial phase of revising DSM, the APA engaged almost 400 international research investigators in 13 NIH supported conferences. In order to invite comments from the wider research, clinical and consumer communities, the APA launched a DSM-5 Prelude Web site in 2004 to garner questions, comments, and research findings during the revision process.

Starting in 2007, the DSM-5 Task Force and Work Groups, made up of over 160 world-renowned clinicians and researchers, were tasked with building on the previous seven years of scientific reviews, conducting additional focused reviews, and garnering input from a wide range of advisors as the basis for proposing draft criteria. In addition to the work groups in diagnostic categories, there were study groups assigned to review gender, age and cross-cultural issues.

Based on the upcoming comments to the draft criteria and findings of the field trials, the work groups will propose final revisions to the diagnostic criteria in 2012. The final draft of DSM-5 will be submitted to the APA’s Assembly and Board of Trustees for their review and approval. A release of the final, approved DSM-5 is expected in May 2013.

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The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psych.org  and www.healthyminds.org .

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