The medicalisation of childhood: Time for a paradigm shift: BPS House of Commons event

Post #250 Shortlink: http://wp.me/pKrrB-31Q

British Psychological Society (BPS) Division of Educational & Child Psychology Debate

The medicalization of childhood: Time for a paradigm shift

11 June 2013 2–5pm | Committee Room 12 | House of Commons | John McDonnell, MP

Expert Panel: Prof Allen Frances, Prof Peter Tyrer, Prof Simon Wessely, Prof Peter Kinderman, Vivian Hill

Click link for PDF document   Division of Educational & Child Psychology Flyer
BPSHoC

Three BMJ letters published in response to Somatic Symptom Disorder commentary

Three letters are published this week in response to Allen Frances’ BMJ commentary on ‘Somatic Symptom Disorder’

Post #237 Shortlink: http://wp.me/pKrrB-2No

On March 19, BMJ published a commentary by Allen Frances, MD, with contribution from Suzy Chapman, in both the print and online editions, strongly opposing the inclusion of ‘Somatic Symptom Disorder’ in the forthcoming DSM-5:

PERSONAL VIEW
The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill
This new condition suggested in the bible of mental health diagnoses lacks specificity, says Allen Frances

The opinion piece was also featured as US Editor’s Choice:

DSM-5 and the rough ride from approval to publication
Edward Davies, US news and features editor, BMJ

BMJ press released the commentary which was picked up by a number of international media sites including UK Times and Deborah Brauser for Medscape Medical News. To date, 31 Rapid Responses have been received.

Three letters (all US respondents) are printed in this week’s BMJ print edition (20 April 2013 Vol 346, Issue 7904). The letters are behind a paywall so I am giving links to the original BMJ Rapid Responses, with the caveat that responses may have been edited for the print edition:

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LETTERS
New somatic symptom disorder in DSM-5

Helping to find the most accurate diagnosis

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2228 (Published 16 April 2013) BMJ 2013;346:f2228
Joel E Dimsdale, professor of psychiatry emeritus, Michael Sharpe, professor of psychiatry, Francis Creed, professor of psychiatry, DSM-5 Somatic Symptom Disorders work group  BMJ Rapid Response 20 March 2013

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Guilty of diagnostic expansion

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2254 (Published 16 April 2013) BMJ 2013;346:f2254
James Phillips, psychiatrist, USA  BMJ Rapid Response 25 March 2013

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A step in the wrong direction

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2233 (Published 16 April 2013) BMJ 2013;346:f2233
Steven A King, chair, DSM-IV and DSM-IV-TR pain disorders committees; Pain Management and Psychiatry, New York  BMJ Rapid Response 28 March 2013

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Further reading:

Somatic Symptom Disorder could capture millions more under mental health diagnosis Suzy Chapman, May 26, 2012
Mislabeling Medical Illness As Mental Disorder Allen Frances, MD, Psychology Today, DSM 5 in Distress, December 8, 2012
Why Did DSM 5 Botch Somatic Symptom Disorder? Allen Frances, MD, Psychology Today, Saving Normal, February 6, 2013
New Psych Disorder Could Mislabel Sick as Mentally Ill Susan Donaldson James, ABC News, February 27, 2013
Dimsdale JE. Medically unexplained symptoms: a treacherous foundation for somatoform disorders? Psychiatr Clin North Am 2011;34:511-3. [PMID: 21889675]

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American Psychiatric Association justifications for SSD:

APA Somatic Symptom Disorder Fact Sheet 
Somatic Chapter Drops Centrality Of Unexplained Medical Symptoms Psychiatric News, Mark Moran, March 1, 2013
Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care David J Kupfer, MD, Chair, DSM-5 Task Force, defends the SSD construct, Huffington Post, February 8, 2013

‘Somatic Symptom Disorders in DSM-5: A step forward or a fall back?’ Eleanor Stein MD FRCP(C)

‘Somatic Symptom Disorders in DSM-5: A step forward or a fall back?’ Eleanor Stein MD FRCP(C) slide presentation

Post #233 Shortlink: http://wp.me/pKrrB-2Jt

Eleanor Stein MD FRCP(C) is a psychiatrist in private practice and a Clinical Assistant Professor in the Department of Psychiatry, University of Calgary, Canada.

In March, Dr Stein gave a presentation on the new Somatic Symptom Disorder category (as it had stood at the third draft) to the Alberta Psychiatric Association and has very kindly made her presentation slides available. These are in PDF format so no PowerPoint viewer is required.

Somatic Symptom Disorders in DSM-5 A step forward or a fall back?

Alberta Psychiatric Association March 23, 2013

 Click link for PDF document   SSD Stein Presentation March 2013

The American Psychiatric Association is not affiliated with nor endorses this presentation.

The next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders unwraps next month; finalized criteria sets are embargoed until May 22.

Until then, you will have to make do with the DSM-5 Table of Contents and Highlights of Changes from DSM-IV-TR to DSM-5 and the fact sheets and justifications on this APA webpage.

Erasing the interface between psychiatry and general medicine?

It’s four years, now, since I first started reporting on the deliberations of the Somatic Symptom Disorders Work Group.

The Somatoform Disorders section of DSM-IV has been dismantled and four rarely used disorders replaced for DSM-5 by a single new diagnosis, ‘Somatic Symptom Disorder’ (SSD).

From May, everyone with chronic medical illness or long-term pain becomes a potential candidate for this new mental disorder label.

Out go DSM-IV’s rigorous criteria sets and the requirement for multiple symptoms to be medically unexplained; in comes a far looser definition that doesn’t distinguish between ‘medically unexplained’ somatic symptoms or symptoms in association with diagnosed medical disease.

You can read APA’s rationale for the change here and here and Task Force Chair, David J Kupfer, defending the SSD work group’s decisions here, on Huffington Post.

For DSM-5, the SSD criteria set focuses on the psychological impact of persistent, distressing bodily symptoms on the patient’s thoughts, feelings and behaviours and the degree to which their response is perceived to be ‘disproportionate’ or ‘excessive’ – irrespective of symptom etiology.

Patients with common diseases like cancer, angina, diabetes, CVD, or multiple sclerosis; with long-term pain; with chronic illnesses and conditions like irritable bowel syndrome, fibromyalgia, CFS, interstitial cystitis, chronic Lyme disease, or persistent, somatic symptoms of unclear etiology may qualify for an additional mental disorder diagnosis if the clinician considers the patient also meets the criteria for ‘Somatic Symptom Disorder’ and may benefit from treatment  – psychotropic drugs, CBT or other therapies to modify ‘faulty illness beliefs’ and ‘maladaptive’ coping strategies.

“[The SSD Work Group’s] framework will allow a diagnosis of somatic symptom disorder in addition to a general medical condition*, whether the latter is a well-recognized organic disease or a functional somatic syndrome such as irritable bowel syndrome or chronic fatigue syndrome” [1]

“These disorders typically present first in non-psychiatric settings and somatic symptom disorders can accompany diverse general medical as well as psychiatric diagnoses. Having somatic symptoms of unclear etiology is not in itself sufficient to make this diagnosis. Some patients, for instance with irritable bowel syndrome or fibromyalgia would not necessarily qualify for a somatic symptom disorder diagnosis. Conversely, having somatic symptoms of an established disorder (e.g. diabetes) does not exclude these diagnoses if the criteria are otherwise met.

“The symptoms may or may not be associated with a known medical condition. Symptoms may be specific (such as localized pain) or relatively non-specific (e.g. fatigue). The symptoms sometimes represent normal bodily sensations (e.g., orthostatic dizziness), or discomfort that does not generally signify serious disease.” [2]

*According to page 1 of APA document Highlights of Changes from DSM-IV-TR to DSM-5, under the heading “Terminology,” the document states: ‘The phrase “general medical condition” is replaced in DSM-5 with “another medical condition” where relevant across all disorders.’ Without better context for this change of terminology, it’s not clear what the implications might be or whether this might represent evidence of intent to blur the boundary between psychiatric and general medical conditions, or the colonization of general medicine. (If any readers are aware of earlier references to this change of terminology for DSM-5 and/or APA’s rationale, I should be pleased to receive information, as I can find no reference prior to January 21.)

Psychiatric creep

This new category will potentially result in a ‘bolt-on’ mental disorder diagnosis being applied to all chronic illnesses and medical conditions if the clinician decides the patient’s response to distressing bodily symptoms is ‘excessive’ or their coping strategies are ‘maladaptive,’ or that the patient is ‘catastrophising,’ or displaying ‘fear avoidance’ or is overly preoccupied with their symptoms (or in the case of a parent, a child’s symptoms).

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 dual-diagnosis with a mental disorder.

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, may be vulnerable to misdiagnosis with a mental disorder and premature case closure.

Families caring for children with chronic illness may be placed at risk of wrongful accusation of ‘over-involvement’ or of being ‘excessively concerned’ with a child’s symptoms or of colluding in the maintenance of ‘sick role behaviour.’

Just one distressing symptom for at least six months duration plus one of the three ‘B type’ criteria is all that is required to tick the box for a diagnosis of a mental health disorder – cancer + SSD; angina + SSD; asthma + SSD; COPD + SSD; diabetes + SSD; IBS + SSD; CFS + SSD…

15% of the ‘diagnosed illness’ study group (cancer and coronary disease) met the criteria for an additional diagnosis of SSD in the DSM-5 field trials.

In the ‘functional somatic’ study group (irritable bowel syndrome or chronic widespread pain), 26% were coded with SSD.

The criteria, as they stood at the third draft, caught 7% of the ‘healthy’ field trial control group.

The Somatic Symptom Disorder construct represents a significant change to the current DSM-IV-TR categories.

There is no substantial body of evidence to support the validity, reliability and safety of the application of SSD in adults or children nor any published data on projected prevalence rates across the entire disease spectrum or on the potential clinical and economic burdens for providers and payers – yet the SSD Work Group, Task Force and APA Board of Trustees have barrelled this through.

In February, SSD Work Group Chair, Joel E Dimsdale, MD, told journalist, Susan Donaldson James, for ABC News:

 “…If it doesn’t work, we’ll fix it in the DSM-5.1 or DSM-6.”

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. Advocates and patient groups are not reassured by APA’s ‘publish first – patch later’ approach: is this science or Windows 7?

This section of DSM-5, seemingly overlooked by clinicians in the field, both within and outside psychiatry and psychosomatics, and by medico-legal and disability specialists demands scrutiny and investigation.

The SSD construct is now influencing emerging proposals and field testing for three severities of a new category for ICD-11, Bodily Distress Disorder, proposed to replace half a dozen existing ICD-10 Somatoform Disorders [3] [4].

As Dr James Brennan wrote in a recent BMJ Rapid Response:

“…All human distress occurs within the context of complicated factors (biological, psychological, emotional, interpersonal, social etc) and it is this context that demands our assessment and understanding, not reducing it all to a subjective judgment by a clinician as to whether a particular emotion is ‘excessive’ or ‘disproportionate’. How much distress ought a cancer patient to have? What democratic authority gives any of us the right to say what is excessive or proportionate about another person’s thoughts, emotions and behaviour? The SSD criteria in this regard are dangerously loose and over-inclusive.”

References

1 Dimsdale J, Creed F. DSM-V Workgroup on Somatic Symptom Disorders: the proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report. J Psychosom Res 2009;66:473-6.
2 DSM-5 Somatic Symptom Disorders Work Group Disorder Descriptions PDF document, published May 4, 2011 for the second stakeholder review.
3 Creed F, Gureje O. Emerging themes in the revision of the classification of somatoform disorders. Int Rev Psychiatry 2012;24:556-67.
4 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.

 

Further reading

APA Somatic Symptom Disorder Fact Sheet

Somatic Chapter Drops Centrality Of Unexplained Medical Symptoms Psychiatric News, Mark Moran, March 1, 2013

Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care David J Kupfer, MD, Chair, DSM-5 Task Force, defends the SSD construct, Huffington Post, February 8, 2013

The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill Allen Frances, MD, BMJ 2013;346:f1580 BMJ Press Release

Somatic Symptom Disorder could capture millions more under mental health diagnosis Suzy Chapman, May 26, 2012

Mislabeling Medical Illness As Mental Disorder Allen Frances, MD, Psychology Today, DSM 5 in Distress, December 8, 2012

Why Did DSM 5 Botch Somatic Symptom Disorder? Allen Frances, MD, Psychology Today, Saving Normal, February 6, 2013

New Psych Disorder Could Mislabel Sick as Mentally Ill Susan Donaldson James, ABC News, February 27, 2013

Dimsdale JE. Medically unexplained symptoms: a treacherous foundation for somatoform disorders? Psychiatr Clin North Am 2011;34:511-3. [PMID: 21889675]

‘Somatic Symptom Disorder’ – the most ubiquitous mental health diagnosis you never heard of

‘Somatic Symptom Disorder’ – the most ubiquitous mental health diagnosis you never heard of

Lead psychiatrist for DSM-IV voices opposition to DSM-5’s new ‘catch-all’ criteria in BMJ, today

Post #229 Shortlink: http://wp.me/pKrrB-2GI

Update: Rapid Responses to the BMJ article can be read here:

http://www.bmj.com/content/346/bmj.f1580?tab=responses

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The opinion piece published under BMJ’s “Personal View” section, on Wednesday, is now featured in this week’s “Editor’s Choice”:

http://www.bmj.com/content/346/bmj.f1918

Editor’s Choice
US Editor’s Choice

DSM-5 and the rough ride from approval to publication

BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f1918 (Published 22 March 2013)

Edward Davies, US news and features editor, BMJ

Update: Media coverage for BMJ article:

Times of India

Eat or surf a lot? You risk being labelled mentally ill

Malathy Iyer, TNN | Mar 24, 2013

…Earlier this week, American psychiatrist Allen Frances, who helped devise the fourth edition of the manual (DSM-IV), lashed out against the new installment in the British Medical Journal. “It risks mislabelling a sizeable number of population as mentally ill,” Frances wrote.

He is disturbed about a new introduction called ‘somatic symptom disorder’ that will need only one bodily symptom distressing or disrupting daily life for about six months. “This new category will extend the scope of mental disorder classification by eliminating the requirement that somatic symptoms must be medically unexplained,” he wrote. In a field trial study to check for somatic symptom disorder, the results included 15% of patients with cancer or heart disease and 26% with irritable bowel syndrome or fibromyalgia. “The rate of psychiatric disorder among medically ill patients is unknown, but these rates seem high,” added Frances.

Doctors in India are not too supportive of the somatic symptom disorder…

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Medscape Medical News > Psychiatry

DSM-5 Somatic Symptom Disorder Debate Rages On

Deborah Brauser | March 21, 2013

The inclusion of the new somatic symptom disorder category in the soon-to-be-released Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) continues to spark heated debate in the field of psychiatry.

In a “Personal View” published online March 19 in BMJ, Allen Frances, MD, writes that the new disorder could result in “inappropriate diagnoses of mental disorder and inappropriate medical decision making” and urged clinicians to ignore the category completely…

…”The proposed diagnosis is unsupported by any substantial evidence on its likely validity and safety and was strongly opposed by patients, families, caregivers, and advocacy organizations,” he writes.

“Every diagnostic decision is a delicate balancing act between definitions that will result in too much versus too little diagnosis — the DSM-5 work group chose a remarkably sensitive definition that is also remarkably non-specific.”

He adds that clinicians should just ignore this classification altogether…

(Free registration for access to full article.)

Rheumatology Update

New ‘somatic symptom disorder’ captures fibromyalgia

Tony James | March 22, 2013

The new diagnosis of ‘somatic symptom disorder’ due for inclusion in the American Psychiatric Association’s updated diagnostic manual will capture up to a quarter of fibromyalgia patients…

Psychiatry Update (Australia)

Clinicians urged to ignore DSM-5 ‘somatic symptom disorder’

Tony James | March 20, 2013

The chair of the DSM-IV task force has told clinicians to ignore the new diagnosis of ‘somatic symptom disorder’ in DSM-5.

In a strongly-worded critique in this week’s BMJ, Professor Frances said that every diagnostic decision was a delicate balancing act between over-diagnosis and under-diagnosis…

“…The diagnosis of somatic symptom disorder is based on subjective and difficult to measure cognitions that will enable a ‘bolt-on’ diagnosis of mental disorder to be applied to all medical conditions, irrespective of cause.”

Field trials had shown that the new definition captured 15% of patients with cancer or heart disease and 26% with irritable bowel syndrome or fibromyalgia.

(Registered Medical Practitioner site; registration required for access to full article.)

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Inform 21

Un nuevo trastorno podría clasificar a millones de personas como enfermos mentales

March 21, 2013

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UK Times

The Times Mental Health

Psychologists to fight new list of mental illnesses

Martin Barrow, Health Editor | March 21, 2013

Everyday Health

Why Obsessing Over Physical Symptoms Could Equal Mental Illness

A psychiatrist argues in a new paper that a change in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) could lead to misdiagnosis of people with cancer and heart disease as mentally ill.

Jaimie Dalessio | Everyday Health Staff Writer | March 20, 2013

Come May, everyone with chronic medical illness or long-term pain – from cancer to coronary disease, MS to myalgia, becomes a potential candidate for a new mental health label.

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On Wednesday, BMJ publishes a commentary on the DSM-5 ‘Somatic Symptom Disorder’ by Allen Frances, MD, who chaired the Task Force for DSM-IV, with contribution from Dx Revision Watch:

http://www.bmj.com/uk/comment

Full article available without subscription, here:

http://www.bmj.com/content/346/bmj.f1580

PDF here:

http://www.bmj.com/highwire/filestream/636761/field_highwire_article_pdf/0/bmj.f1580.full.pdf

PERSONAL VIEW

The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill

This new condition suggested in the bible of mental health diagnoses lacks specificity, says Allen Frances

Allen Frances chair of the DSM-IV task force

The fuzzy boundary between psychiatry and general medicine is about to experience a seismic shift. The next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is scheduled for release this May amid controversy about many of its new disorders. Among these, DSM-5 introduces a poorly tested diagnosis—somatic symptom disorder—which risks mislabeling a sizeable proportion of the population as mentally ill…

BMJ Media release will be available here:

http://group.bmj.com/group/media/latest-news

Psychiatric creep

For DSM-5, the somatoform disorders section is being dismantled and four rarely used disorders are being replaced by a single new diagnosis, ‘Somatic Symptom Disorder.’

Out go DSM-IV’s rigorous criteria sets and the requirement for multiple symptoms to be medically unexplained; in comes a far looser definition that doesn’t distinguish between ‘medically unexplained’ symptoms or somatic symptoms in association with diagnosed medical illness.

From May, patients with common diseases like cancer, angina, diabetes or multiple sclerosis; with long-term pain, chronic illnesses like irritable bowel syndrome, fibromyalgia or CFS, or with unexplained conditions that have so far presented with somatic (bodily) symptoms of unclear cause may qualify for an additional mental disorder diagnosis of ‘Somatic Symptom Disorder’ if the clinician considers they also meet the criteria for ‘Somatic Symptom Disorder,’ and may benefit from treatment.

The SSD criteria set focuses on the psychological impact of persistent, distressing bodily symptoms on the patient’s thoughts, feelings and behaviors and the degree to which their response is considered ‘disproportionate’ or ‘excessive.’

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 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-5s new disorders, post publication, and that it intends to start work on a ‘DSM-5.1′ release. Patient groups, advocates and professionals are not reassured by a ‘publish first – patch later’ approach to science.

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 medical insurance 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

DSM-5 Round up: March #1

DSM-5 Round up: March #1

Post #229 Shortlink: http://wp.me/pKrrB-2H2

New York Times

Letter to the Editor

RONALD PIES
Lexington, Mass., March 18, 2013

The writer is a professor of psychiatry at SUNY Upstate Medical University and Tufts University.

Letter
Invitation to a Dialogue: Psychiatric Diagnoses

Published: March 19, 2013

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Macleans Canada

Normal behaviour, or mental illness?

Temper tantrum, or ‘disruptive mood dysregulation disorder’? A look at the new psychiatric guidelines that are pitting doctors against doctors

Anne Kingston | Tuesday, March 19, 2013

…Under the new “somatic symptom disorder” (SSD), for instance, people who express any anxiety about physical symptoms could also be saddled with a mental illness diagnosis, which could thwart their attempts to have their physical issues taken seriously. To meet the definition one only needs to report a single bodily symptom that’s distressing and/or disruptive to daily life and have just one of the following three reactions for at least six months: “ ‘disproportionate’ thoughts about the seriousness of their symptom(s); a high level of anxiety about their health; devoting excessive time and energy to symptoms or health concerns.”

Read more of this post

APA website: New documents and videos on ‘Somatic Symptom Disorder; article: Psychiatric News

APA website: New documents and videos on ‘Somatic Symptom Disorder; article: Psychiatric News

Post #228 Shortlink: http://wp.me/pKrrB-2Gi

Updates at March 7

Article in Die Psychiatrie

Somatic Symptom Disorders: a new approach in DSM-5

J. E. Dimsdale, University of California, San Diego, DSM Task force, Somatic Symptoms Work Group

Die Psychiatrie 2013; 10: 30–32

Summary

Following a brief historic discourse, problems with the current use and concepts the of somatoform disorders are described. The rationale for substituting the term “somatoform” with “somatic symptom” in DSM5 is explained and the new classification criteria for the group of “somatic symptom related disorders” are described, which include severity ratings.

A special aspect is that “Illness anxiety disorder” is introduced as a new diagnostic entity in DSM-5.

“Störung mit somatischen Symptomen”: ein neuer Ansatz in DSM-5

Zusammenfassung

Nach einem kurzen historischen Diskurs werden die Problembereiche und die Konzepte der somatoformen Störungen erläutert. Das Rational für einen Ersatz der “somatoformen” Störung durch eine “Störung mit somatischen Symptomen” in DSM5 wird erläutert. Die Klassifikationskriterien der Gruppe der “Störungen mit somatischen Symptomen” wird dargestellt.

Ein besonderer Aspekt ist die Einführung einer “Erkrankungsangst-Störung” in DSM-5.

Full paper can be downloaded here: http://bit.ly/W7filu

Doug Bremner, MD, comments on ‘Somatic Symptom Disorder’ here:

DSM-5 Somatic Symptoms Disorder is Going to Make Us All Mental

Doug Bremner | February 12, 2013

 

A number of new documents and short videos on ‘Somatic Symptom Disorder’ have been published on the APA’s new webpages, plus an article in Psychiatric News, published on March 1.

These are followed by recent, mainstream media coverage of concerns for all illness groups for the implications of misdiagnosis with ‘Somatic Symptom Disorder’ or for an additional diagnosis of ‘Somatic Symptom Disorder.’

http://www.psychiatry.org/practice/dsm/dsm5/dsm-5

Fact Sheet: Click link for PDF document   Somatic Symptom Disorder

Videos:

Joel E Dimsdale, Chair, DSM-5 Somatic Symptom Disorders Work Group

What is Somatic Symptom Disorder?

http://www.psychiatry.org/practice/dsm/dsm5/dsm-5-video-series-somatic-symptom-disorder

What was the rationale behind changes to Somatic Symptom Disorder?

http://www.psychiatry.org/practice/dsm/dsm5/dsm-5-video-series-changes-to-somatic-symptoms

Will Somatic Symptom Disorder result in the missing of other medical problems?

http://www.psychiatry.org/practice/dsm/dsm5/dsm-5-video-series-somatic-symptom-disorder-and-other-medical-problems

Article: Psychiatric News (organ of the APA):

http://psychnews.psychiatryonline.org/newsArticle.aspx?articleid=1659603

Psychiatric News | March 01, 2013
Volume 48 Number 5 page 7-7
10.1176/appi.pn.2013.3a26
American Psychiatric Association
Professional News

Somatic Chapter Drops Centrality Of Unexplained Medical Symptoms

Mark Moran

“…But Joel Dimsdale, M.D., chair of the Somatic Symptom and Related Disorders Work Group, emphasized that the most important change overall in this set of disorders is removal of the centrality of medically unexplained symptoms. “That was a defining characteristic of these disorders in DSM-IV, but we believe it was unhelpful and promoted a mind-body dualism that is hard to justify,” he told Psychiatric News.

So, for instance, the diagnosis of somatization disorder in DSM-IV was based on a long and complex symptom count of medically unexplained symptoms. DSM-5 criteria eliminate that requirement and recognize that individuals who meet criteria for somatic symptom disorder—the new designation, marked by disproportionate thoughts, feelings, and behaviors related to somatic symptoms—may or may not have a medically diagnosed condition.

Hypochondriasis has been eliminated; most individuals who would previously have been diagnosed with hypochondriasis have significant somatic symptoms in addition to their high health anxiety and should receive a DSM-5 diagnosis of somatic symptom disorder. Those with high health anxiety without somatic symptoms should receive a diagnosis of illness anxiety disorder…

Read full article here

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Related material

Dimsdale JE. Medically Unexplained Symptoms: A Treacherous Foundation for Somatoform Disorders? Psychiatr Clin North Am, Volume 34, Issue 3, Pages 511-513 [PUBMED 21889675]

Overlapping Conditions Alliance (OCA)

“Members of the Overlapping Conditions Alliance (OCA) produced a white paper, Chronic Pain in Women: Neglect, Dismissal and Discrimination, to promote awareness and research of neglected and poorly understood chronic pain conditions that affect millions of American women. This report, which can be viewed and downloaded below, includes detailed policy recommendations to further these goals.” (Report 2010 and Report 2011)

http://www.endwomenspain.org/resources/policy-analysis-recommendations

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Recent mainstream media coverage of the SSD issue

ABC News Radio:
Guidelines for Diagnosing Psychiatric Disorder May Overlook Physical Illnesses

ABC News:
New Psych Disorder Could Mislabel Sick as Mentally Ill

Canada.com and syndicated to a number of other Canadian media sites:
New “catch all” psychiatric disorder could label people who worry about their health as mentally ill

Fox News Health:
Does somatic symptom disorder really exist?

DSM-5 Task Force Chair, David J Kupfer, MD, defends the SSD construct on Huffington Post (but provides no answers to my questions):

David J. Kupfer, M.D. Chair, DSM-5 Task Force

Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care