Somatic Symptom Disorder | dx revision watch

Index: Recent posts around DSM-5 second public review

May 23, 2011 by meagenda

Index: Recent posts around DSM-5 second public review

Post #84 Shortlink: http://wp.me/pKrrB-18z

As a number of posts have been published recently on the DSM-5 public review, I am providing an Index:

5 May 2011 Post #73: http://wp.me/pKrrB-12k

American Psychiatric Association (APA) announces second public review of DSM-5 draft criteria and structure

Post announcing launch of second DSM-5 public review period with links to DSM-5 Development site and to media coverage.

6 May 2011 Post #74: http://wp.me/pKrrB-12x

APA News Release 4 May 2011: New Framework Proposed for Manual of Mental Disorders

Copy of APA News Release No. 11-27 announcing the posting on 4 May of revised draft criteria for DSM-5 on the DSM-5 Development website and a second public review period running from May to June 15.

8 May 2011 Post #75: http://wp.me/pKrrB-12P

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 1)

Part 1 of this report is a Q & A addressing some of the queries that have been raised with me around the DSM-5 public review process. Includes table comparing “Current DSM-IV Codes and Categories for Somatoform Disorders and ICD-10 Equivalents”. Also includes a screenshot from Chapter 5 (V) Somatoform Disorders (the F codes) F45 – F48.0 (as displaying in the iCAT Alpha Drafting platform in November 2010; this drafting platform has since been replaced by another public Alpha drafting browser launched on 17 May 2011 – see Post #81: ICD-11 Alpha Drafting platform launched 17 May (public version): http://wp.me/pKrrB-16N).

10 May 2011 Post #77: http://wp.me/pKrrB-13z

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 2)

In Part 2 of this report, I set out the latest proposals for draft criteria (dated 14 April 2011) from the DSM-5 Somatic Symptom Disorders Work Group, as published on the DSM-5 Development website, on 4 May.

12 May 2011 Post #78: http://wp.me/pKrrB-15q

Registering to submit comment in the second DSM-5 public review of draft criteria

Information on registering for and submitting comment in the second DSM-5 public review.

18 May 2011 Post #80: http://wp.me/pKrrB-15X

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 3)

In Part 3 of this report, I posted extracts from “Disorders Description”, the first of the two key PDF documents that accompany the revised proposals, highlighting passages in yellow to indicate why ME and CFS patient representation organizations, professionals and advocates need to register their concerns via this second public review.

22 May 2011 Post #82: http://wp.me/pKrrB-16B

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 4)

In Part 4 of this report, I posted the complete text of the key “Rationale” document that accompanies the draft proposals of the Somatic Symptom Disorders Work Group, omitting several pages of references to published and unpublished research papers.

22 May 2011 Post #83: http://wp.me/pKrrB-12d

Call for Action – Second DSM-5 public comment period closes June 15

Sets out why patients, patient organizations, advocates, clinicians, allied health professionals, lawyers and other professional end users need to review the proposals of the Somatic Symptom Disorders Work Group and submit responses. Includes copy of post in Word .doc and PDF formats.

Some of last year’s submissions are collated on this page: http://wp.me/PKrrB-AQ

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, Joel Dimsdale, MUS, Somatic Symptom Disorder, Somatoform Disorders

Call for Action – Second DSM-5 public comment period closes June 15

May 22, 2011 by meagenda

Call for Action – Second DSM-5 public comment period closes June 15

Post #83 Shortlink Post: http://wp.me/pKrrB-12d

Disorders Description Key Document One: “Somatic Symptom Disorders”

Rationale Document Key Document Two: “Justification of Criteria — Somatic Symptoms”

MS Word .doc format: Call for Action Second DSM-5 public review

PDF format: Call for Action Second DSM-5 public review

For immediate circulation to US and international ME and CFS patient organizations, clinicians, advocates

22 May 2011

Call for Action – Second DSM-5 public comment period closes June 15

The American Psychiatric Association’s DSM-5 Task Force is accepting public comment on its latest proposals for the revision of diagnostic criteria for psychiatric disorders.

The deadline for stakeholder feedback is June 15.

Is this a US specific issue?

No. International input is also required. The Diagnostic and Statistical Manual of Mental Disorders (the DSM) is the primary diagnostic system in the US for defining mental disorders and used to a varying extent in other countries. The next edition of the manual, slated for publication in 2013, will inform health care providers and policy makers for many years to come. DSM-5 will shape international research, influence literature in the fields of psychiatry and psychosomatics and inform perceptions of patients’ medical needs throughout the world.

What is being proposed?

The DSM-5 “Somatic Symptom Disorders” Work Group has responsibility for the revision of the DSM-IV “Somatoform Disorders” categories.

The Work Group is recommending renaming the “Somatoform Disorders” section to “Somatic Symptom Disorders” and combining existing categories – “Somatoform Disorders”, “Psychological Factors Affecting Medical Condition (PFAMC)” and possibly “Factitious Disorders” into one group.

(“Somatic” means “bodily” or “of the body”.)

The Work Group also proposes repackaging “Somatization Disorder”, “Hypochondriasis”, “Undifferentiated Somatoform Disorder” and “Pain Disorder” under a new category entitled “Complex Somatic Symptom Disorder” (CSSD). There is also a “Simple Somatic Symptom Disorder” (SSSD) and a proposal to rebrand “Conversion Disorder” as “Functional Neurological Disorder”.

Where can I find the full criteria for “CSSD”, “PFAMC” and other proposed categories?

Proposed criteria are set out on the DSM-5 Development site: http://tinyurl.com/Somatic-Symptom-Disorders

The CSSD criteria are here: http://tinyurl.com/DSM-5-CSSD

There are two key PDF documents here, “Disorders Descriptions” and “Rationale”, which expand on the Work Group’s proposals, here, or above:

http://tinyurl.com/SSD-Disorders-Description

http://tinyurl.com/SSD-Justification-of-Criteria

Which patient groups might be hurt by these proposals?

The Chronic Fatigue Syndrome Advisory Committee (CFSAC) provides advice and recommendations to the Secretary of Health and Human Services (HHS). On Day One of the May 10-11 CFSAC meeting, CFSAC Committee discussed the implications of these proposals for CFS and ME patients as part of the agenda item around the proposed coding of CFS for ICD-10-CM. You can watch this section of the meeting (4hrs 27mins in from start of video) here:

http://nih.granicus.com/ViewPublisher.php?view_id=26

If the Work Group’s proposals gain DSM Task Force approval, all medical diseases, whether “established general medical conditions or disorders”, like diabetes or heart disease, or conditions presenting with “somatic symptoms of unclear etiology” will have the potential for a bolt-on diagnosis of a “somatic symptom disorder” – if the practitioner feels the patient meets the new criteria.

As discussed by CFSAC committee members, earlier this month, CFS, ME, Fibromyalgia and IBS patients, already diagnosed or waiting on a diagnosis, may be especially vulnerable to highly subjective criteria and difficult to quantify concepts such as “disproportionate distress and disability”, “catastrophising”, “health-related anxiety” and “[appraising] bodily symptoms as unduly threatening, harmful, or troublesome.”

Other patient groups that are also bundled under the so-called “Functional somatic syndromes” and “medically unexplained” umbrellas, like Chemical Injury (CI), Chemical Sensitivity (CS), chronic Lyme disease and GWS, are highly vulnerable.

In a 2009 Editorial on the progress of the Work Group, the chair wrote that by doing away with the “controversial concept of medically unexplained”, their proposed classification might diminish “the dichotomy, inherent in the ‘Somatoform’ section of DSM-IV, between disorders based on medically unexplained symptoms and patients with organic disease.” The conceptual framework the Work Group proposes:

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

So under the guise of eliminating “medically unexplained” symptoms as a diagnostic criterion in order to diminish “stigma”, eradicating “terminology [that] enforces a dualism between psychiatric and medical conditions” and language that is “divisive between patients and clinicians”, the APA appears hell bent on colonising the entire medical field by licensing the potential application of a mental health diagnosis to all medical diseases and disorders, if the clinician considers that the patient’s response to their bodily symptoms or their perceived level of disability is “disproportionate” or their coping styles, “maladaptive”.

In its latest proposals, the Work Group writes:

“…Having somatic symptoms of unclear etiology is not in itself sufficient to make this diagnosis. Some patients, for instance with irritable bowel syndrome or fibromyalgia would not necessarily qualify for a somatic symptom disorder diagnosis. Conversely, having somatic symptoms of an established disorder (e.g. diabetes) does not exclude these diagnoses if the criteria are otherwise met.”

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

“…Patients with this diagnosis tend to have very high levels of health-related anxiety. They appraise their bodily symptoms as unduly threatening, harmful, or troublesome and often fear the worst about their health. Even when there is evidence to the contrary, they still fear the medical seriousness of their symptoms. Health concerns may assume a central role in the individual’s life, becoming a feature of his/her identity and dominating interpersonal relationships.”

These proposals could result in misdiagnosis of a mental health disorder or the misapplication of an additional diagnosis of a mental health disorder. There may be considerable implications for these highly subjective criteria for the diagnoses assigned to patients, for the provision of social care, the payment of employment, medical and disability insurance, the types of treatment and testing insurers are prepared to fund and the length of time for which insurers are prepared to pay out.

Dual-diagnosis may bring thousands more patients, potentially, under a mental health banner where they may be subject to inappropriate treatments, psychiatric services, antidepressants, antipsychotics and behavioural therapies such as CBT, for the “modification of dysfunctional and maladaptive beliefs about symptoms and disease, and behavioral techniques to alter illness and sick role behaviors and promote more effective coping [with their somatic symptoms].”

Coding CFS in the “Signs, symptoms and ill-defined conditions” chapter of the forthcoming ICD-10-CM would also render CFS and ME patients more vulnerable to these DSM-5 Work Group recommendations that will provide another dustbin in which to shovel patients with so-called “medically unexplained” bodily symptoms.

Who should submit comment on these proposals?

All stakeholders are permitted to submit comment and the views of patients, carers, families and advocates are important. But evidence-based submissions from the perspective of informed medical professionals – clinicians, psychiatrists, researchers, allied health professionals, lawyers and other professional end users are likely to have more influence.

National and state patient organizations also need to submit comment.

To date, not one patient organization in the US or UK has confirmed to me that they intend to submit feedback, this year. So we need to lean heavily on our patient organizations to review these criteria.

Where can I read last year’s submissions?

Copies of international patient organization submissions for the first DSM-5 public and stakeholder review are collated on this page of my site, together with selected patient and advocate submissions:

DSM-5 Submissions to the 2010 review: http://tinyurl.com/DSM5submissions

How to comment:

More information on registration and preparing submissions here: http://tinyurl.com/DSM-5-register-to-comment

What else can I do?

Use mailing lists, forums, blogs, websites and contacts to get this information out – especially platforms where clinicians, allied health professionals, medical lawyers and patient organization reps participate. Alert state and national ME, CFS, FM and IBS patient organizations to the deadline and lobby for their involvement.

This is the last alert I shall be sending out. Remember, the deadline is June 15.

Thank you.

—————–

Text and formatted versions of this document in Word .doc and PDF format will be available on my website.

Suzy Chapman

https://dxrevisionwatch.wordpress.com

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

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 4)

May 22, 2011 by meagenda

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 4)

Post #82 Shortlink: http://wp.me/pKrrB-16B

Part 1 of this report can be read here in Post #75:

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 1)

Part 2 of this report can be read in Post #77:

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 2)

Part 3 of this report can be read in Post #80:

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 3)

The second public review of draft proposals for DSM-5 criteria closes on 15th June

Information about registering to submit comment can be found in Post #78: http://wp.me/pKrrB-15q

In Part 3 of this report, I set out extracts from the first of two key PDF documents that accompany the latest proposals of the DSM-5 Somatic Symptom Disorders Work Group, highlighting in yellow why ME and CFS patient representation organizations, professionals and advocates need to register their concerns. Stakeholder feedback in this second public review is being accepted until 15 June.

In Part 4, I am posting all the text from the “Rationale” document, omitting several pages of references to research papers. Both key documents can be downloaded here:

For extracts from the “Disorders Description” document see Post #80

Disorders Description Key Document One: “Somatic Symptom Disorders”

Rationale Document Key Document Two: “Justification of Criteria — Somatic Symptoms”

Filed under American Psychiatric Association (APA), CFSAC meetings, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-V, Javier Escobar, Joel Dimsdale, MUS, Somatic Symptom Disorder, Somatoform Disorders

ICD-11 Alpha Drafting platform launched 17 May (public version)

May 19, 2011 by meagenda

ICD-11 Alpha Drafting platform launched 17 May (public version)

Post #81 Shortlink: http://wp.me/pKrrB-16N

This information does not apply to the forthcoming US specific “Clinical Modification” of ICD-10, called ICD-10-CM, scheduled for implementation in October 2013.

Changes to Alpha Draft since May 17, 2011:

May 19 – 11:02 UTC : Code/sorting label assigned to Parent class “Other disorders of the nervous system” changed from 06N to 06L.

Screenshot from ICD11 Alpha May 17 – 11.02 UTC Chapter 6 Diseases of the nervous system: Foundation Tab selected

ICD11 Alpha Chapter 6

» http://apps.who.int/classifications/icd11/browse/f/en#/@_@who_3_int_1_icd_2_G93_3_3

Screenshot from ICD11 Alpha May 19 – 11.02 UTC Chapter 6: Linearizations Tab > Morbidity selected

» http://apps.who.int/classifications/icd11/browse/l-m/en#/@_@who_3_int_1_icd_2_G93_3_3

Four new pages were published on the WHO’s main website on 17 May – the revised Timeline for ICD-11, the announcement of an Alpha Draft browser, a Registration form and a Caveat. Yesterday, I posted the revised ICD-11 Revision Timeline.

What can be seen for PVFS, (B)ME and CFS in the public Alpha Draft?

For the Alpha browser, go to this page:

http://www.who.int/classifications/icd/revision/en/index.html

Here it states:

The International Classification of Diseases 11th Revision is due by 2015

ICD is the international standard to measure health & health services

• Mortality statistics
• Morbidity statistics
• Health care costs
• Progress towards the Millenium Development Goals
• Research

– Alpha draft is updated daily as the work progresses
– It is intended to show the new features to stakeholders early
– Commenting will be available in July 2011

The link for the alpha browser is:

http://apps.who.int/classifications/icd11/browse/f/en

This is the link to a page for “Caveats”

“Read more on what to expect in the ICD-11 Alpha Draft”

ICD-11 Alpha Draft Caveats

ICD-11 alpha draft is:

• Incomplete
• May contain errors, omissions or imperfections
• The work in different chapters are at different stages
• The alpha drafting work is going on by the WHO, Revision Steering Group and Topic Advisory Groups
• The alpha draft is going to be updated on a daily basis
• The alpha draft is NOT TO BE USED for CODING at this stage
• The alpha draft has not yet been approved by the Topic Advisory Groups, Revision Steering Group or WHO

Click here to access the public Alpha Draft browser

Poke around and open the Parent and Child categories and the Tabs – you cannot edit or break anything.

This new interface is not as detailed or as easy to navigate as the software version of the iCAT collaborative drafting platform that was in the public domain up until November, last year. Less information is visible, for example, some of the paramenter tabs, including “Definitions”. (Compare with what could be seen in this iCAT screenshot from last June.)

This is a public draft and another platform is being used by ICD Revision for ongoing drafting. The public draft will be updated as the work of the various Topic Advisory Groups and working groups progresses. ICD Revision has not reached its targets for the generation of content and population of “Content Model” fields across all chapters and this draft is not as far forward as ICD Revision had projected for a May 2011 release.

Though viewable now, the Alpha drafting browser is not planned to be open for public comment until July, this year. It’s not yet clear which classes of public stakeholder will be able to participate in the drafting process, come July, or to what extent.

If you are interested in the proposed public comment, interaction and input processes for the Alpha and Beta drafting stages, see this DSM-5 and ICD-11 Watch post for meeting presentation slides.

Summary

First a caveat: It had been anticipated that a Beta drafting platform would be released in May, this year. WHO has cited lack of content and underdeveloped software for delaying the launch of a Beta drafting platform.

This public version of an Alpha drafting platform is a “work in progress”; not all disease and disorder categories may have been entered into the draft and proposed textual content is in the process of being authored and reviewed by the various Topic Advisory Groups, ICD Revision Steering Group and external peer reviewers.

From what can be seen, today, 19 May:

06L00 Chronic fatigue syndrome

is proposed to be coded within Chapter 6 Diseases of the nervous system (the Neurology chapter), as an ICD Title category, under the Parent class, 06L Other disorders of the nervous system.

Benign myalgic encephalomyelitis is specified as an Inclusion to 06L00 Chronic fatigue syndrome.

“Causal mechanisms” for 06L00 Chronic fatigue syndrome are cited as “Virus (organism)”.

The relationship between ICD Title category 06L00 Chronic fatigue syndrome and Inclusion term Benign myalgic encephalomyelitis is not yet specified, ie whether for ICD-11, “Benign myalgic encephalomyelitis” is proposed to be specified as a Synonym , Subclass or other relationship to “06L00 Chronic fatigue syndrome”.

Many categories within the draft are waiting for their Inclusion terms to be specified, not just the three terms of interest to us.

For explanation of Inclusions and other “Content Model” parameter terms, see: iCAT Glossary or the key ICD-11 Content Model document.

6 Inclusions

Details: Inclusion terms appear in the tabular list [Ed: ICD Volume 1] of the traditional print version and show users that entities are included in the relevant concept. All of the ICD-10 inclusion terms have been imported and accessible in the iCat. These are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy. Since we have synonyms as a separate entity in our ICD-11 content model, the new synonyms suggested by the users should go into the synonyms section. In the future, iCat will provide a mechanism to identify whether an inclusion is a synonym or a subclass.”

What is the proposed relationship between PVFS and CFS?

Postviral fatigue syndrome is not accounted for in the “Foundations” or “Linearizations > Morbidity” listings.

In ICD-10, Postviral fatigue syndrome is an ICD Title category under G93 Other disorders of brain. I cannot confirm, but it may be that due to the hierarchy change, “Postviral fatigue syndrome” is proposed to be subsumed under “06L00 Chronic fatigue syndrome” with “06L00 Chronic fatigue syndrome” becoming the ICD Title category, because “G93.3 Postviral fatigue syndrome” has lost its ICD-10 Parent category.

At the moment, there is not sufficient information displaying to determine what the intention is. Last June, I requested a clarification from Dr Raad Shakir, chair of Topic Advisory Group for Neurology, but no clarification has been forthcoming.

In the iCAT initial drafting platform, last November, where “Postviral fatigue syndrome” was referenced within a “Category Note” and specified as an Exclusion to Chapter 5 and Chapter 18, it was referenced as:

“G93.3 Postviral fatigue syndrome -> Gj92 Chronic fatigue syndrome”

[“Note: Gj92” is a “Sorting label” assigned for the initial Alpha drafting process, not an eventual ICD-11 code.]

“Change history” note from May 2010

In ICD-10, “Postviral fatigue syndrome” is a Title code at G93.3 under Parent category “G93 Other disorders of brain”. “Benign myalgic encephalomyelitis” sits under “G93.3 Postviral fatigue syndrome” (relationship unspecified).

As previously reported, an iCAT “Change history” note, dated 1 May 2010, records a “Change in hierarchy for class: G93.3 Postviral fatigue syndrome because its parent category (G93 Other disorders of brain) is removed.”

This would leaves the existing ICD-10 G93.3 Title category, “Postviral fatigue syndrome” and “Benign myalgic encephalomyelitis” that sits beneath it, and also the G93.3 index entry for Chronic fatigue syndrome with no parent category.

Note that the removal of the parent “G93 Other disorders of brain” affects many other categories also classified under G93 in ICD-10 which have also been assigned new parents under the reorganization of Chapter 6 (VI).

Screenshot of “Change history” Note from May 2010

Exclusions

No Exclusions have been specified yet for “06L00 Chronic fatigue syndrome”.

“Postviral fatigue syndrome” is specified as an Exclusion to the following ICD-11 chapters:

Chapter 5 “05E06 Other neurotic disorders > 05E06.00 Neurasthenia”
Chapter 18 “18GF General symptoms and signs > 18F03 Malaise and fatigue.”

(Chapter 18 is the “R code” chapter of ICD-10; ICD-10-CM proposes to retain CFS under R53 Malaise and fatigue at R53.82 Chronic fatigue, unspecified, as “Chronic fatigue syndrome NOS”, with the Exclusion: Postviral fatigue syndrome G93.3.)

Go here for ICD-11 Chapter 5 “Neurotic, stress-related and somatoform disorders” > Somatoform Disorders:

http://apps.who.int/classifications/icd11/browse/f/en#/@_@who_3_int_1_icd_2_F40-F48

Go here for ICD-11 Chapter 18 “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified”:

http://apps.who.int/classifications/icd11/browse/l-m/en#/@_@who_3_int_1_icd_2_XVIII

Congruency with DSM-5 proposals for revision of DSM-IV “Somatoform Disorders”

There is no obvious mirroring of the radical proposals currently being put forward by the DSM-5 Somatic Symptom Disorders Work Group to rename “Somatoform Disorders” to “Somatic Symptom Disorders” and combine a number of existing somatoform categories under a new rubric, “Complex Somatic Symptom Disorder”.

Registering for involvement

There is a Registration form here

This form appears to be aimed at recruiting medical health professionals for putting their names down to be contacted at some point to “Make comments; Make proposals to change ICD categories; Participate in field trials; Assist in translating“. It’s not clear whether or at what point in the Alpha/Beta drafting processes involvement might be extended to non professional stakeholders.

Register to become involved

ICD-11 Registration

“WHO wants to know if you are interested in being involved in the ICD Revision. We will contact you as certain features are opened to the public.”

[Fields are: Family name*; First name*; Email address*; Organization or Company*; LinkedIn ID; Are you a health care professional?* Yes/No. Continue…] *Required fields

Related information

1] ICD11 Alpha browser

2] ICD Revision Process Alpha Evaluation Meeting documents and PowerPoint slide presentations

3] Key document: ICD Revision Project Plan version 2.1 9 July 2010

4] Key document: Content Model Reference Guide version January 2011

Filed under ICD revision process, ICD-10, ICD-11, ICD-11 Alpha Draft, ICD-11 Beta Draft, ICD-11 consultation, ICD-11 revision docs, Somatic Symptom Disorder, Somatoform Disorders, WHO (World Health Organization)

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 3)

May 18, 2011 by meagenda

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 3)

Post #80 Shortlink: http://wp.me/pKrrB-15X

Part 1 of this report can be read here in Post #75:

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 1)

Part 2 of this report can be read in Post #77:

What are the latest proposals for DSM-5 “Somatic Symptom Disorders” categories and why are they problematic? (Part 2)

The second public review of draft proposals for DSM-5 criteria is now open and runs from May to 15th June

Information about registering to submit comment can be read here in Post #78: http://wp.me/pKrrB-15q

In the first part of this report, I addressed some of the queries that have been raised around the second public review of proposals for the revision of DSM categories and diagnostic criteria.

In Part 2, I linked to the latest proposals (dated 14 April 2011) from the DSM-5 Somatic Symptom Disorders Work Group, as published on the DSM-5 Development website, on 4 May.

Stakeholder feedback is being accepted now until 15 June.

Disorders Description Key Document One: “Somatic Symptom Disorders

Rationale Document Key Document Two: “Justification of Criteria — Somatic Symptoms”

Related information:

Submissions by international patient organizations and advocates in February to April 2010 DSM-5 public review can be read here: http://wp.me/PKrrB-AQ

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, Joel Dimsdale, MSPB (FII), MUS, Somatic Symptom Disorder, Somatoform Disorders

Registering to submit comment in the second DSM-5 public review of draft criteria

May 12, 2011 by meagenda

Registering to submit comment in the second DSM-5 public review of draft criteria

Post #78 Shortlink: http://wp.me/pKrrB-15q

Second public review of draft proposals for DSM-5 criteria now open and runs from May to 15th June

Under the guise of “eliminating stigma” and eradicating “terminology [that] enforces a dualism between psychiatric and medical conditions” the American Psychiatric Association (APA) appears hell bent on colonising the entire medical field by licensing the application of a mental health diagnosis to all medical diseases and disorders.

If the most recent proposals of the “Somatic Symptom Disorders” Work Group gain DSM Task Force approval, all medical diseases and disorders, whether “established general medical conditions or disorders” like diabetes or conditions presenting with “somatic symptoms of unclear etiology” will have the potential for a bolt-on diagnosis of “somatic symptom disorder”.

CFS and ME patients, diagnosed or awaiting diagnosis, may be especially vulnerable to highly subjective criteria and difficult to quantify constructs such as “disproportionate distress and disability”, “catastrophising”, “health-related anxiety”, “[appraising] bodily symptoms as unduly threatening, harmful, or troublesome” with “health concerns [that] may assume a central role in the individual’s life, becoming a feature of his/her identity and dominating interpersonal relationships.”

There may be considerable implications for these highly subjective classifications for the diagnoses assigned and the treatments offered to US patients, for the provision of social care and payment of medical and disability insurance.

Who can submit comment?

The APA is inviting all stakeholders to submit comment and feedback on the draft framework for DSM-5 and the latest proposed revisions to diagnostic criteria – patients and families, patient advocates and patient organizations as well as clinicians, researchers, allied health professionals, lawyers and other end users.

It’s important that patients who are able to submit comment do so, but please also encourage patient organizations, informed clinicians, researchers, psychiatrists, psychologists and allied health professionals to submit feedback, too.

Last year, the APA received over 8000 comments from stakeholders across all DSM categories.

Where can I read examples of last year’s submissions?

Copies of last year’s submissions by patient organizations and advocates can be read here: http://tinyurl.com/DSM5submissions

I shall be opening a new page for copies of this year’s patient organization and patient advocate submissions.

How do I register to submit comment?

1. Go to the DSM-5 Development website: http://www.dsm5.org/Pages/Default.aspx

2. Look for the “Participate” box (right hand side of Home Page) and click on “Register Now”. (Log in names and passwords from last year’s public review do appear to have been retained.)

3. Complete the “Register to Make Comments” form: http://www.dsm5.org/Pages/Registration.aspx

Having registered a username, name, email address and country, and entered the “Captcha” code, a confirmation email with a temporary password will be auto generated. The Registration form is also accessible from each of the category Criteria pages, as well as from the Home Page.

You can register in advance, if you wish, then prepare and upload your submission at a later date, but remember the feedback period closes on 15 June.

4. To comment on the proposals of the “Somatic Symptom Disorders” Work Group, Login in and go to this page:

http://www.dsm5.org/proposedrevision/Pages/SomaticSymptomDisorders.aspx

You can submit comment, on that page, for one or more categories, or click on a specific category, for example,

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=368

J 00 Complex Somatic Symptom Disorder

I would strongly recommend composing your comment in a draft email or word processor first and saving a copy, as last year, there were complaints that Captcha characters were hard to read and the uploading procedure glitchy – so please save a copy first. External links and references can be included but there is no facility for including attachments. There appears to be no maximum word or character length specified. I would also suggest that you head your submission with “For the attention of the Somatic Symptom Disorders Work Group” or similar.

What are the latest proposals for the “Somatic Symptom Disorders” categories?

The latest proposals are set out here, where the two key “Disorder Descriptions” and “Rationale” documents can also be downloaded: http://wp.me/pKrrB-13z

I’ll be posting extracts from the two key documents in the next post.

More Q and As on and around the public review, here: http://wp.me/pKrrB-12P

Related material:

On the subject of the use of the word “somatic” and “somatic symptom” , Angela Kennedy published this note, in June 2009:

I’ve noticed for some time that various people have been using the term ‘somatic’ as if it signified a ‘psychosomatic’ or ‘psychogenic’ condition.

This is incorrect. The OED definition of ‘somatic’ is “of or relating to the body, especially as distinct from the mind” (my italics). The word comes from the Greek ‘soma’ meaning ‘body’.

Even when proponents of ‘psychogenic’ explanations (it’s in your mind, you’re imagining it, misinterpreting it, faking it, caused it by your own beliefs etc. etc. etc.) use the term ‘somatic illness’ they actually do mean an illness of the body. They may then claim this somatic (or bodily illness) is caused by psychological dysfunction, but the word ‘somatic’ does not mean “illness caused by psychological dysfunction”. It merely means illness of a body, or a bodily illness.

It is important that this word is used correctly, especially when people write to the media, government, the medical establishment etc. Otherwise we are in danger of seeing apparent objections published, from advocates, to saying ME/CFS is a bodily illness, purely because someone has used the word ‘somatic’ incorrectly!

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, Francis Creed, Joel Dimsdale, Somatic Symptom Disorder, Somatoform Disorders

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