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

Submissions in response to proposals by the DSM-5 Work Group for Somatic Symptom Disorders

February 23, 2010 by

Submissions in response to proposals by the DSM-5 Work Group for Somatic Symptom Disorders

Post #22 Shortlink: http://wp.me/pKrrB-BX

Shortlink for Dx Revision Watch submissions page: http://wp.me/PKrrB-AQ

Public review process

The American Psychiatric Association (APA) published draft proposals for revisions to DSM disorders and criteria on 10 February. Comments from the public are being accepted until 20 April 2010. 

More information in this posting. 

Registering to submit comment

Register here on the APA’s new DSM-5 Development site to submit a response.

To date, UK patient organisations Action for M.E., the ME Association, AYME, The Young ME Sufferers Trust, Invest in ME, the 25% ME Group and BRAME have been silent on the DSM-5 revision process. These organisations will be approached this week for position statements on whether they intend to participate in the public review process and if so, whether they will be publishing their submissions.

International patient organisations, professionals and advocates who are submitting comments are invited to provide ME agenda with copies for publication on this page.

The following published with kind permission of Mary M. Schweitzer, PhD:

Submission to the Work Group for Somatic Symptom Disorders

The new category of Complex Somatic Symptom Disorder, or CSSD, bears a disturbing resemblance to the CDC’s Holmes (1988) and Fukuda (1994) definitions of the disease Chronic Fatigue Syndrome (CFS). The requirement that patients experience six months of debilitating fatigue is taken straight from CDC’s definitions. This development is disturbing for three reasons:

1. For two decades, British psychiatrists Michael Sharpe, Peter White, and Simon Wessely – all proponents of the ideology-driven “biopsychosocial” school of medicine – have ignored the CDC’s definition for one of their own, which omits the physical symptoms required of the CDC diagnoses, and includes concurrent major mood disorders (exclusionary in Holmes and Fukuda). They have long insisted that “CFS” is really a modern version of “neurasthenia”, which was removed from DSM a generation ago but is still diagnosed in the UK.

2. Earlier efforts to portray CFS as a somatisizing illness were foiled by requirements in the definition of somatisizing, such as the length of the illness (decades) and the absence of any gain. It strikes one as somewhat disingenuous to deliberately replace that category with another that can then be used to portray as psychological, a disease described as biomedical by the Chronic Fatigue Syndrome Advisory Committee of DHHS.

3. The APA has stated elsewhere that many of the changes in DSM-5 are intended to avoid gender biases in existing medical categories. Isn’t is strange that the proponents of the new category CSSD have often stated 90 percent of victims of CFS (and CSSD by distinction) are female?

At the end of the 1980s, when CDC adopted the name of “chronic fatigue syndrome” for a series of outbreaks of a mysterious, debilitating illness, Simon Wessely resurrected the diagnosis of “neurasthenia” [aka “the vapors”] for CFS patients in England. Although it is a direct violation of ICD-10, British psychiatric manuals classify CFS under neurasthenia, but could not do so in the U.S. because the diagnosis “neurasthenia” was removed from DSM a generation ago for gender bias.

In choosing the term neurasthenia, Wessely referenced not Freud but a New York physician named Beard who coined the term “neurasthenia” in 1869. Beard’s book, “American Nervousness”, is well-known among women’s studies professors for advancing the theory that girls who were allowed to study science and math in high school would end up with either a shrivelled uterus (his version of “hysteria”), or struggle with a life-long “nervous condition” (neurasthenia). Beard openly wondered whether allowing girls to attend high school would result in the death of the “American race”; the “Celtic race” did not permit their daughters a secondary education, and they enjoyed large families as opposed to the small number of children born to the middle class of the “American race”.

I have to say I never thought I would see that book cited as a reputable source by a contemporary scholar, but both Wessely and the late Stephen Straus of NIH used it frequently.

Adoption of CSSD will allow this bizarre nineteenth century view of the way women’s bodies work to return to DSM, albeit under a more modern name.

In England, the insistence that CFS is really neurasthenia has led to cruel results, with women thrown into mental hospitals against their will. CBT (to cure the patient of her “inappropriate illness beliefs”) and GET (to get her back into shape after she has allowed herself to become deconditioned) are the only treatments recommended by British public health.

The result is that patients with the most severe cases of this disease are forced into hiding, bereft of all medical care whatsoever.

Adults in the U.S. have, in general, not been subjected to that level of cruelty – although doctors ignorant of the large body of literature on the biomedical symptoms and causes of CFS are inclined to throw SSRIs at patients, whether it helps them or not.

However, more vulnerable victims of CFS – teenagers – have been subject to removal from their homes and sent to foster care for the sin of having a poorly understood illness. Laypersons in school boards or child protective services have felt competent to diagnose MSBP (or its more recent incarnation, Factitious Illness by Proxy) after hearing a lecture or reading an article on the subject. The more the parents fight the diagnosis, the more its proponents can claim it is true.

The phenomenon is reminiscent of the belief that autism is caused by “cold mother syndrome”, or multiple sclerosis really “hysterical paralysis”.

It is particularly ironic to see such a push towards psychologizing a physical disorder at the very moment evidence points to a new, serious cause.

In October 2009, an article published in “Science” demonstrated that 2/3 of a sample of patients diagnosed with CFS are victims of the third known human retrovirus, XMRV.

I was in that study, and I have XMRV.

At this point I must admit that I have a personal interest in this issue. But I have been fortunate; my university connections have allowed me to participate in cutting edge studies. Let me share with you what scientists have learned about CFS, using myself as the case study.

As mentioned, I have been diagnosed with the newly discovered retrovirus XMRV, only the third known human retrovirus.

I also have the 37kDa Rnase-L defect, and my natural killer cell function is 2%.

Perhaps that is why I suffer from recurring bouts of EBV, and have chronically activated cytomegalovirus (CMV), HHV-6 (Variant A), HHV-7, among other viruses.

I have been sick since suffering a blackout in my office in 1994. I have ataxia, expressive aphasia, expressive dysphasia, short-term memory loss, and profound confusion (I once poured a cup of coffee into a silverware drawer convinced it was a cup). I suffer from constant severe pain behind my eyes, in the back of my neck, and in the large muscles of my thighs and upper arms. Even one flight of stairs is very difficult for me. When we go places, we have to use a wheelchair. And I used to be an avid skier.

I cannot pass a simple Romberg test. I have abnormal SPECT scans and my VO2 MAX score is 15.5, lower than would be expected of my 85-year-old mother.

I have been helped greatly by an experimental immune modulator, only to relapse when permission from FDA to have the drug was removed.

If you believe that a retrovirus, significantly abnormal immune biomarkers, and herpes viruses known to cause encephalitis, meningitis, myocarditis, and other serious diseases when active over a long period of time – if you believe all of this can be resolved using talking therapy and SSRIs, then proceed with your new category.

Neither could help me in the past – only pharmacological intervention directed at the viruses and immune defects has improved my condition.

How many biomarkers and viruses must a patient have to be taken seriously? If one is in constant pain, does it not make sense to worry about pain? If one suffers from a significantly debilitating illness, does it not make sense to be concerned about the state of your health?

This new category would place those sensible concerns in the realm of abnormal anxiety dysfunction. Patients would be denied access to the tests – and treatments – I have been fortunate to be able to have.

According to the CDC, at most, 15% of the 1 million adult patients with CFS in the U.S. even have a diagnosis. Of those 150,000, only a handful have had access to the care, testing, and treatment I have.

It is a Dickensian world, where the victims of this disease are relegated to extreme poverty, no matter what their profession prior to the illness.

Who, then, would benefit from creating a psychological category for this very biophysical disease?

This is a question that the profession needs to answer before proceeding with plans for CSSD.

Mary M. Schweitzer, Ph.D.

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

Submitting comments in the DSM-5 Draft Proposal review process

February 17, 2010 by

Submitting comments in the DSM-5 Draft Proposal review process

Post #21 Shortlink: http://wp.me/pKrrB-AB

According to DSM-5 Development page:

Proposed Draft Revisions to DSM Disorders and Criteria

All stakeholders may participate in the review process by registering on the site and submitting their comments.

The APA will be posting draft criteria for input until April 20th.

“After this time, the work group members may make revisions based on the input received”

“Revised draft criteria for select disorders will then be subjected to field trials (real-world testing in clinical settings). The draft criteria may also change based on incorporation of dimensional measures and other areas that will affect diagnosis across DSM-5. Once these changes have been implemented and/or tested, we will post the revised criteria on this site to allow commentary once again, before beginning a second wave of field trials.”

There are just under nine weeks during which stakeholders in DSM-5 – members of the public, patient representation organisations, professionals and end users can submit their comments.

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

I would welcome copies of comments from patient organisations, professionals and advocates for publication on a dedicated DSM-5 submissions page on this site.

 

The comment period runs from 10 February to 20 April.

Register here:

APA’s new DSM-5 Development site:

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

Participate [Top right]

New User Register Now

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

> APA DSM-5 Registration

“Please complete the registration below in order to submit comments. If you are a clinician, you may also elect to receive an email about possible participation in DSM-5 field trials by checking the appropriate checkbox.”

Required fields are:

User Name
Email
[Enter a valid email address for the verification process.]
First Name
Last Name
Country

There are also optional fields for

Job Title
Profession
Affiliation

[There is a six character security field.]

When the registration is completed, an auto generated verification email is sent confirming Username, and a Temporary Password which can be changed, if desired.

You can also register via a link at the bottom of each proposal, for example, at the bottom of these two key pages:

Complex Somatic symptom disorder (CSSD)
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=368

Psychological Factors Affecting Medical Condition
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=387

Once registered and logged in, you will be able to upload your comments via a Rich Text Editor at the foot of each proposal.

I would suggest composing your submission off line, for example, in a draft email, in order to retain a copy should the upload screw up or your connection go down just as you are about to hit “Submit”.

 

Note that if you are viewing proposals from this page:

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

you won’t see the page for:

“Psychological Factors Affecting Medical Condition”

This is one of the DSM-IV categories that the Work Group is proposing should be combined with several other current categories under “Somatic Symptom Disorders”.

In order to view this page, the Proposed Revision, Rationale and other Tabs, or if you wished to submit a comment specifically in relation to this proposal, this is the path:

Meet us Tab
http://www.dsm5.org/MeetUs/Pages/Default.aspx

Click on link

Somatic Symptoms Disorders [under Work Groups heading]

which takes you to:

http://www.dsm5.org/MeetUs/Pages/SomaticDistressDisorders.aspx

Scroll down to:

Disorders

[list of 20 links in which is listed]

316 Psychological Factors Affecting Medical Condition

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=387

or use the link above to go directly to that page.

There are two key PDF documents associated with proposals for the DSM categories currently classified under “Somatoform Disorders” [5]. These provide an overview of the new proposals and revisions and a “Justification of Criteria” rationale document. I would recommend downloading these.

 

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] Psychological Factors Affecting Medical Condition:
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=387

[5] Key documents:

      PDF Somatic Symptom Disorders Introduction DRAFT 1/29/10

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

[6] For more information see this DSM-5 and ICD-11 Watch site, DSM-5 proposals page: http://wp.me/PKrrB-jZ

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

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

February 16, 2010 by

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]

Filed under American Psychiatric Association (APA), CISSD Project, 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

DSM-5 Draft Criteria Available for Public Comment through April 20

February 4, 2010 by

DSM-5 Draft Criteria Available for Public Comment through April 20

Post #13 Shortlink: http://wp.me/pKrrB-x2

Source: Student Doctor

The American Psychiatric Association is seeking your comments on proposed criteria for the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard classification of mental disorders used by mental health and other health professionals for diagnostic and research purposes.

Proposed DSM-5 draft criteria will be available for review and comment at http://www.DSM5.org from February 10 to April 20, 2010. Health professionals, mental health consumers and family members are invited to visit the site to review and comment on the draft criteria.

DSM-5 remains a work in progress: following the public comment period, the DSM-5 Task Force and Work Groups will spend two years reviewing and refining proposed criteria based on public comments and the results of field trials, which will be conducted in three phases to test some of the proposed diagnostic criteria in real-world clinical settings.

The release of the final DSM-5 is expected in May 2013.

For more information, visit http://www.DSM5.org

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), Somatic Symptom Disorder, Somatoform Disorders

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