dx revision watch

Erasing the interface between psychiatry and medicine (DSM-5)

February 13, 2011 by meagenda

Erasing the interface between psychiatry and medicine (DSM-5)

Post #61 Shortlink: http://wp.me/pKrrB-Vn

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.

While a stream of often acerbic commentaries from two former DSM Task Force chairs, Allen Frances and Robert Spitzer, have focused on the implications for introducing new additions into the DSM and broadening the definitions of existing diagnostic criteria, the DSM-5 “Somatic Symptom Disorders” Work Group (Chair, Joel E Dimsdale) has been quietly redefining DSM’s “Somatoform Disorders” categories with proposals that if approved, would legitimise the application of an additional diagnosis of “Somatic Symptom Disorder” to all medical diseases and disorders.

Radical proposals for renaming the “Somatoform Disorders” category “Somatic Symptom Disorders” and combining a number of existing categories under a new rubric, “Complex Somatic Symptom Disorder (CSSD)”, and a more recently proposed “Simple Somatic Symptom Disorder (SSSD)”, have the potential for bringing millions more patients under a mental health banner and expanding markets for psychiatric services, antidepressants, antipsychotics and behavioural therapies such as Cognitive Behavioural Therapy (CBT) for the “modification of dysfunctional and maladaptive beliefs about symptoms and disease, and behavioral techniques to alter illness and sick role behaviors” for all patients with somatic symptoms, irrespective of cause.

In a June ’09 Editorial, titled “The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report”, which expanded on a brief DSM-5 Work Group progress report published on the DSM-5 Development website that April, Joel E Dimsdale and fellow DSM-5 Work Group member, Francis Creed, reported that by doing away with the “controversial concept of medically unexplained symptoms”, 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.”

If the most recent “Somatic Symptom Disorders” Work Group proposals 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 may be especially vulnerable to highly subjective 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 criteria for the treatments offered to US patients, the provision of social care packages and the payment of medical and disability insurance.

Criteria are set out very briefly in the PowerPoint slides, but the full criteria and key documents need to be scrutinized. The most recent proposals of the DSM-5 “Somatic Symptoms Disorders” Work Group plus two key Disorder Description and Rationale PDF documents can be read on the APA’s DSM-5 Development site here:

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

Two key Somatic Symptoms Disorders Work Group Draft Proposal documents:

Revised Justification of Criteria Version 1/31/11

Revised Disorder Descriptions: Version 1/14/11

The next public review of draft criteria and disorder descriptions has been postponed to August – September, this year, for a period of approximately one month for public review and feedback.

[1] Psychiatric Times Special Report, PSYCHIATRY AND MEDICAL ILLNESS Unexplained Physical Symptoms What’s a Psychiatrist to Do? Humberto Marin, MD and Javier I. Escobar, MD, 01 August 2008

[Draft criteria superceded by third draft published on May 2, 2012]

Images copyright ME agenda 2011 No unauthorized reproduction.

The next public review of draft criteria and disorder descriptions is scheduled for May/June 2011.

Shortlink for this Post: http://wp.me/pKrrB-Vn

Filed under Allen Frances, 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, MUS, Somatoform Disorders

CFS orphaned in the “R” codes in ICD-10-CM

February 13, 2011 by meagenda

CFS orphaned in the “R” codes in US specific ICD-10-CM

Post #60 Shortlink: http://wp.me/pKrrB-V4

Current proposals for ICD-10-CM place CFS in Chapter 18, under R53 Malaise and fatigue at R53.82 Chronic fatigue syndrome NOS (Not otherwise specified).

According to a Note to a Recommendation on the CSFSAC webpages:

*DFO Note: The ICD 10-CM is scheduled for implementation on October 1, 2013. In that classification, two mutually exclusive codes exist for chronic fatigue [sic]:

post-viral fatigue syndrome (in the nervous system chapter), and
chronic fatigue syndrome, unspecified (in the signs and symptoms chapter).

HHS has no plans at this time to change this classification in the ICD 10-CM.

Images Copyright 2011 ME agenda No unauthorized reproduction

The revision of ICD-10, ICD-11, is scheduled for implementation in 2015.

Once ICD-10-CM has been adopted, the US does not envisage moving on to ICD-11 (or a “Clinical Modification” adaptation of ICD-11) for many years.

Partial Code Freeze

Although ICD-10-CM is not scheduled for implementation until October 2013, it had been proposed that at some point prior that date codes might be “frozen”.

At the ICD-9-CM Coordination & Maintenance Committee Meeting on Sept. 15, 2010, it was announced that the committee had finalized the decision to implement a partial freeze for both ICD-9-CM codes and ICD-10-CM and ICD-10-PCS codes prior to implementation of ICD-10 on Oct. 1, 2013.

Partial Code Freeze Announcement

As of October 1, 2011, only limited updates will be instituted into the code sets so that providers, payers, clearinghouses, and health IT vendors will not have to simultaneously keep pace with code updates while also reconfiguring their existing systems for ICD-10-CM/PCS.

So the clock is ticking for CFS and US advocates and patients need to be aware of how little time may be left.

References:

[1] International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Note: The 2011 release of ICD-10-CM is now available. It replaces the December 2010 release:
http://www.cdc.gov/nchs/icd/icd10cm.htm

[2] US “Clinical Modification” ICD-10-CM
This article clarifies any confusion between ICD-10, ICD-11 and the forthcoming US Clinical Modification, ICD-10-CM: http://wp.me/pKrrB-Ka

[3] Chronic Fatigue Syndrome Advisory Committee (CFSAC). The Chronic Fatigue Syndrome Advisory Committee (CFSAC) provides advice and recommendations to the Secretary of Health and Human Services via the Assistant Secretary for Health of the U.S. Minutes of meetings, Recommendations and meeting videocasts:
http://www.hhs.gov/advcomcfs/meetings/index.html

Filed under ICD revision process, ICD-10, ICD-10-CM, ICD-11, ICD-11 Alpha Draft, ICD-11 Beta Draft, ICD-11 consultation, ICD-11 revision docs, WHO (World Health Organization), WHO Collaborating Centre

The clock is ticking for CFS: Partial Code Freeze for ICD-9-CM and ICD-10-CM/PCS Finalized

February 6, 2011 by meagenda

The clock is ticking for CFS: Partial Code Freeze for ICD-9-CM and ICD-10-CM/PCS Finalized (US)

Post #59 Shortlink: http://wp.me/pKrrB-Un

The clock is ticking…

The US was authorized by the WHO to develop its own country specific adaptation of the WHO’s now retired ICD-9, called ICD-9-CM, and has been slow to move on to a “Clinical Modification” of ICD-10.

Rather than skip ICD-10 and move straight onto ICD-11 in 2015, the National Center for Health Statistics (NCHS) has been developing a “clinical modification” of ICD-10 called ICD-10-CM. This development process has been in progress for a number of years.

So ICD-10-CM is US specific and it’s scheduled for implementation in October 2013 [1].

The US does not envisage moving on to ICD-11 (or an adaptation of ICD-11) for many years. So although the majority of countries will be implementing ICD-11 in 2015+, the US will sail on with ICD-10-CM.

Several other countries use a modification of ICD-10. Canada is authorized to use its adaptation of ICD-10, ICD-10-CA. According to one source, Canada may not adopt ICD-11 (or an adaptation of ICD-11) until beyond 2018.

ICD-10-CM

The US clinical modification is proposing to retain CFS in the R codes and to classify it at R53.82 in Chapter 18, rather than code CFS in Chapter 6: Diseases of the nervous system, along with ME and PVFS, at G93.3.

“Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.” [2]

For ICD-10-CM, then, PVFS and (B)ME are proposed to be coded thus, in Chapter 6:

Diseases of the nervous system (G00-G99)

Excludes2:

[…]
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

G93 Other disorders of brain

[…]

G93.3 Postviral fatigue syndrome

Benign myalgic encephalomyelitis
Excludes1: chronic fatigue syndrome NOS (R53.82)

which would bring the classification of PVFS and ME for the US in line with existing ICD-10 codes. (Though note that in ICD-10, Chronic fatigue syndrome is indexed to G93.3 in Volume 3: The Alphabetical Index and does not appear in Volume 1: The Tabular list under the G93 parent category.)

Whereas for ICD-10-CM, CFS is proposed to be coded thus, in Chapter 18:

R53: Malaise and fatigue

[…]

R53.82 Chronic fatigue, unspecified

Chronic fatigue syndrome NOS
Excludes1: postviral fatigue syndrome (G93.3)

Retaining CFS in the R codes and coding CFS in Chapter 18 under R53.82 (which specifically excludes G93.3) means that in ICD-10-CM, the coding of the terms CFS, PVFS and ME will be out of step with four classification systems:

1 The International ICD-10, which is used in the majority of countries.

2 The Canadian Clinical Modification ICD-10-CA.

3 The German Clinical Modification ICD-10-GM.

4 The proposals for Chapter 6 of ICD-11 as they stood in the iCAT ICD Revision Platform at November 2010, where CFS is proposed to be classified in Chapter 6: Diseases of the nervous system, with (B)ME specified as an Inclusion to CFS.

(I am informed that “PVFS” is a term little used by the US medical profession.)

Schism

This issue is proving divisive because some US patients would prefer to see CFS split from ME in ICD-10-CM.

But retaining CFS in the R codes and placing it under the R53: Malaise and fatigue parent category may have considerable implications for patients who already have a diagnosis of CFS or who may receive a diagnosis of CFS in the future – for the treatments that are provided, the care packages received and for medical and disability insurance.

So I consider it will hurt patients to have CFS coded under the R chapter, rather than in Chapter 6: Diseases of the nervous system and that coding CFS under “ill-defined conditions” will render CFS and ME patients more vulnerable to the current proposals for the revision of the “Somatoform Disorders” section for DSM-5 [4].

If I were a patient who already had a diagnosis of CFS or might be given diagnosis of CFS in the future, I would feel safer if CFS were coded at G93.3, until the science has got it sorted. For there are no guarantees that US medics will diagnose ME and use the new ME code for billing purposes.

But this is not a new issue.

US patients organizations, advocates and patients have known about these proposals for several years. The issue has been discussed at meetings of the Chronic Fatigue Syndrome Advisory Committee (CFSAC).

CFSAC provides advice and recommendations to the Secretary of Health and Human Services via the Assistant Secretary for Health of the U.S. Department of Health and Human Services on issues related to chronic fatigue syndrome (CFS). Copies of meeting agendas, minutes, recommendations, some presentations and since 2009, videocasts of entire meeting proceedings, can be accessed from the CFSAC pages. Minutes of meetings go back to September 2003 [3].

The codings issue had been discussed by CFSAC in June 2004 and again in September 2005, when a presentation had been given by the CDC’s Donna Pickett. In 2005, the committee had recommend that CFS be classified under G93.3.

“Recommendation 10: We would encourage the classification of CFS as a ‘Nervous System Disease,’ as worded in the ICD-10 G93.3.” CFSAC Committee Recommendations August 2005

The issue was discussed more recently, at the May 2010 CFSAC meeting. During the last ten minutes of that meeting, Dr Lenny Jason discussed his concerns with the committee that the placement of CFS in ICD-10-CM under the Chapter 18 “R” codes could be problematic.

CFSAC 10.05.10 Agenda

CFSAC 10.05.10 Minutes

Videocast of CFSAC meeting

The Recommendations for that meeting in relation to the coding of CFS in ICD-10-CM had been:

“CFSAC rejects proposals to classify CFS as a psychiatric condition in U.S. disease classification systems. CFS is a multi-system disease and should be retained in its current classification structure, which is within the “Signs and Symptoms” chapter of the International Classification of Diseases 9-Clinical Modification (ICD 9-CM).*

“*DFO Note: The ICD 10-CM is scheduled for implementation on October 1, 2013. In that classification, two mutually exclusive codes exist for chronic fatigue [sic]:

“post-viral fatigue syndrome (in the nervous system chapter), and
chronic fatigue syndrome, unspecified (in the signs and symptoms chapter).

“HHS has no plans at this time to change this classification in the ICD 10-CM.”

Incidently, amongst the Recommendations of the CFSAC committee for the October 2010 meeting was:

3. Adopt the term “ME/CFS” across HHS programs.

I hope further discussion of ICD-10-CM codings can be pushed back up the agenda for the next CFSAC meeting because a number of issues were left hanging.

Code “freezing”

Although ICD-10-CM is not scheduled for implementation until October 2013, it had been proposed that at some point prior that date codes might be “frozen”.

So the clock is ticking and US advocates and patients need to be aware of how little time may be left.

A few days ago, I contacted Donna Pickett, Medical Systems Administrator, Classifications and Public Health Data Standards, National Center for Health Statistics, Centers for Disease Control and Prevention (CDC) to enquire whether the proposed date by which ICD-10-CM codings might be “frozen” had been finalized.

Ms Pickett has provided information regarding the freezing of the ICD-9-CM and ICD-10-CM code sets.

She also confirmed that Clinical criteria and diagnostic guidelines will not be included in ICD-10-CM.

(As I have reported before, for ICD-11, diseases and disorders will be defined through multiple parameters according to a common “Content Model” so there will be definitions, clinical descriptions etc and the potential for considerably more textual content than in ICD-10. See: http://wp.me/pKrrB-KK for screenshots.)

The notice below is also available in PDF format here

There is an associated meeting Agenda Handout which also includes this information and dates of ICD-9-CM and ICD-10-CM meetings: Agenda. ICD-9-CM Coordination and Maintenance Committee. DHSS

Partial Code Freeze for ICD-9-CM and ICD-10 Finalized

The ICD-9-CM Coordination and Maintenance Committee will implement a partial freeze of the ICD-9-CM and ICD-10 (ICD-10-CM and ICD-10-PCS) codes prior to the implementation of ICD-10 on October 1, 2013. There was considerable support for this partial freeze. The partial freeze will be implemented as follows:

• The last regular, annual updates to both ICD-9-CM and ICD-10 code sets will be made on October 1, 2011.

•On October 1, 2012, there will be only limited code updates to both the ICD-9-CM and ICD-10 code sets to capture new technologies and diseases as required by section 503(a) of Pub. L. 108-173.

• On October 1, 2013, there will be only limited code updates to ICD-10 code sets to capture new technologies and diagnoses as required by section 503(a) of Pub. L. 108-173. There will be no updates to ICD-9-CM, as it will no longer be used for reporting.

• On October 1, 2014, regular updates to ICD-10 will begin.

The ICD-9-CM Coordination and Maintenance Committee will continue to meet twice a year during the partial freeze. At these meetings, the public will be asked to comment on whether or not requests for new diagnosis or procedure codes should be created based on the criteria of the need to capture a new technology or disease. Any code requests that do not meet the criteria will be evaluated for implementation within ICD-10 on and after October 1, 2014 once the partial freeze has ended.

Codes discussed at the September 15 – 16, 2010 and March 9 – 10, 2011 ICD-9-CM Coordination and Maintenance Committee meeting will be considered for implementation on October 1, 2011, the last regular updates for ICD-9-CM and ICD-10. Code requests discussed at the September 14 – 15, 2011 and additional meetings during the freeze will be evaluated for either the limited updates to capture new technologies and diseases during the freeze period or for implementation to ICD-10 on October 1, 2014. The public will be actively involved in discussing the merits of any such requests during the period of the partial freeze.

References:

(For history of ICD in the US to 2001, see archive CDC document: A Summary of Chronic Fatigue Syndrome and Its Classification in the International Classification of Diseases. The March 2001 proposals are since superceded as per 2009, 2010 and 2011 proposals.)

[2] US “Clinical Modification” ICD-10-CM
This article clarifies any confusion between ICD-10, ICD-11 and the forthcoming US Clinical Modification, ICD-10-CM: http://wp.me/pKrrB-Ka

[4] The most recent proposals of the DSM-5 “Somatic Symptoms Disorders” Work Group plus two key Disorder Description and Rationale PDF documents can be read on the APA’s DSM-5 Development site:
http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx

or here on Dx Revision Watch site: http://wp.me/pKrrB-St

Filed under Clinical Modification, DSM-5, DSM-5 draft proposals, iCAT, ICD-10, ICD-10-CM, ICD-11, WHO (World Health Organization)

Washington Examiner: Corrupting Psychiatry by Max Borders

January 23, 2011 by meagenda

Washington Examiner: Corrupting Psychiatry by Max Borders

Post #58 Shortlink: http://wp.me/pKrrB-TU

Interesting commentary from writer Max Borders, last week, on the website of the Washington Examiner around the revision of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM):

Washington Examiner

Corrupting Psychiatry

By Max Borders 01/18/11 10:22 AM

“The American Psychiatric Association (APA) has gone crazy — like a fox.

“There was a time when we could be more charitable about the vagaries in the APA’s Bible, the DSM. But not anymore. If you’ve never heard of the DSM, it’s the Diagnostic and Statistical Manual series the APA publishes. Psychiatrists all over the world use the DSM as a guidebook for treating people with some form of mental illness. But the APA may test credulity with its upcoming edition.

“I refer specifically to proposed changes in the DSM-V due out in 2013. It’s no accident these changes reflect new political realities about how psychiatric medicine gets paid for and by whom…”

Read rest of article at the Washington Examiner

Commentary in response to “Corrupting Psychiatry” from Dutch philosopher and psychologist, Maarten Maartensz, on Nederlog here More on the APA’s mockery of medicine and morality and here More on the APA and the DSM-5

Comments on Washington Examiner to article “Corrupting Psychiatry” by Max Borders

By: Skeeter
Jan 21, 2011 9:55 PM

Good article, that says things that need to be said, long and loud.

Both the APA, and the broader psychiatric profession, are currently indulging in a seriously unjustified power grab, and they and their claims are in desperate need of much closer and tougher (and ongoing) external scrutiny then they have been subject to date.

Generally speaking, I would have to agree that the profession is becoming much too closely aligned with and mutually reliant on both state and corporate interests, as opposed to the interests of the patient and the science on which they base their claims to authority.

One small point: I would not invoke British psychiatry as any counterbalance to the excesses of their American colleagues. The Brits have their own serious problems. Not least of which is that they are mired deep in the methodological and ethical swamp of somatoform disorders (aka conversion or psychosomatic disorders, and their related ‘treatments’), and a lot of patients are paying a very heavy price indeed for this obsession by certain influential members of the British psych establishment.

By: Suzy Chapman
Jan 22, 2011 7:28 AM

Erasing the interface between psychiatry and medicine

The previous commenter cautions against invoking members of the “British psych establishment”. Two very influential members of the British psychiatry and psychosomatics establishment, Professors Michael Sharpe and Francis Creed, have seats on the DSM-5 “Somatic Symptom Disorders” Work Group.

While many column inches by rightly perturbed journalists and a stream of often acerbic critiques from former DSM Task Force chairs, Allen Frances and Robert Spitzer, have focussed on the implications for introducing new additions into the DSM and broadening the definitions of existing diagnostic criteria, the DSM-5 “Somatic Symptom Disorders” Work Group (Chair, Joel E Dimsdale) has been quietly redefining DSM’s “Somatoform Disorders” categories with proposals that if approved would legitimise the application of an additional diagnosis of “Somatic Symptom Disorder” to all medical diseases and disorders.

Radical proposals for renaming the “Somatoform Disorders” category “Somatic Symptom Disorders” and combining a number of existing categories under a new umbrella, “Complex Somatic Symptom Disorder (CSSD)” and a more recently suggested “Simple Somatic Symptom Disorder (SSSD)”, have the potential for bringing millions more patients under a mental health banner and expanding markets for psychiatric services, antidepressants, antipsychotics and behavioural therapies such as Cognitive Behavioural Therapy (CBT) for all patients with somatic symptoms, irrespective of cause.

Professor Creed is co-editor of The Journal of Psychosomatic Research. In a June ’09 Editorial, titled “The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report”, which expanded on a brief DSM-5 Work Group progress report published on the DSM-5 Development website that April, Joel E Dimsdale and fellow DSM-5 Work Group member, Francis Creed, reported that by doing away with the “controversial concept of medically unexplained symptoms”, 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.”

If the most recent “Somatic Symptom Disorders” Work Group proposals gain DSM Task Force approval, all medical conditions, 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”.

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.

By: KAL
Jan 23, 2011 1:36 PM

Who else might benefit? Disability Insurance. If you can be shown to have a “mental illness” then disability insurance only pays a maximum of two years of payments vs. a lifetime of payments for an organic disease.

Check the APA website for conflicts of interest for members of the working group for Somatic Disorders.

References:

DSM-5 Development website: Somatoform Disorders
http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx

Proposal: Complex Somatic Symptom Disorder
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=368

Proposal: Simple Somatic Symptom Disorder
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=491

The most recent versions of the two key documents associated with the proposals of the “Somatic Symptom Disorders” Work Group are:

Update @ 7 February 2011

The Justification of Criteria document was revised again by the SSD Work Group on 1/31/11 to incorporate the new proposal for SSSD and other revisions and is replaced by:

DRAFT 1/31/11 Justification of Criteria – Somatic Symptoms

Revised Disorder Descriptions: Version 1/14/11

Previous revised Justification of Criteria: Version 10/4/10

DSM-5: New category proposal “Simple Somatic Symptom Disorder”

January 23, 2011 by meagenda

DSM-5: New category proposal “Simple Somatic Symptom Disorder”

Post #57 Shortlink: http://wp.me/pKrrB-TA

On 16 January, I reported that the page for current DSM-5 proposals for the revision of the DSM-IV “Somatoform Disorders” categories and diagnostic criteria had been updated on 14 January, with a new category proposal called “Simple Somatic Symptom Disorder”.

This proposal is in addition to the recommendations of the Somatic Symptom Disorders Work Group, published in February 2010, for grouping a number of existing Somatoform categories under a common rubric “Complex Somatic Symptom Disorder (CSSD)” and does not replace “CSSD”.

For full details see previous Post #56: http://wp.me/pKrrB-St

Simple Somatic Symptom Disorder

Updated January-14-2011

See Tab: Proposed Revision:

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=491

Simple (or abridged) Somatic Symptom Disorder (e.g. pain)

To meet criteria for Simple Somatic Symptom Disorder, criteria A, B, and C are necessary.

A. One or more highly distressign [sic] and disabling somatic symptoms

B. One of the following symptoms from CSSD (i.e. Disproportionate and persistent concerns about the medical seriousness of one’s symptoms; high level of health-related anxiety; or excessive time and energy devoted to these symptoms or health concerns)

C. Symptom duration is greater than 1 month

For full proposals for “Simple Somatic Symptom Disorder” open the Tabs on this page:

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=491

Key links and documents associated with the proposals of the Somatic Symptom Disorders Work Group:

DSM-5 Development website: Somatoform Disorders
http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx

Proposal: Complex Somatic Symptom Disorder
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=368

Proposal: Simple Somatic Symptom Disorder
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=491

Update @ 7 February 2011

The Justification of Criteria document was revised again by the SSD Work Group on 1/31/11 to incorporate the proposal for SSSD and other revisions and is replaced by:

DRAFT 1/31/11 Justification of Criteria – Somatic Symptoms

Revised Disorder Descriptions: Version 1/14/11

Previous revised Justification of Criteria: Version 10/4/10

I shall be monitoring the DSM-5 Development website and if there are any further revisions to either document before the DSM-5 beta is published I will update this site.

According to the APA’s DSM-5 Development Timeline, the second draft is scheduled to be published by the DSM-5 Task Force in May-June, with a public review period of only around a month. The public review and comment period for the first draft, last year, had been around ten weeks.

The following patient organisations have been alerted to these revisions and sent copies of the key documents:

UK patient organisations:

Heather Walker, Action for M.E.
Neil Riley, Chair, Board of Trustees, ME Association
25% ME Group
Invest in ME
Jane Colby, The Young ME Sufferers Trust

US patient organisations and professionals:

Dr Alan Gurwitt, Massachusetts Chronic Fatigue and Immune Dysfunction Syndrome/Myalgic Encephalopathy and Fibromyalgia Association (Mass. CFIDS/ME & FM)
Dr Kenneth Friedman, IACFS/ME
Jennie Spotila, CFIDS Association of America
Dr Lenny Jason

International patient organisations and professionals:

ESME (European Society for ME)
Dr Eleanor Stein, Canada

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

Revisions to DSM-5 proposals on 14.01.11: New category proposed “Simple Somatic Symptom Disorder”

January 16, 2011 by meagenda

Revisions to DSM-5 proposals on 14.01.11: New category proposed “Simple Somatic Symptom Disorder”

Post #56 Shortlink: http://wp.me/pKrrB-St

DSM-5 Dustbin Diagnosis

For copies of International patient organisation and patient advocate submissions in the APA’s spring 2010 DSM-5 draft proposals review process see: http://wp.me/PKrrB-AQ

The page for current DSM-5 proposals for the “Somatoform Disorders” section of DSM-IV was updated on January 14, 2011 with a new category proposal called “Simple Somatic Symptom Disorder”.

Note this proposal is in addition to the recommendation of the Somatic Symptom Disorders Work Group, in February 2010, for grouping a number of existing disorders under a common rubric “Complex Somatic Symptom Disorder (CSSD)” and it does not replace “CSSD”.

As I have been highlighting for some time now, under these DSM-5 Task Force proposals, all medical conditions, whether “established” general medical conditions or disorders, or conditions presenting with “somatic symptoms of unclear etiology”, have the potential for qualifying for an additional diagnosis of a “somatic symptom disorder”.

There have also been revisions and additions to some of the text of the “Disorder descriptions” document dated “DRAFT January 29, 2010” that was first published by the DSM-5 Task Force when draft proposals for revisions to DSM-IV were posted on the APA’s DSM-5 website on February 10, 2010, for public review and comment.

Note also that the key document: “Justification of Criteria-Somatic Symptoms DRAFT 1/29/10” which is also associated with the proposals of the Somatic Symptom Disorders Work Group has now been revised twice since February 2010.

Update @ 7 February 2011

The Justification of Criteria document was revised for a second time by the SSD Work Group on 1/31/11 to incorporate the new proposal for SSSD and other revisions and is replaced by:

DRAFT 1/31/11 Justification of Criteria – Somatic Symptoms

Previous revised Justification of Criteria: Version 10/4/10

What are the changes since draft proposals were released in February 2010?

On the APA’s DSM-5 Development web page:

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

under “Somatoform Disorders Not Currently Listed in DSM-IV”

are now listed two proposals:

“Complex Somatic Symptom Disorder”

(which was discussed last year when the DSM-5 draft proposals were first released) and a new proposal:

“Simple Somatic Symptom Disorder”

See:

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

Somatoform Disorders

Submissions 2010

International patient organisation and patient advocate submissions to DSM-5 draft proposals public review process, Feb-April 2010: 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, Functional Somatic Syndrome (FSS), Javier Escobar, MUS, Somatic Symptom Disorder, Somatoform Disorders

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Images copyright ME agenda 2011 No unauthorized reproduction.