Vermont CFIDS Association: Submission for DSM-5 public review process

April 9, 2010 by

Vermont CFIDS Association: Submission for DSM-5 public review process

Post #30 Shortlink: http://wp.me/pKrrB-EI

Submissions

Patient organisations, professionals and advocates submitting comments in the DSM-5 draft proposal review process are invited to provide copies of their submissions for collation on this page: http://wp.me/PKrrB-AQ

Vermont CFIDS Association

First Do No Harm

[…]

The following partial pre-release draft letter speaks eloquently for this issue, and can be shared, adapted, and/or sent to the DSM-5 Website.

Rik Carlson

(We) are deeply concerned by the American Psychiatric Association’s possible reclassification of CFS as a somatoform disorder in DSM-5.

Researchers at both the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) have documented the physiological and pathophysiological underpinnings of this illness. The CDC, under the leadership of Julie Gerberding, launched a multi-million-dollar campaign within the past few years to underscore that CFS is a multi-system disorder which can and should be treated as such.

Based upon the numerous, peer-reviewed studies that have linked CFS to infection and multiple organ systems abnormalities, classifying CFS as a Complex Somatic Symptom Disorder seems unreasonable and unwarranted.

As estimated and communicated to you by the IACFS/ME: Over the past 25 years, 2,000 peer-reviewed 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 lead to symptom worsening. In contrast to clinical depression, motivation is much less affected in CFS and the desire to be active remains intact.

In the past, the absence of a documentable, medical explanation has relegated other illnesses to a psychiatric diagnosis. Illnesses given psychiatric diagnoses out of ignorance are later given more accurate, medical diagnoses with additional scientific research. Surely, you do not wish to demean the field of psychiatry by repeating the errors of psychiatry’s past.

We are further concerned that the reclassification of CFS as a somatoform disorder in the DSM-5 will result in decreased care of CFS patients. The CDC’s Chronic Fatigue Syndrome educational programs for physicians explicitly suggest the management of CFS by primary care physicians with the suggestion of a psychiatric consult if the patient manifests appropriate symptoms. The reclassification of CFS as a somatoform disorder in the DSM-5 will create confusion for many practitioners. The confusion thereby created will demean the illness, and the willingness of some practitioners to treat it. Moreover, the listing of CFS as a somatoform disorder may impact the ability of CFS patients to receive reimbursement of their treatment costs resulting in a loss of treatment and benefits.

Filed under American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-V, Functional Somatic Syndrome (FSS), MUS, Somatic Symptom Disorder, Somatoform Disorders

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

March 26, 2010 by

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

Filed under American Psychiatric Association (APA), CISSD Project, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-V, Functional Somatic Syndrome (FSS), MUS, Somatic Symptom Disorder, Somatoform Disorders

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

March 25, 2010 by

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

Filed under American Psychiatric Association (APA), CISSD Project, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 in the media, DSM-V, Functional Somatic Syndrome (FSS), Somatic Symptom Disorder, Somatoform Disorders

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

March 23, 2010 by

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

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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

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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

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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
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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

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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.”

Filed under American Psychiatric Association (APA), CISSD Project, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-V, Functional Somatic Syndrome (FSS), ICD-11, MUS, Somatic Symptom Disorder, Somatoform Disorders

Feedback invited on DSM-5 draft criteria

March 20, 2010 by

APA President, Alan F. Schatzberg, M.D., invites feedback on the DSM-5 draft criteria from APA members, professionals and the lay public

Post #25 Shortlink: http://wp.me/pKrrB-D4

Psychiatric News March 5, 2010
Volume 45 Number 5 Page 1

Association News

Feedback Invited

The proposed revisions for DSM-5 are available for review and comment at www.dsm5.org until April 20. After comments are reviewed and further revisions made, the criteria will be tested in field trials for about a one-year period starting in July. The final draft of DSM-5 will be submitted to the APA Assembly and Board of Trustees for review and approval, with an expected publication date of May 2013.

Psychiatric News March 5, 2010
Volume 45 Number 5 Page 3

From the President

DSM-5: The Next Steps Begin
Alan F. Schatzberg, M.D.

Last month, APA posted the DSM-5 draft criteria on the DSM-5 Web site and held a variety of press and advocacy-group briefings about the launching (see APA Makes DSM-5 Proposals Available for Comment). The resulting coverage has been generally positive, although there will continue to be naysayers and those who want to emphasize the controversies rather than the science and great efforts than have been extended thus far…

…The next steps in the DSM process are to gather the responses from our members and the professional and lay public and determine whether any of the proposed changes need to be amended before the field trials begin in the summer.

The DSM-5 Web site can be found at www.dsm5.org. After registering, anyone can access this very informative, user-friendly site. I invite you to log on, review, and comment on the proposed changes.

Read full article here

Psychiatric News March 5, 2010
Volume 45 Number 5 Page 1

Association News

APA Makes DSM-5 Proposals Available for Comment
Jun Yan

Proposed changes to diagnostic criteria and rationales for those changes are laid out online for clinicians and the public to review and comment on before they are tested in field trials.

The much-anticipated draft revisions proposed for DSM-5 have been posted online for view and comment by psychiatrists, mental health professionals, and the public, APA announced in February.

Substantial changes to the current diagnostic criteria have been proposed by 13 work groups based on accumulated research evidence. Sugested changes include the consolidation and elimination of numerous diagnoses and the addition of several new ones. These proposed revisions and rationale for them are posted at www.dsm5.org…

…To ensure the transparency of the DSM-5 development process, APA members, other psychiatrists, mental health professionals, medical professionals, and the public are invited to review and comment on the draft criteria. After the public-comment period closes on April 20, the DSM-5 work groups will review the comments. Field trials will then test the proposed criteria, with changes, in both specialty mental health and primary care settings starting in July. The field trials are expected to be concluded in July 2011. Data obtained from these field trials will be incorporated into later drafts.

The final draft of DSM-5 will be submitted to the APA Assembly and Board of Trustees for review and final approval. The new manual is expected to be published in May 2013.

Read full article here

 

On 10 February, I posted information on the DSM-5 Somatic Symptom Disorders Work Group proposal to rename the existing 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 DSM-5 and ICD-11 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 for revision]

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

Filed under American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 in the media, DSM-V

APA News Release: 09 March 10: APA Modifies DSM Naming Convention to Reflect Publication Changes

March 9, 2010 by

APA News Release: 09 March 10: APA Modifies DSM Naming Convention to Reflect Publication Changes 

Post #24 Shortlink: http://wp.me/pKrrB-CS 

Today, the APA has issued News Release No. 10-17 

Open PDF for News Release here: DSM Name Change 09.03.10 

Text

For Information Contact:
Eve Herold, 703-907-8640
press@psych.org
Jaime Valora, 703-907-8562
jvalora@psych.org 

For Immediate Release:
March 8, 2010
Release No. 10-17 

Graphic of working DSM-5 cover available upon request. 

APA Modifies DSM Naming Convention to Reflect Publication Changes 

ARLINGTON, Va. (March 9, 2010) – Beginning with the upcoming fifth edition, new versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will be identified with Arabic rather than Roman numerals, marking a change in how future updates will be created, according to the American Psychiatric Association. 

The new edition will be identified as DSM-5, breaking the pattern established with publication of the DSM-II in 1968. The change reflects the ability of the APA to use new technologies to create a document that can respond more quickly when a preponderance of research supports a change. 

“While knowledge about mental illnesses has grown significantly in the last half century, knowledge of neurobiology will continue to advance,” said APA President Alan F. Schatzberg, M.D. “Some of the changes coming with DSM-5 will facilitate new approaches to research that will lead to further advances.”

Following the publication of the DSM-5, ongoing review groups will be established to coordinate and oversee periodic assessments of advancements. The review groups will determine if a more intensive assessment or changes to the diagnostic criteria are warranted. APA practice guidelines and other diagnostic manuals are updated following a similar process.

“Advances in research will continue to drive changes to the DSM,” said David Kupfer, M.D., chair of the DSM-5 Task Force, which is in charge of the current revision process. “Our primary commitment will continue to be to create a manual that is based on science and is useful in diagnosing and treating patients.”

Incremental updates will be identified with decimals, i.e. DSM-5.1, DSM-5.2, etc., until a new edition is required.

“The research base is evolving at different rates for different disorders,” said Darrel Regier, M.D., M.P.H., vice chair of the DSM Task Force and executive director of the American Psychiatric Institute for Research and Education. “By making the DSM-5 a living document, we will ensure that the DSM will remain a common language in the field. It will hasten our response to breakthroughs in research.”

The anticipated bibliographic citation to the book is American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC, American Psychiatric Association, 2013.

Draft criteria for DSM-5 are available for review and comment until April 20 at www.dsm5.org. 

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, www.HealthyMinds.org and http://www.psychiatryonline.com/ .

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Filed under American Psychiatric Association (APA), DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 in the media, DSM-V

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