11th hour call: “Mislabeling Medical Illness As Mental Disorder” by Allen J. Frances, MD.

December 24, 2012 by

11th hour call: “Mislabeling Medical Illness As Mental Disorder” by Allen J. Frances, MD.

Post #217 Shortlink: http://wp.me/pKrrB-2AL

Image Copyright Dx Revision Watch 2012On December 8, Allen J. Frances, MD, blogged at Psychology Today on our shared concerns for the new DSM-5 category – Somatic Symptom Disorder. Dr Frances was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus, Duke.

One in six people suffering from cancer, heart and other serious diseases risks being saddled with a psychiatric diagnosis if they are considered to be “excessively” worried about their illness or spending more time on the internet researching their symptoms than the American Psychiatric Association (APA) thinks good for them.

But many illness groups – particularly the so-called “functional somatic syndromes” – stand to be captured by these new criteria and assigned an additional mental health diagnosis, or placed at risk of misdiagnosis.

The DSM-5 manual texts are still being finalized and the Somatic Symptom Disorder Work Group has been asked to reconsider its criteria and tighten them up before the next edition of DSM is sent to the publishers.

Please demonstrate to the APA and the Somatic Symptom Disorder Work Group the level of concern amongst clinicians and allied health professionals, patients, caregivers and advocacy organizations by visiting Dr Frances’ blog post and leaving a comment. You can read the commentary at the link, below.

If you share our concerns that these catch-all criteria will see thousands more patients tagged with a mental health label please forward the link to your colleagues and contacts and post on Twitter, blogs and social media platforms.

Thank you,

Suzy Chapman for Dx Revision Watch

Mislabeling Medical Illness As Mental Disorder: The Eleventh DSM-5 Mistake

Psychology Today, DSM5 in Distress, Allen Frances, MD, December 8, 2012

Additional commentary

Oak Park Behavioral Medicine, Mind Your Body blog

Moving in the Wrong Direction

Dr Tiffany Taft, Ph.D., Northwestern University, December 13, 2012

IBS Impact IBS Impact blog

Proposed DSM-5 Criteria May Unfairly Label Physical Conditions as Psychological Disorders

The most recent proposals for new category “J 00 Somatic Symptom Disorder”

Ed: Proposals, criteria and rationales, as posted for the third stakeholder review and comment period, in May 2012, were removed from the DSM-5 Development website on November 15, 2012 and placed behind a non public log in. Criteria as they had stood for the third draft can no longer be viewed but are set out on Slide 9 in this presentation, which note, does not include the three, optional Severity Specifiers that were included in the third iteration.

Note that the requirement for “at least two from the B type criteria” was reduced to “at least one from the B type criteria” between the second and third set of draft proposals.

IASP and the Classification of Pain in ICD-11  Prof. Dr. Winfried Rief, University of Marburg,

Slide 9

Related material

Somatic Symptom Disorder could capture millions more under mental health diagnosis

Submission to Somatic Symptom Disorder Work Group in response to third draft proposals

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 , , , , , , , , ,

Bloomberg: How Many Billions a Year Will the DSM-5 Cost? Allen Frances, MD

December 21, 2012 by

Bloomberg: How Many Billions a Year Will the DSM-5 Cost? Allen Frances, MD

Post #216 Shortlink: http://wp.me/pKrrB-2Av

Update: Additional recent articles on DSM-5 development:

Healio Psychiatric Annals > Practice Management > News

DSM-5: a ‘living document’ that may impact practice, patients health

December 21, 2012

Bloomberg

How Many Billions a Year Will the DSM-5 Cost?

Illustration by Pete Gamlen

Allen Frances, MD | December 20, 2012

Further responses to the commentary on DSM-5 Somatic Symptom Disorder by Allen Frances and Suzy Chapman published last week on Psychology Today, Huffington Post and Education Update:

IBS Impact blog

Proposed DSM-5 Criteria May Unfairly Label Physical Conditions as Psychological Disorders

“Recently in the IBS and chronic illness community, several professionals and self-advocates have begun expressing concern about proposed changes in the Diagnostic and Statistical Manual for Mental Disorders, commonly known as the DSM…The DSM is revised periodically and the 5th edition is expected to be released in 2013. While there are many controversial proposed changes, one that has received relatively little attention in the mainstream media is particularly alarming in its potential implications for people with chronic illnesses, especially ones that are still scientifically poorly understood, like irritable bowel syndrome or commonly overlapping conditions like fibromyalgia, chronic fatigue syndrome and interstitial cystitis among others…”

Mind Your Body

Moving in the Wrong Direction

Dr Tiffany Taft, Ph.D., Northwestern University | December 13, 2012

“…Rather than repeating what’s in store in DSM 5, this article provides an excellent summary of the proposed changes. It’s really worth taking the time to read, whether you have diabetes, irritable bowel syndrome, lupus, or fibromyalgia. The bottom line is, regardless of the etiology of your chronic illness you are a candidate for the Somatic Symptom Disorder (SDD) diagnosis. If you’re a parent caregiver, your reactions to your child’s illness may be deemed pathological as well…”

The Reporting on Health Member Blog

DSM 5 – Misdiagnosing or Mislabeling of Medical Diseases

Kate Benson | December 19, 2012

Related material

Somatic Symptom Disorder could capture millions more under mental health diagnosis

Submission to Somatic Symptom Disorder Work Group in response to third draft proposals

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 , , , , , , , , ,

One Last Chance For APA To Make DSM 5 Safer: Allen Frances, M.D.

December 17, 2012 by

One Last Chance For APA To Make DSM 5 Safer: Allen Frances, M.D.

Post #215 Shortlink: http://wp.me/pKrrB-2Ae

Psychology Today Blogs | DSM5 in Distress | Allen Frances, M.D.

One Last Chance For APA To Make DSM 5 Safer

Other wise there will likely be a buyer’s revolt.

Allen J. Frances, M.D. | December, 16 2012

Two weeks ago the Trustees of the American Psychiatric Association made the serious mistake of approving and rushing to press a DSM 5 that has many unsafe and untested suggestions.

The reaction has been unexpectedly heated: dozens of extremely negative news stories, many highly critical blogs, and a number of calls for a DSM 5 boycott in the US, England, France, Australia, Spain, and Italy…

Round up of recent DSM-5 media

The Daily Beast

The DSM’s Controversial Update

December 9, 2012

New Scientist

Magazine issue 2895.

Target faulty brain circuits to treat mental illness

Peter Aldhous | December 12, 2012

“Some critics argue that it’s time to rip up the manual and start again – with wider input. In the coming weeks, organisers of a petition to reform DSM-5 backed by 14,000 mental health professionals plan to launch an online forum to debate a new diagnostic system…”

Related material

Mislabeling Medical Illness As Mental Disorder  Allen J Frances MD, December 9, 2012

Somatic Symptom Disorder could capture millions more under mental health diagnosis 

Submission to Somatic Symptom Disorder Work Group in response to third draft proposals

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 , , , , , , , , ,

Mislabeling Medical Illness As Mental Disorder: The Eleventh DSM 5 Mistake: Allen Frances, MD

December 9, 2012 by

Mislabeling Medical Illness As Mental Disorder: The eleventh DSM 5 mistake needs an eleventh hour correction by Allen Frances, MD

Post #214 Shortlink: http://wp.me/pKrrB-2zk

Update: Responses to Psychology Today commentary

Huffington Post
Huff Po Science

Allen Frances, Professor Emeritus, Duke University; Chair, Task Force for DSM-IV

Mislabeling Medical Illness As Mental Disorder: The Eleventh DSM-5 Mistake

Allen Frances MD | December 12, 2012

http://www.madinamerica.com/

Featured Blogs

Boycott The DSM-5: Anachronistic Before Its Time

Jack Carney, DSW | December 10, 2012

When plans for the DSM-5 were first announced about ten years ago, most folks’ reaction was “Why?”. Many of us asked that same question several times as the publication date for the new tome kept on getting pushed back. Finally, the curtain enshrouding the DSM-5 Task Force and its several committees began to part and proposed revisions/additions began to appear on its website. To our dismay, we found our question answered…

Beyond Meds

DSM‘s Somatoform Disorders: millions more might be diagnosed (those with withdrawal syndrome are high risk for such misdiagnosis)

Monica Cassani | December 10, 2012

1 Boring Old Man

1 Boring Old Man | December 09, 2012

Danger! Danger!…

Today, Allen Frances, MD, who chaired the Task Force for DSM-IV, publishes his considerable concern for potential harm to all illness groups if DSM-5 Somatic Symptom Disorder (SSD) criteria go ahead in their current form.

Psychology Today blogs

DSM5 in Distress

The DSM’s impact on mental health practice and research

Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke.

http://www.psychologytoday.com/blog/dsm5-in-distress/201212/mislabeling-medical-illness-mental-disorder

Mislabeling Medical Illness As Mental Disorder

The eleventh DSM 5 mistake needs an eleventh hour correction.

Allen J Frances MD | December 9, 2012

Allen Frances said, “…Adding to the woes of the medically ill could be one of the biggest problems caused by DSM 5. It will do this in two ways: 1) by encouraging a quick jump to the erroneous conclusion that someone’s physical symptoms are ‘all in the head’; and 2) by mislabeling as mental disorders what are really just the normal emotional reactions that people understandably have in response to a medical illness…”

Suzy Chapman said, “…the requirement of ‘medically unexplained’ symptoms is replaced by much looser and more subjective ‘excessive thoughts, behaviors and feelings’ and the clinician’s perception of “dysfunctional illness belief’ or ‘excessive preoccupation’ with the bodily symptom.

“That, and a duration of at least six months, is all that is required to tick the box for a bolt-on diagnosis of a mental health disorder – Colorectal cancer + SSD; Angina + SSD; Type 2 diabetes + SSD; IBS + SSD…”

Read full commentary here on Psychology Today

All patient groups stand to be hurt by this new DSM-5 disorder

In the DSM-5 field trials, one in six patients with serious diseases like cancer, heart disease and diabetes met the criteria for an additional diagnosis of “Somatic Symptom Disorder”.  Over 25% of the “functional somatic” field trial study group (irritable bowel and chronic widespread pain patients) were coded with ‘SSD’.

The new SSD category (which would replace four categories under the DSM-IV Somatoform Disorders) de-emphazises “medically unexplained symptoms” as the defining feature of this disorder group.

Instead, focus shifts to the subjective perceptions of the patient’s “excessive thoughts, behaviors and feelings” about the seriousness of distressing and persistent bodily symptoms, which may or may not accompany diagnosed general medical conditions, and the extent to which “illness preoccupation” is perceived to have come to “dominate” or “subsume” the patient’s life.

Families with children with chronic medical illness will also be vulnerable, as the proposals, as they stood at the third draft, allow for assigning a diagnosis of “SSD” to parents perceived as being “over-involved” in their child’s illness and symptomatology or encouraging the maintenance of “sick role behavior.”

The elderly, with higher rates of cancer, heart disease and age-onset diabetes, will also be vulnerable – all three diseases are cited by the SSD Work Group as candidates for an additional diagnosis of a mental health disorder + a diagnosed illness – if the patient is considered to also meet the criteria for ‘SSD’.

The DSM-5 manual texts have not yet been finalized for the publishers: it’s not too late to put pressure on the Work Group to reconsider damaging proposals that are likely to increase rates of mental health diagnosis and add to the burden of ill health in diverse patient populations.

Please click through now to Dr Frances’ blog to demonstrate to the SSD Work Group and DSM-5 Task Force the high level of concern that continues for the implications of these SSD criteria.

And please circulate the link for Dr Frances’ opposition to these criteria on forums, Facebook, Twitter, blogs and websites and all health and patient advocacy platforms. 

The most recent proposals for new category “J 00 Somatic Symptom Disorder”

IASP and the Classification of Pain in ICD-11  Prof. Dr. Winfried Rief, University of Marburg,

Slide 9

Ed: Note that the requirement for “at least two from the B type criteria” was reduced to “at least one from the B type criteria” for the third iteration of draft proposals. This lowering of the threshold is presumably in order to accommodate the merging of the previously proposed “Simple Somatic Symptom Disorder” category into the “Complex Somatic Symptom Disorder” category, a conflation now proposed to be renamed to “Somatic Symptom Disorder,” also the disorder section name. A revised “Rationale/Validity” PDF document was not issued for the third and final draft. A brief, revised “Rationale” text was published on a Tab Page for the Somatic Symptom Disorder proposal and criteria but is no longer accessible.

Proposals, criteria and rationales, as posted for the third draft in May 2012, were removed from the DSM-5 Development website on November 15, 2012 and placed behind a non public log in. Criteria as they had stood for the third draft can no longer be viewed but are set out on Slide 9 in this presentation, which note, does not include three, optional Severity Specifiers that were included with the third draft criteria.

 

Related material

Somatic Symptom Disorder could capture millions more under mental health diagnosis

Submission to Somatic Symptom Disorder Work Group in response to third draft proposals

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 , , , , , , , , ,

APA finally posts DSM-5 Field Trials online and DSM-5 Round up

October 31, 2012 by

APA finally posts DSM-5 Field Trials online and DSM-5 Round up

Post #206 Shortlink: http://wp.me/pKrrB-2vu

Three papers discussing the results of the DSM-5 field trials were posted online yesterday by the American Journal of Psychiatry. The papers describe the methods and results of the 23 diagnoses assessed during the field trials.

APA failed to publish field trial results during the life of the third and final public review and comment period.

Access to the abstracts is free but you will need subscriber or institution access for the full PDFs or cough up $$ for the papers. ($35 per paper for 24 hours’ access. Why have these reports not been published on the DSM-5 Development website? Many classes of stakeholder will be disenfranchised.)

The article states that criteria were tested in October 2010 through February 2012 by 279 clinicians at 11 U.S. and Canadian academic centers. A second set of data from small group practices and private practices is expected to be reported early next year (that is, after the finalized draft has gone to the publishers).

Proposed criteria are still under review and won’t be finalized until approved by APA Board of Trustees.

DSM-5 draft proposals for criteria and categories as issued for the third and final stakeholder review can be read here on the DSM-5 Development website.

Note that the draft is now frozen and criteria sets and manual texts subject to embargo until publication of the DSM-5 manual. Any revisions made by the Task Force and Work Groups since the third iteration was released in May, this year, won’t be reflected on the DSM-5 Development website.

Published yesterday in the American Journal of Psychiatry and at Psychiatry Online:

Tuesday, October 30, 2012

Full text of article:

DSM-5 Field Trials Posted Online by AJP

http://alert.psychiatricnews.org/2012/10/dsm-5-field-trials-posted-online-by-ajp.html

+++
Article 1 | October 30, 2012

Abstract: http://psychiatryonline.org/article.aspx?articleid=1387935

DSM-5 Field Trials in the United States and Canada, Part I: Study Design, Sampling Strategy, Implementation, and Analytic Approaches

Diana E. Clarke, Ph.D., M.Sc.; William E. Narrow, M.D., M.P.H.; Darrel A. Regier, M.D., M.P.H.; S. Janet Kuramoto, Ph.D., M.H.S.; David J. Kupfer, M.D.; Emily A. Kuhl, Ph.D.; Lisa Greiner, M.S.S.A.; Helena C. Kraemer, Ph.D.

Am J Psychiatry 2012;:. 10.1176/appi.ajp.2012.12070998

PDF for those with subscriber access: http://ajp.psychiatryonline.org/data/Journals/AJP/0/appi.ajp.2012.12070998.pdf

+++
Article 2 | October 30, 2012

Abstract: http://psychiatryonline.org/article.aspx?articleid=1387906

DSM-5 Field Trials in the United States and Canada, Part II: Test-Retest Reliability of Selected Categorical Diagnoses

Darrel A. Regier, M.D., M.P.H.; William E. Narrow, M.D., M.P.H.; Diana E. Clarke, Ph.D., M.Sc.; Helena C. Kraemer, Ph.D.; S. Janet Kuramoto, Ph.D., M.H.S.; Emily A. Kuhl, Ph.D.; David J. Kupfer, M.D.

Am J Psychiatry 2012;:. 10.1176/appi.ajp.2012.12070999

PDF for those with subscriber access:
http://ajp.psychiatryonline.org/data/Journals/AJP/0/appi.ajp.2012.12070999.pdf

+++
Article 3 | October 30, 2012

Abstract: http://psychiatryonline.org/article.aspx?articleid=1387907

DSM-5 Field Trials in the United States and Canada, Part III: Development and Reliability Testing of a Cross-Cutting Symptom Assessment for DSM-5

William E. Narrow, M.D., M.P.H.; Diana E. Clarke, Ph.D., M.Sc.; S. Janet Kuramoto, Ph.D., M.H.S.; Helena C. Kraemer, Ph.D.; David J. Kupfer, M.D.; Lisa Greiner, M.S.S.A.; Darrel A. Regier, M.D., M.P.H.

Am J Psychiatry 2012;:. 10.1176/appi.ajp.2012.12071000

PDF for those with subscriber access:
http://ajp.psychiatryonline.org/data/Journals/AJP/0/appi.ajp.2012.12071000.pdf

Commentaries:

DSM5 in Distress
The DSM’s impact on mental health practice and research.

by Allen Frances, M.D.

DSM 5 Field Trials Discredits APA

You can’t turn a sow’s ear into a silk purse.

…According to the authors, 14 of the 23 disorders had “very good” or “good” reliability; 6 had questionable, but ‘acceptable’ levels; and just three had “unacceptable” rates. Sounds okay until you look at the actual data and discover that the cheerful words used by the DSM 5 leaders simply don’t fit their extremely disappointing results. The paper is a classic example of Orwellian ‘newspeak’…

Allen Frances, M.D. | August 30, 2012

Read full article here

Also on Huffington Post

+++

1 Boring Old Man

finally…

1 Boring Old Man | October 30, 2012

Well, they finally published the results of the DSM-5 Field Trials. Here are the links to the abstracts and the main table of kappa values to look over…

 

DSM-5 Round up

Public Lecture St Mary’s College of Maryland

http://www.smcm.edu/calendar/events/index.php?com=detail&eID=2317

DSM-V: Social, Political, and Ethical Implications

November 2

3:00 PM – 5:00 PM

Cole Cinema, Campus Center

This presentation will describe the DSM-V, scheduled for publication in May 2013, and the controversy surrounding its development. Dr. Ancis will provide an overview of the newly proposed classification system and diagnoses.

It is imperative that those involved in using the DSM-V, or potentially impacted by the DSM, be duly informed. Questions associated with the DSM-V revision process; the empirical bases of proposed changes; social, legal, and political implications; and ethical and cultural considerations will be addressed.

Dr. Ancis will describe her involvement in a number of initiatives related to DSM-V proposals, including those of the Association of Women in Psychology and Counselors for Social Justice. She will also review concerns of major mental health organizations worldwide, such as the American Psychological Association, the American Counseling Association, and the British Psychological Society, and related divisions.

Dr. Ancis is currently a Professor of Counseling and Psychological Services at Georgia State University. She earned her Bachelors, Masters, and Ph.D from the University at Albany, State University of New York. Her major areas of interest are multicultural competency training, diversity attitudes, race and gender issues, education and career development, and legal system experiences.

Event Contact Info

Janet Kosarych-Coy

Email: jmkosarychcoy@smcm.edu

Phone: 2408954283

Website: Click to Visit

Location: Cole Cinema, Campus Center

18952 E. Fisher Rd

St. Mary’s City, MD 20686

Categories:





Psychology Today

Side Effects

From quirky to serious, trends in psychology and psychiatry

The Tranquilizer Trap The scandal over benzodiazepines gets different emphasis in the UK and U.S.

Published on October 3, 2012 by Christopher Lane, Ph.D. in Side Effects

Anti-DSM Sentiment Rises in France Why French psychiatrists and psychoanalysts are opposed to the diagnostic manual  (French Stop DSM-5 Campaign)

Published on September 28, 2012 by Christopher Lane, Ph.D. in Side Effects

New York Times

Report Sees Less Impact in New Autism Definition

By BENEDICT CAREY | Published: October 2, 2012

Proposed changes to the official diagnosis of autism will not reduce the proportion of children found to have it as steeply as many have feared, scientists reported on Tuesday, in an analysis that contradicts several previous studies…

Medscape

Medscape Medical News > Psychiatry

Controversial New Diagnosis in DSM-5 May Be Faulty

Pam Harrison | October 17, 2012

Attenuated psychosis syndrome (APS), a new and controversial diagnosis for potential inclusion in the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is questionable, new research suggests…

DSM-5 and Employment Law

In September, Douglas Hass (Franczet Radelet) published an article Could the American Psychiatric Association Cause You Headaches? The Dangerous Interaction between the DSM-5 and Employment Law:

Abstract:

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2153268

Since its first publication in 1952, the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) has long served not only as the primary reference for mental health disorders for medical practitioners, but also as a primary authority for the legal community…

Full text in PDF format: Hass

Research Article

http://onlinelibrary.wiley.com/doi/10.1002/da.22012/abstract

Research Article

The Effect of Draft DSM-V Criteria on Posttraumatic Stress Disorder Prevalence

Patrick S. Calhoun Ph.D.1,2,3,*,
Jeffrey S. Hertzberg B.A.3,
Angela C. Kirby M.S.3,
Michelle F. Dennis B.A.2,
Lauren P. Hair M.S.3,
Eric A. Dedert Ph.D.1,2,3,
Jean C. Beckham Ph.D.1,2,3
Article first published online: 26 OCT 2012

DOI: 10.1002/da.22012

© 2012 Wiley Periodicals, Inc.

Journal of Psychosomatic Research

November 2012 Issue, Journal of Psychosomatic Research

http://www.jpsychores.com/current

Issue: Vol 73 | No. 5 | November 2012 | Pages 325-400

http://www.jpsychores.com/article/S0022-3999(12)00225-5/abstract

Predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder – Comparison with DSM-IV somatoform disorders and additional criteria for consideration

Katharina Voigt
Affiliations
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany

Corresponding author at: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Tel.: +49 40 7410 54408; fax: +49 40 7410 54975.

Eileen Wollburg
Affiliations
Schön Klinik Bad Bramstedt, Bad Bramstedt, Germany

Nina Weinmann
Affiliations
Schön Klinik Bad Bramstedt, Bad Bramstedt, Germany

Annabel Herzog
Affiliations
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany

Björn Meyer
Affiliations
GAIA AG, Hamburg, Germany

Gernot Langs
Affiliations
Schön Klinik Bad Bramstedt, Bad Bramstedt, Germany

Bernd Löwe
Affiliations
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany

Received 3 July 2012; received in revised form 29 August 2012; accepted 30 August 2012; published online 24 September 2012.

Abstract

Objective
Major changes to the diagnostic category of somatoform disorders are being proposed for DSM-5. The effect of e.g. the inclusion of psychological criteria (criterion B) on prevalence, predictive validity, and clinical utility of “Somatic Symptom Disorder” (SSD) remains unclear. A prospective study was conducted to compare current and new diagnostic approaches.

Methods
In a sample of N=456 psychosomatic inpatients (61% female, mean age=44.8±10.4years) diagnosed with somatoform, depressive and anxiety disorders, we investigated the current DSM-5 proposal (SSD) plus potential psychological criteria, somatic symptom severity, and health-related quality of life at admission and discharge.

Results
N=259 patients were diagnosed with DSM-IV somatoform disorder (56.8%). With a threshold of 6 on the Whiteley Index to assess psychological criteria, the diagnosis of SSD was similarly frequent (51.8%, N=230). However, SSD was a more frequent diagnosis when we employed the recommended threshold of one subcriterion of criterion B. Patients diagnosed with only SSD but not with DSM-IV somatoform disorder showed greater psychological impairment. Both diagnoses similarly predicted physical functioning at discharge. Bodily weakness and somatic and psychological attributions at admission were among significant predictors of physical functioning at discharge. Reduction of health anxiety, bodily weakness, and body scanning significantly predicted an improvement of physical functioning.

Conclusions
Psychological symptoms enhance predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder compared to DSM-IV somatoform disorders. The SSD diagnosis identifies more psychologically impaired patients than its DSM-IV precursor. The currently suggested diagnostic threshold for criterion B might increase the disorder’s prevalence.

Keywords: Somatoform disorder, Diagnosis, Diagnostic and Statistical Manual of Mental Disorders, Classification of diseases, Validation studies as topic

Ed: Note: Between publication of the second iteration of the DSM-5 draft proposals for public review and publication of the third set of draft proposals, the SSD “B type criteria” were reduced from the requirement to meet at least two from the “B type” criteria to at least one [1].

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

Somatic Symptom Disorder Criteria

Filed under Allen Frances, American Psychiatric Association (APA), Christopher Lane, Criticism of DSM-V, DSM-5, David Kupfer, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media Tagged with , , , , , , , , ,

Two resign from DSM-5 Personality Disorders Work Group over “seriously flawed” proposals

July 12, 2012 by

Two resign from DSM-5 Personality Disorders Work Group over “seriously flawed” proposals

Post #191 Shortlink: http://wp.me/pKrrB-2kN

Update at July 24, 2012: Additional reporting from Straight.com, Vancouver, on the resignations of two members of the DSM-5 Personality Disorders Work Group:

UBC prof emeritus John Livesley and Dutch expert quit DSM-V committee defining personality disorders

Charlie Smith | July 23, 2012

Update at July 16, 2012:

In the July issue of Clinical Psychology & Psychology there is an Editorial and two Commentaries around DSM-5 proposals for Personality and Personality Disorders.

Clinical Psychology & Psychotherapy

http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-0879/earlyview

Commentary

No abstract is available for this article.

Personality Disorder Proposal for DSM-5: A Heroic and Innovative but Nevertheless Fundamentally Flawed Attempt to Improve DSM-IV

Roel Verheul

Article first published online: 12 JUL 2012 | DOI: 10.1002/cpp.1809

Editorials

No abstract is available for this article.

DSM-5 Personality Disorders: Stop Before it is Too Late

Paul Emmelkamp and Mick Power

Article first published online: 3 JUL 2012 | DOI: 10.1002/cpp.1807

Commentary

No abstract is available for this article.

Disorder in the Proposed DSM-5 Classification of Personality Disorders

W. John Livesley

Article first published online: 3 JUL 2012 | DOI: 10.1002/cpp.1808

Roel Verheul, Ph.D. and W. John Livesley, M.D., Ph.D. resigned as members of the DSM-5 Personality and Personality Disorders Work Group in April.

Dr Roel Verheul is CEO of de Viersprong, Netherlands Institute for Personality Disorders.

Dr. John Livesley is Professor Emeritus at the University of British Columbia.

Allen Frances, M.D. who chaired the DSM-IV Task Force blogs at DSM 5 in Distress. Drs Verheul and Livesley have written to Dr Frances setting out their concerns for what they believe to be “seriously flawed proposals” and “a truly stunning disregard for evidence.”

DSM5 in Distress
The DSM’s impact on mental health practice and research.

by Allen Frances, M.D.

Two Who Resigned From DSM-5 Explain Why
They spell out the defects in the personality section

Allen Frances, M.D. | July 11, 2012

Roel Verheul and John Livesley both felt compelled to resign from the DSM-5 Personality Disorders Work Group. Here is an email from them describing what went wrong in the preparation of this section:

“…Regrettably, the Work Group has been unable to capitalize on the opportunity and has advanced a proposal that is seriously flawed. It has also demonstrated an inability to respond to constructive feedback both from within the Work Group and from the many experts in the field who have communicated their concerns directly and indirectly. We also regret the need to resign because we were the only International members of the Work Group which is now without representation from outside the US…”

“…Early on in the DSM-5 process, we developed major concerns about the Work Group’s mode of working and its emerging recommendations that we communicated to the Work Group and Task Force… We considered the current proposal to be fundamentally flawed and decided that it would be wrong of us to appear to collude with it any longer…As we see it, there are two major problems with the proposal…”

Read full article here

Proposals for the DSM-5 Personality Disorders as issued for the third and final stakeholder review can be read here on the DSM-5 Development site.

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 Tagged with , , , , , , , , , , ,

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