DSM-5 goes to press with ‘Somatic Symptom Disorder’ amid widespread professional and consumer concern

February 6, 2013 by

DSM-5 goes to press with ‘Somatic Symptom Disorder’ amid widespread professional and consumer concern

Post #224 Shortlink: http://wp.me/pKrrB-2EV

Update: On February 8, David J. Kupfer, MD, Chair, DSM-5 Task Force, published in defence of the ‘Somatic Symptom Disorder’ category on Huffington Post:

Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care

Last week, the American Psychiatric Association sent the next edition of its Diagnostic and Statistical Manual of Mental Disorders to the publishers.

When DSM-5 is released in May, it will introduce a new ‘catch-all’ diagnosis that could capture many thousands more patients under a mental disorder label.

Today, on Saving Normal at Psychology Today, Allen Frances, MD, who chaired the DSM-IV Task Force, publishes the third in a series of commentaries voicing considerable concern for all illness groups for the implications of an additional diagnosis of ‘Somatic Symptom Disorder.’

Why Did DSM 5 Botch Somatic Symptom Disorder?

Allen Frances writes:

“Once it is an official DSM 5 mental disorder, SSD is likely to be widely misapplied – to 1 in 6 people with cancer and heart disease and to 1 in 4 with irritable bowel syndrome and fibromyalgia…The definition of SSD is so loose it will capture 7% of healthy people (14 million in the US alone) suddenly making this pseudo diagnosis one of the most common of all ‘mental disorders’ in the general population.”

Suzy Chapman writes:

“These highly subjective, difficult to assess criteria have the potential for widespread misapplication, particularly in busy primary care settings – causing stigma to the medically ill and potentially resulting in poor medical workups, inappropriate treatment regimes and medico-legal claims against clinicians for missed diagnoses.

“Why has the Task Force and APA Board of Trustees been prepared to sign off on a definition and criteria set that lacks a body of rigorous evidence for its validity, safety and prevalence, thereby potentially putting the public at risk? And why is APA prepared to abrogate its duty of care as a professional body and expose its membership, physicians and the allied health professional end-users of its manual to the risk of potential law suits?”

From May, an additional mental health diagnosis of ‘Somatic Symptom Disorder’ (SSD) can be applied whether patients have diagnosed medical diseases like diabetes, angina, cancer or multiple sclerosis, chronic illnesses like IBS, fibromyalgia, chronic fatigue syndrome or chronic pain disorders, or unexplained conditions that have so far presented with bodily symptoms of unclear etiology.

A person will meet the criteria for ‘Somatic Symptom Disorder’ by reporting just one or more bodily symptoms that are distressing or disruptive to daily life, that have persisted for at least six months, and having just one of the following three responses:

1) disproportionate, persistent thoughts about the seriousness of their symptoms;
2) persistently high level of anxiety about their health or symptoms;
3) devoting excessive time and energy to symptoms or health concerns.

In the DSM-5 field trials, 15% of the ‘diagnosed illness’ study group (the trials looked at patients with either cancer or coronary heart disease) met the criteria for an additional mental health diagnosis of SSD.

26% of patients who comprised the irritable bowel syndrome or fibromyalgia study group were coded for SSD.

A disturbingly high 7% of the ‘healthy’ control group were also caught by these overly-inclusive criteria.

+++

Psychiatric creep

As the criteria stand, this new disorder will potentially result in a ‘bolt-on’ mental health diagnosis being applied to all chronic illnesses and medical conditions if the clinician decides the patient’s response to distressing symptoms is ‘excessive’ or their coping strategies are ‘maladaptive,’ or that they are ‘catastrophising’ or displaying ‘fear avoidance.’ Or if the practitioner feels the patient is spending too much time on the internet researching data, symptoms and treatments, or that their lives have become ‘dominated’ by ‘illness worries,’ they may be vulnerable to an additional diagnosis of SSD.

Patients with chronic, multiple bodily symptoms due to rare conditions or multi-system diseases like Behçet’s syndrome or Systemic lupus, which may take several years to diagnose, will also be vulnerable to misdiagnosis with a mental disorder.

There is no substantial body of research to support the validity, reliability or safety of the ‘Somatic Symptom Disorder’ diagnosis.

During the second public review of draft criteria for DSM-5, the ‘Somatic Symptom Disorder’ section received more submissions from advocacy organizations, patients, and professionals than almost any other disorder category. But rather than tighten up the criteria or subject the entire disorder section to independent scientific review, the SSD Work Group’s response has been to lower the threshold even further – potentially pulling even more patients under a mental disorder label.

The ‘Somatic Symptom Disorder’ Work Group has rejected eleventh hour calls from professionals and patients to review its criteria before going to print.

APA says there will be opportunities to reassess and revise DSM-5‘s new disorders, post publication, and that it intends to start work on a ‘DSM-5.1’ release. But patient groups, advocates and professionals are not reassured by a ‘publish first – patch later’ approach to science.

Read Parts One and Two, here:

Part One: Mislabeling Medical Illness As Mental Disorder | Allen Frances, December 8, 2012

Part Two: Bad News DSM-5 Refuses To Correct Somatic Symptom Disorder | Allen Frances, January 16, 2013

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Notes for media, websites, bloggers:

1. The next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will be published by American Psychiatric Publishing Inc. in May 2013. It will be known as ‘DSM-5 ‘ and has been under development since 1999.
http://www.dsm5.org/Pages/Default.aspx
http://www.dsm5.org/Documents/DSM%205%20development%20factsheet%201-16-13.pdf

2. The American Psychiatric Association (APA) has spent $25 million on the development of DSM-5.

3. The Diagnostic and Statistical Manual of Mental Disorders is used by mental health and medical professionals for diagnosing and coding mental disorders. It is used by psychiatrists, psychologists, therapists, counselors, primary health care physicians, nurses, social workers, occupational and rehabilitation therapists and allied health professionals.

The DSM is also used for reimbursement and informs government, public health policy, courts and legal specialists, education, forensic science, prisons, drug regulation agencies, pharmaceutical companies and researchers. Diagnostic criteria defined within DSM determine what is considered a mental disorder and what is not, which treatments and therapies health insurers will authorise funding for, and for how long.

4. Four existing disorder categories in the DSM-IV ‘Somatoform Disorders’ section: somatization disorder [300.81], hypochondriasis [300.7], pain disorder, and undifferentiated somatoform disorder [300.82] will be eliminated and replaced with a single new category – ‘Somatic Symptom Disorder’ for DSM-5.

5. APA has held three stakeholder comment periods during which professional and public stakeholders have been invited to submit comment on the proposals for the revision of DSM-IV categories and criteria (in February-April 2010; May-June 2011; May-June 2012).

6. DSM-5 is slated for release at the American Psychiatric Association’s 166th Annual Meeting, San Francisco (May 18-22, 2013). The new manual is available for pre-order and will cost $199: http://www.psychiatry.org/dsm5

7. Allen Frances, MD, was chair of the DSM-IV Task Force and of the Department of Psychiatry at Duke University School of Medicine, Durham, NC; Dr Frances is currently professor emeritus, Duke.

8. Dr Frances blogs at DSM 5 in Distress, and Saving Normal at Psychology Today.

Mislabeling Medical Illness As Mental Disorder was published on December 8, 2012

Bad News DSM-5 Refuses To Correct Somatic Symptom Disorder was published on January 16, 2013

For additional information on ‘Somatic Symptom Disorder’:

Somatic Symptom Disorder could capture millions more under mental health diagnosis by Suzy Chapman for Dx Revision Watch, May 26, 2012

Suzy Chapman

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, Somatic Symptom Disorder, Somatoform Disorders Tagged with , , , , , , , , ,

Deutschlandfunk Radio: Wissenschaft Im Brennpunkt: Störungswahn? DSM-5 with Allen Frances

February 3, 2013 by

Deutschlandfunk Radio: Wissenschaft Im Brennpunkt: Störungswahn? (DSM-5) with Allen Frances, MD

Post #223 Shortlink: http://wp.me/pKrrB-2EH

Flash:
http://www.dradio.de/dlf/sendungen/wib/1990949

Mp3 (12MB):
http://ondemand-mp3.dradio.de/file/dradio/2013/02/03/dlf_20130203_1630_c745d088.mp3

Deutschlandfunk Radio

http://www.dradio.de/dlf/sendungen/wib/1990949/

27:21 mins

WISSENSCHAFT IM BRENNPUNKT (Science In Focus)
03.02.2013

Störungswahn? (Delusional disorder?)

Psychiater streiten um die Zukunft ihres Fachs (Psychiatrists argue about the future of their profession)

Von Martin Hubert with contributions from Allen Frances, MD, and others

In einigen Monaten erscheint das neue amerikanische Handbuch zur Diagnose psychiatrischer Krankheiten, das “DSM-5”. Aber schon heute erzeugt es heftigen Streit. Denn das “DSM-5” wird die Entwicklung der Psychiatrie auf Jahre hinaus wesentlich beeinflussen.

Kritiker meinen, dass es zu viel neue und überflüssige Störungsbilder enthalte. Außerdem definiere es Störungen oft so weich, dass auch Durchschnittsmenschen künftig zum psychiatrischen Fall würden. Die Verteidiger des Handbuchs kontern: Es habe in der Geschichte immer wieder neue Störungen gegeben, auf die die Psychiater zu reagieren hätten. Außerdem seien weiche Kriterien nötig, um Risikopatienten früh erkennen und therapieren zu können. Wann ist ein Patient wirklich gefährdet – und wann leiden die Psychiater selbst unter Störungswahn? Der Streit zeigt, in welche Richtung sich die Psychiatrie insgesamt entwickeln könnte.

Weiterführende Links:

Seiten des Deutschlandradios:

Links ins Netz:

Filed under Allen Frances, American Psychiatric Association (APA), Bereavement, Conflicts of interest, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media, ICD-11 in the media Tagged with , , , , , , , , ,

ICD-11 Beta draft and Bodily Distress Disorders; Per Fink and Bodily Distress Syndrome: Parts One and Two

February 3, 2013 by

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

Post #222 Shortlink: http://wp.me/pKrrB-2Dz

Caveats: The ICD-11 Beta drafting platform is not a static document: it is a work in progress, subject to daily edits and revisions, to field test evaluation and to approval by Topic Advisory Group Managing Editors, the ICD Revision Steering Group and WHO classification experts. The current draft may differ to the information in this report.

Part One

On January 6, I posted a brief update on proposals for the revision of ICD-10’s Somatoform Disorders based on what can be seen in the public version of the ICD-11 Beta drafting platform and on a book chapter by Professor, Sir David Goldberg. [1]

Professor Goldberg chairs the working group for revision of the mental health chapter of ICD-1o-PHC, the abridged, primary care version of ICD-10.

For the revision of ICD-10’s Somatoform Disorders sections for ICD-11, a WHO Expert Working Group on Somatic Distress and Dissociative Disorders has been assembled.

Professor Francis Creed (also a member of the DSM-5 Somatic Symptom and Related Disorders Work Group) is a member of this WHO working group, which is chaired by Professor Oye Gureje.

An April 2011 announcement by Stony Brook Medical Center states that Dr Joan E. Broderick, PhD had been appointed to the WHO Expert Working Group on Somatic Distress and Dissociative Disorders and that the first meeting of the group (said to consist of 17 international behavioral health professionals) was expected to be held in June 2011, in Madrid.

WHO has not published a list of  members of this working group or any progress reports and the names and affiliations of the 14 other members are unknown, so I am unable to confirm whether Professor Per Fink is a member of the group, which reports to the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders.

ICD-11 and Bodily Distress Disorders

ICD-11 is currently scheduled for completion in 2015/16. When viewing the public version of the Beta drafting platform please bear in mind the ICD-11 Revision Caveats: that the Beta draft is a work in progress, updated daily, is incomplete, may contain errors and is subject to change; not all proposals may be approved by the ICD-11 Revision Steering Committee or WHO classification experts, or retained following analysis of ICD-11 and ICD-11-PHC field trials.

The Bodily Distress Disorders section of ICD-11 Beta draft Chapter 5 can be found here:

Foundation View: http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1472866636
Linearization View: http://apps.who.int/classifications/icd11/browse/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1472866636

As the ICD-11 Beta drafting platform stands at the time of compiling this report, the existing ICD-10 Somatoform Disorders are proposed to be subsumed under or replaced by Bodily Distress Disorders, and Psychological and behavioural factors associated with disorders or diseases classified elsewhere.

The following proposed ICD-11 categories are listed as child categories under parent term, Bodily Distress Disorders, and Psychological and behavioural factors associated with disorders or diseases classified elsewhere:

EC5 Mild bodily distress disorder
EC6 Moderate bodily distress disorder
EC7 Severe bodily distress disorder
EC8 Psychological and behavioural factors associated with disorders or diseases classified elsewhere

No Definition or any other Content Model parameters have been populated for the proposed categories EC5, EC6 and EC7, which are new entities to ICD. (EC8 is a legacy category from ICD-10.)

Note that the sorting codes assigned to categories are subject to frequent change as chapters are reorganized.

From the information currently displaying in the Beta draft, it is not possible to determine:

• how ICD-11 proposes to define Bodily Distress Disorders;

• what diagnostic criteria are being proposed;

• whether diagnostic criteria would be based on a requirement for excessive or disproportionate psychological and behavioral characteristics in response to distressing somatic symptoms, such as illness anxiety, symptom focusing, catastrophising, maladaptive coping strategies, avoidance behavior or misattribution; or based on somatic symptom counts, or specific symptom clusters, or number of bodily systems affected, or a combination of these;

• how the three Severity Specifiers: Mild, Moderate and Severe would be categorized;

• how the three Severities would be assessed for within primary and secondary care;

• whether ICD-11’s proposed Bodily Distress Disorder construct is intended to mirror or incorporate DSM-5’s Somatic Symptom Disorder (SSD) construct, in line with ICD-11/DSM-5 harmonization, or

• whether it is intended to mirror or incorporate Per Fink’s Bodily Distress Syndrome (BDS) construct, or to combine elements from both;

• whether the Bodily Distress Disorder construct is proposed only to be applied to patients with distressing ‘medically unexplained somatic symptoms’ (MUS), or the so-called ‘Functional somatic syndromes’ (FSS), if the patient is considered to also meet the BDD criteria, or

• whether it is proposed to be inclusive of patients with distressing somatic symptoms in the presence of diagnosed illness and general medical conditions, if the patient is considered to also meet the criteria;

• whether the Bodily Distress Disorder construct is proposed to be inclusive of parents or caregivers perceived as encouraging maintenance of sick role behavior or over-involved.

• whether the Bodily Distress Disorder construct is proposed to be inclusive of children;

• whether it is proposed that all or selected of the following: Neurasthenia and Fatigue syndrome (F48.0), Chronic fatigue syndrome (indexed to G93.3 in ICD-10; classified in ICD-11 Beta draft as an ICD Title term in Chapter 6: Diseases of the nervous system), IBS (K58), and Fibromyalgia (M79.7) should be reclassified under Bodily Distress Disorders;

• whether the Bodily Distress Disorder construct is proposed to subsume ICD-10’s Hypochondriacal disorder with somatic symptoms or incorporate this entity under Illness Anxiety Disorder for ICD-11.

(For ICD-11, ICD-10’s Hypochondriacal disorder [F45.2] is currently proposed to be renamed to Illness Anxiety Disorder and located underANXIETY AND FEAR-RELATED DISORDERS.)

 • what ICD-11 proposes to do with ICD-10’s Neurasthenia;

(ICD-10’s Chapter V Neurasthenia [F48.0] is no longer listed in the public version of the ICD-11 Beta draft. For ICD-11-PHC, the primary care version of ICD-11, the proposal is for the term Neurasthenia to be eliminated. Since terms used in ICD-11-PHC require corresponding terms in the main classification, the intention may be to eliminate Neurasthenia from the main version, or subsume under another term.) [2]

All that can be determined from the Beta draft is that these earlier ICD-11 Beta draft Somatoform Disorders categories appear proposed to be subsumed under or replaced with the new BDD categories, EC5, EC6 and EC7, set out above:

Somatization disorder [F45.0 in ICD-10]
Undifferentiated somatoform disorder [F45.1 in ICD-10]
Somatoform autonomic dysfunction [F45.3 in ICD-10]
Persistent somatoform pain disorder [F45.4 in ICD-10]
    > Persistent somatoform pain disorder
    > Chronic pain disorder with somatic and psychological factors [Not in ICD-10]
Other somatoform disorders [F45.8 in ICD-10]
Somatoform disorder, unspecified [F45.9 in ICD-10]

I have previously reported that for ICD-11-PHC, the proposal, last year, was for a new disorder section called Bodily distress disorders, under which would sit new category Bodily stress [sic] syndrome.

This category is proposed for the ICD-11 primary care version to include “milder somatic symptom disorders” as well as “DSM-5’s Complex somatic symptom disorder” and would replace “medically unexplained somatic symptoms.” [2]

In a future post (Part Three of this report), I shall be discussing emerging proposals for the ICD-11 construct, Bodily Distress Disorders, which may serve to fill in some of the gaps.

In the meantime, since it is unclear whether and to what extent the ICD-11 Bodily Distress Disorders category is proposed to mirror or incorporate the Bodily Distress Syndrome construct developed by Per Fink et al, Aarhus, Denmark, I am providing some material on Bodily Distress Syndrome in Part Two

Filed under Bodily Distress Disorders, Bodily distress syndrome, DSM-5 draft proposals, ICD revision process, ICD-10, ICD-11 Beta Draft, MUS, Somatic Symptom Disorder, Somatoform Disorders, WHO (World Health Organization) Tagged with , , , , , , , , ,

Brief update on DSM-5 ‘Somatic Symptom Disorder’

January 30, 2013 by

Brief update on DSM-5 ‘Somatic Symptom Disorder’

Post #221 Shortlink: http://wp.me/pKrrB-2Dd

As previously reported, all draft proposals for categories and criteria for DSM-5 were frozen on the DSM-5 Development website on June 15, 2012, immediately following the closure of the third and final stakeholder review and comment period.

Changes made to the draft after June 15, 2012 are embargoed and final disorder descriptions and criteria sets won’t be evident until DSM-5 is released, in May, this year, unless APA elects to release selected information.

The manual texts that expand on the various disorder sections and the categories that sit within them have not been made public at any stage in the development process. It is understood that for the ‘Somatic Symptom Disorders’ group, for example, the manual text that accompanies these new categories and criteria sets will run to five or six pages.

On November 15, 2012, APA removed the entire third draft from the DSM-5 Development website.

According to this APA Permissions, Licensing & Reprints page, because the most recently posted draft [the third draft that was released on May 2, 2012] has undergone revisions and is no longer current, the criteria texts have been removed from the website in order to avoid confusion or use of outdated categories and definitions. [1]

The page also states that although APA Board of Trustees approved all the proposed diagnoses [in December, 2012] there continue to be minor editorial and content changes as APA moves towards the final stages of the publication process.

Although the DSM-5 Development Timeline has “Final Revisions by the APA Task Force; Final Approval by APA Board of Trustees; Submission to American Psychiatric Publishing, Inc” scheduled for December 2012, according to my sources, the manual texts were now expected to be finalized for the publishers by end of January.

 

DSM-5 Table of Contents

As also previously reported, APA has created new pages for information and resources for DSM-5, where a number of new articles and documents are available to download. [2][3]

http://www.psychiatry.org/dsm5

Documents include a DSM-5 Table of Contents which lists the disorder sections and the category terms that sit within them.

The DSM-5 Table of Contents reveals that changes to the overall section name for  the ‘Somatic Symptom Disorders’ categories and to the category names that sit within this section have been made since closure of the third and final draft.

For the overall disorder section name, DSM-5 will now be using

‘Somatic Symptom and Related Disorders’

rather than

‘Somatic Symptom Disorders’ as per the first, second and third drafts.

For the third draft, the 6 disorders proposed to sit under this disorder section were:

Somatic Symptom Disorders (SSD)

J 00 Somatic Symptom Disorder
J 01 Illness Anxiety Disorder
J 02 Conversion Disorder (Functional Neurological Symptom Disorder)
J 03 Psychological Factors Affecting Medical Condition
J 04 Factitious Disorder
J 05 Somatic Symptom Disorder Not Elsewhere Classified

7 categories are now listed (on Page 3) of the DSM-5 Table of Contents as follows:

Somatic Symptom and Related Disorders

Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion Disorder (Functional Neurological Symptom Disorder)
Psychological Factors Affecting Other Medical Conditions
Factitious Disorder
Other Specified Somatic Symptom and Related Disorder
Unspecified Somatic Symptom and Related Disorder

Other than these revisions to the SSD disorder section name and category names, there are no other texts disclosed within the DSM-5 Table of Contents. So whatever text is included for the latter two categories, ‘Other Specified Somatic Symptom and Related Disorder’ and ‘Unspecified Somatic Symptom and Related Disorder,’ isn’t known.

Whether any revisions have been made to the disorder descriptions and criteria for the five other disorders since the third draft proposals were posted is also unknown because of the embargo on disclosure of changes to categories and criteria beyond June 15, last year.

 

SSD Work Group asked to reconsider

In December, Allen Frances, MD, who had chaired the Task Force that had oversight of the development of DSM-IV, asked the SSD Work Group, key APA Board of Trustees members and Task Force Chairs to reconsider the proposals for specifically the ‘Somatic Symptom Disorder’ category. [4]

These representations were made in response to Dr Frances’ own considerable concerns, and those of lay and professional stakeholders, for the looseness of the SSD definition and criteria set, as it had stood at the third draft, and the absence of a body of robust evidence for the validity and safety of ‘SSD’ as a construct, and data on likely prevalence rates.

Dr Frances also proffered suggestions for revisions that he considered would tighten up the criteria and reduce the potential for misapplication.

The response on behalf of the work group was that although Dr Frances’ suggestions were discussed, the work group would not be revising their recommendations. [5]

It is not known whether the concerns raised by Dr Frances in December were discussed beyond the SSD Work Group with the DSM-5 Task Force or with the APA Board of Trustees, who are responsible for approving proposals and therefore accountable for the content of the forthcoming manual.

 

ICD-11 and DSM-5

In a January 18 article for Psychiatric News, organ of the APA, Mark Moran reports:

“Kupfer [DSM-5 Task Force Chair] said the classification of disorders is largely harmonized with the World Health Organization’s International Classification of Diseases (ICD) so that the DSM criteria sets are more parallel with the proposed ICD-11. In DSM-5 both the current ICD-9-CM and the future standard ICD-10-CM codes (scheduled for 2014) are attached to the relevant disorders in the classification.” [6]

As reported in my Dx Revision Watch post of January 6, at the time of writing, current proposals in the ICD-11 Beta draft have ICD-10’s ‘Somatoform Disorders’ replaced with ‘Bodily Distress Disorders, and Psychological and behavioural factors associated with disorders or diseases classified elsewhere,’ with three, as yet undefined, Severities of ‘Bodily Distress Disorder.’ [7]

It remains to be clarified whether ICD-11’s Beta draft proposals for three Severities of ‘Bodily Distress Disorder’ to replace six ICD-10 ‘Somatoform Disorders’ proposes to mirror Per Fink’s definition and criteria for ‘Bodily Distress Syndrome’ or are more closely aligned with DSM-5‘s ‘Somatic Symptom Disorder,’ in keeping with the APA and WHO’s joint commitment to strive, where possible, for harmonization between the category names, glossary descriptions and criteria across the two systems. [8]

(I shall be addressing this issue in a future post.)

I have previously reported that for ICD-11-PHC, the abridged, Primary Health Care version of ICD-11, the proposal, last year, was for a disorder section called ‘Bodily distress disorders,’ under which would sit ‘Bodily stress [sic] syndrome.’ [9]

According to Professor, Sir David Goldberg, this category is proposed for ICD-11 Primary Health Care version to include “milder somatic symptom disorders” as well as “DSM-5′s Complex somatic symptom disorder” and would replace “medically unexplained somatic symptoms.” These proposals are subject to rejection or modification following ICD-11 Field Trials. [10]

DSM-5 is scheduled for release at the APA’s 166th Annual Meeting (San Francisco, May 18-22).

 

References and related reports

1] American Psychiatric Publishing Permissions, Licensing & Reprints

2] New DSM-5 webpages

3] DSM-5 Table of Contents

4] Mislabeling Medical Illness As Mental Disorder: The Eleventh DSM-5 Mistake, Psychology Today, DSM5 in Distress, Allen Frances, MD, December 8, 2012

5] Bad News: DSM 5 Refuses to Correct Somatic Symptom Disorder, Psychology Today, DSM5 in Distress, Allen Frances, MD, January 16, 2012

6] Continuity and Changes Mark New Text of DSM-5, Psychiatric News, Volume 48, Number 2, January 18, 2013: pp. 1-6 

7] ICD-11 Beta Draft Public Version: Bodily Distress Disorders
http://apps.who.int/classifications/icd11/browse/l-m/en#/http%3a%2f%2fwho.int%2ficd%23F45

8] Fink P, Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture ten diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res 2010;68:415-26
http://www.ncbi.nlm.nih.gov/pubmed/20403500

9] Lam TP, Goldberg DP, Dowell AC, Fortes S, Mbatia JK, Minhas FA, Klinkman MS. Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study. Fam Pract 2012
http://www.ncbi.nlm.nih.gov/pubmed/22843638

10] Goldberg DP. Comparison Between ICD and DSM Diagnostic Systems for Mental Disorders. In: Sorel E, (Ed.) 21st Century Global Mental Health. Jones & Bartlett Learning, 2012: 37-53 [Free PDF Sample Chapter 2]

11] Somatic Symptom Disorder could capture millions more under mental health diagnosis, Suzy Chapman for Dx Revision Watch, May 26, 2012

Filed under Allen Frances, American Psychiatric Association (APA), Bodily Distress Disorders, Bodily stress syndrome, Criticism of DSM-V, DSM-5, DSM-5, DSM-5 draft proposals, DSM-5 in the media, Somatic Symptom Disorder, Somatoform Disorders Tagged with , , , , , , , , ,

American Psychiatric Association launches new pages for DSM-5 – DSM-5 to cost $199

January 29, 2013 by

American Psychiatric Association (APA) launches new pages for DSM-5 – DSM-5 to cost $199

Post #220 Shortlink: http://wp.me/pKrrB-2CD

Unless you’ve had your head stuck in a bucket this last three years, you’ll be aware that the next edition of the American Psychiatric Association’s diagnostic manual is slated for release this May.

APA has spent $25 million on the development of DSM-5.

DSM-5 will be published by American Psychiatric Publishing Inc. and planned for release at the APA’s 166th Annual Meeting in San Francisco (May 18-22).

A hardback copy is going to set you back $199, though paid up members of the American Psychiatric Association are being offered a discount.

Psychiatrists, psychologists, primary health care physicians, therapists, counselors, social workers and allied health professionals don’t have to use DSM-5.

Instead, when codes are required they can use the codes in Chapter 5 of ICD-9-CM (Mental Disorders) and Chapter 5 of ICD-10-CM (Mental, Behavioral and Neurodevelopmental disorders), when ICD-10-CM is implemented*.

*Effective implementation date for ICD-10-CM (and ICD-10-PCS) is currently October 1, 2014. Until that time the codes in ICD-10-CM are not valid for any purpose or use.

Image Copyright Dx Revision Watch 2013

Don’t like it? Don’t use it. Use ICD codes instead.

Since 2003, ICD-9-CM diagnostic codes have been mandated for third-party billing and reporting by HIPAA for all electronic transactions for billing and reimbursement. The codes in DSM are crosswalked to ICD codes.

So you can use ICD-9-CM codes.

And when ICD-10-CM is implemented, it isn’t going to cost you a cent – it will be freely available on the internet.

The ICD-10-CM draft, currently subject to partial code freeze, and its associated documentation can be accessed here on the CDC site; so you can already have a poke around:

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)

On January 23, Allen Frances, MD, who had oversight of the Task Force that developed DSM-IV had this to say about the $199 manual:

Price Gouging: Why Will DSM-5 Cost $199 a Copy?

 

APA launches new pages for DSM-5

Last week the APA launched new pages to promote DSM-5.

Report by John Gever for Medpage Today:

Psych Group Posts Glimpses of Final DSM-5

John Gever, Senior Editor, MedPage Today | January 21, 2013

Peeks into the final DSM-5, the controversial new edition of the American Psychiatric Association’s diagnostic manual, are now available from the group prior to the guide’s official May 22 debut…

PR piece by Mark Moran for Psychiatric News, organ of the American Psychiatric Association:

Psychiatric News | January 18, 2013
Volume 48 Number 2 page 1-6
10.1176/appi.pn.2013.1b10
American Psychiatric Association
Professional News

Continuity and Changes Mark New Text of DSM-5

Mark Moran

The DSM-5 Task Force chair discusses conceptual themes driving changes to the new manual. This is the first in a series continuing through May that will summarize the diagnostic and organizational differences between DSM-IV and DSM-5.

DSM-5, approved by the APA Board of Trustees in December, reflects the “state of the clinical science” in psychiatric diagnosis, incorporating important findings from genetic, neurobiological, and treatment research, while also maintaining substantial continuity for maximum clinical utility…

Go here for the DSM-5 Collection.

Psychiatric News Alert, where those not intending to boycott DSM-5 are encouraged to explore and pre-order a copy ($199):

Psychiatric News Alert

Tuesday, January 22, 2013

New DSM-5 Series Includes Supplementary Information; Order Your Manual Now!

The new DSM-5 pages can be found here, with articles, fact sheets and videos:

http://www.psychiatry.org/dsm5

Documents include:

DSM-5 Table of Contents  [Lists disorder sections and the categories that sit under them.]

Changes to DSM-5

Continuity and Changes Mark New Text of DSM-5, Psychiatric News, January 18, 2013

Highlights of Changes from DSM-IV-TR to DSM-5
DSM-5 Provides New Take on Developmental Disorders, Psychiatric News, January 18, 2013

DSM-5 Fact Sheets

From Planning to Publication: Developing DSM-5
The People Behind DSM-5
The Organization of DSM-5

Making a Case for New Disorders
Autism Spectrum Disorder
Specific Learning Disorder
Intellectual Disability
Social Communication Disorder
Attention-Deficit/Hyperactivity Disorder

DSM-5 Video Series

How and why was DSM-5 developed?
What has been the goal for revising DSM-5?

What are the changes to autism spectrum disorder in DSM-5?
What will be the impact of DSM-5 changes to autism spectrum disorder?
What are the changes to learning disorder in DSM-5?
What will be the impact of the revised specific learning disorder diagnosis?

The APA’s DSM-5 Development site can still be found here DSM-5 Development.

Proposals for changes to DSM-IV categories and criteria, as they had stood at the third draft, were frozen on June 15, 2012.

Any revisions made to criteria sets following closure of the third and final comment period are subject to embargo and the DSM-5 Development site has not been updated to reflect changes made to categories and criteria beyond June 15.

The entire third draft of proposals was removed from the DSM-5 Development site on November 15.

You can read APA’s rationale for removing the draft on an updated Permissions, Licensing & Reprints page.

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, Darrell Regier, David Kupfer, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media, Psychiatric Times, Somatic Symptom Disorder Tagged with , , , , , , , , ,

DSM-5 Round up: January #2

January 26, 2013 by

DSM-5 Round up: January #2

Post #220 Shortlink: http://wp.me/pKrrB-2Ce

Round up of recent media coverage of DSM-5 issues from US and UK spanning January 18 to January 28:

Scientific American

The Newest Edition of Psychiatry’s “Bible,” the DSM-5, Is Complete

The APA has finished revising the DSM and will publish the manual’s fifth edition in May 2013. Here’s what to expect

Ferris Jabr | January 28, 2013

For more than 11 years, the American Psychiatric Association (APA) has been laboring to revise the current version of its best-selling guidebook, the Diagnostic and Statistical Manual of Mental Disorders (DSM) (see “Psychiatry’s Bible Gets an Overhaul” in Scientific American MIND). Although the DSM is often called the bible of psychiatry, it is not sacred scripture to all clinicians—many regard it more as a helpful corollary to their own expertise. Still, insurance companies in the U.S. often require an official DSM diagnosis before they help cover the costs of medication or therapy, and researchers find it easier to get funding if they are studying a disorder officially recognized by the manual. This past December the APA announced that it has completed the lengthy revision process and will publish the new edition—the DSM-5—in May 2013, after some last (presumably minor) rounds of editing and proofreading. Below are the APA’s final decisions about some of the most controversial new disorders as well as hotly debated changes to existing ones, including a few surprises not anticipated by close observers of the revision process…

Update: New material above

New York Times | New Old Age Blogs | Medical Issues

Time to Recognize Mild Cognitive Disorder?

Paula Span| January 25, 2013

Dr. Allen Frances, chairman of the task force that developed the previous Diagnostic and Statistical Manual of Mental Disorders, predicts inclusion of Mild Neurocognitive Disorder in the new version will lead to “wild overdiagnosis.”

The Diagnostic and Statistical Manual of Mental Disorders, published and periodically updated by the American Psychiatric Association, is one of those documents few laypeople ever read, but many of us are affected by…

Medscape Medical News Psychiatry

No Impact of DSM-5 Criteria on Alcohol Disorder Prevalence

Deborah Brauser | January 25, 2013

Although criteria used to assess serious alcohol problems will be revised in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), these changes will not likely affect the prevalence of these disorders, new research suggests…

Huffington Post Blogs | Allen Frances, MD

Why Will DSM-5 Cost $199 a Copy?

Allen Frances, MD | January 25, 2013

DSM-5 has just announced its price — an incredible $199 (and the paperback is also no bargain at a hefty $149). Compare this to $25 for a DSM III in 1980; $65 for a DSM IV in 1994; and $84 for a DSM-IV-TR in 2000. The price tag on a copy of DSM is escalating at more than twice the rate of inflation.

What’s going on?

Huffington Post Blogs | Allen Frances, MD

Terrible News: DSM-5 Refuses to Reduce Overdiagnosis of ‘Somatic Symptom Disorder’

Allen Frances, MD | January 18, 2013

Many of you will have read a previous blog prepared by Suzy Chapman and me that contained alarming information about the new DSM-5 diagnosis “somatic symptom disorder” (SSD).

DSM-5 defines SSD so over-inclusively that it will mislabel one in six people with cancer and heart disease, one in four with irritable bowel syndrom and fibromyalgia, and one in 14 who are not even medically ill.

I hoped to be able to influence the DSM-5 work group to correct this in two ways: 1) by suggesting improvements in the wording of the SSD criteria set that would reduce mislabeling, and 2) by letting them know how much opposition they would face from concerned professionals and an outraged public if DSM-5 failed to slam on the brakes while there was still time…

New York Times | New Old Age Blogs | Medical Issues

Grief Over New Depression Diagnosis

Paula Span | January 24, 2013, 6:40 am

The next edition of the Diagnostic and Statistical Manual of Mental Disorders will not only abandon the Roman numerals, but will also leave grief considerations out of diagnoses for depression.
When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue…

TIME | Alcohol

Revisions to Mental Health Manual May Turn Binge Drinkers into ‘Mild’ Alcoholics

Maia Szalavitz | January 23, 2013

Are you an alcoholic— or just a problem drinker? It may not matter, according to the latest version of the DSM, psychiatry’s diagnostic manual.

And now, in a new study of the different levels of alcohol misuse, scientists say the changes made to the DSM-5 may not even represent a significant improvement in the diagnosis of alcoholism. In fact, the revised definition collapses the medical distinction between problem drinking and alcoholism, potentially leading college binge drinkers to be mislabeled as possible lifelong alcoholics. The changes take effect in May, when the DSM-5 will be released…

EurekAlert! Press Release | January 22, 2013

Will Proposed DSM-5 Changes to Assessment of Alcohol Problems Do Any Better?

Proposed changes to the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will affect the criteria used to assess alcohol problems. One change would collapse the two diagnoses of alcohol abuse (AA) and alcohol dependence (AD) into a single diagnosis called alcohol use disorder (AUD). A second change would remove “legal problems,” and a third would add a criterion of “craving.” A study of the potential consequences of these changes has found they are unlikely to significantly change the prevalence of diagnoses…

Medpage Today

Psych Group Posts Glimpses of Final DSM-5

John Gever, Senior Editor, MedPage Today | January 21, 2013

Peeks into the final DSM-5, the controversial new edition of the American Psychiatric Association’s diagnostic manual, are now available from the group prior to the guide’s official May 22 debut…

British Psychological Society

Professor Peter Kinderman writes on DSM-5 for the BBC News website

January 18, 2013

People diagnosed with a mental illness need help and understanding, not labels and medication. That is the message of an article published on the BBC News Health pages today by Professor Peter Kinderman from the University of Liverpool, a former chair of our Division of Clinical Psychology…

[BBC News Health report below]

BBC News Health

‘Grief and anxiety are not mental illnesses’

Peter Kinderman, Professor of Clinical Psychology | January 18, 2013

The forthcoming edition of an American psychiatric manual will increase the number of people in the general population diagnosed with a mental illness – but what they need is help and understanding, not labels and medication.

Many people experience a profound and long-lasting grieving process following the death of a loved one. Many soldiers returning from conflict suffer from trauma. Many of us are shy and anxious in social situations or unmotivated and pessimistic if we’re unemployed or dislike our jobs…

Psychiatric Times

DSM-5 Field Trials: What Was Learned

James Phillips, MD | January, 8 2013

With DSM-5 now approved by the APA Board of Trustees—and, to the dismay of this reader, all discussion removed from the DSM-5 Web site—how are we to evaluate the results of the field trials for the end product? I suggest beginning with the short piece published in Psychiatric News, “What We Learned from DSM-5 Field Trials.”1 Authors David Kupfer and Helena Kraemer wrote, “We ultimately tested the criteria for 23 disorders. The question we asked was a straightforward one: In the hands of regular clinicians, assessing typically symptomatic patients in no different way than they would during everyday practice, was a particular disorder reliable?”

Filed under American Psychiatric Association (APA), Bereavement, Conflicts of interest, Criticism of DSM-V, DSM-5, Darrel Regier, David Kupfer, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media Tagged with , , , , , , , , ,

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