Correspondence In Press in response to Dimsdale et al paper: Somatic Symptom Disorder: An important change in DSM

Post #284 Shortlink: http://wp.me/pKrrB-3yQ

Update: The four letters, below, published In Press in Journal of Psychosomatic Research are now published in the December 2013 issue:

Issue: Vol 75 | No. 6 | December 2013 | Pages 497-588

Update: Editorial by Michael Sharpe, DSM-5 Somatic symptom disorder Work Group member

http://bjp.rcpsych.org/content/203/5/320.abstract
http://bjp.rcpsych.org/content/203/5/320.full.pdf+html

Editorial: Somatic symptoms: beyond ‘medically unexplained’

BJP November 2013 203:320-321; doi: 10.1192/bjp.bp.112.122523

Michael Sharpe FRCPsych, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.

Abstract

Somatic symptoms may be classified as either ‘medically explained’ or ‘medically unexplained’ – the former being considered medical and the latter psychiatric. In healthcare systems focused on disease, this distinction has pragmatic value. However, new scientific evidence and psychiatric classification urge a more integrated approach with important implications for psychiatry.

A paper by DSM-5 Work Group members, Dimsdale JE, Creed F, Escobar J, Sharpe M, Wulsin L, Barsky A, Lee S, Irwin MR, Levenson J, titled Somatic Symptom Disorder: An important change in DSM, was published in the September issue of Journal of Psychosomatic Research.

There are four responses to this paper currently In Press. Subscription or payment is required to access the full text of these responses but the Dimsdale et al paper is now available free of charge:

http://www.jpsychores.com/inpress

http://www.jpsychores.com/article/S0022-3999(13)00345-0/fulltext

Correspondence

The somatic symptom disorder in DSM 5 risks mislabelling people with major medical diseases as mentally ill

DOI: 10.1016/j.jpsychores.2013.09.005

Winfried Häuser

Department of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany
Department of Psychosomatic Medicine, Technische Universität München, München, Germany

Frederick Wolfe

National Data Bank for Rheumatic Diseases, Wichita, USA

In Press Corrected Proof Received 2 September 2013; accepted 25 September 2013. published online 28 October 2013.

Dimsdale and co-authors present data on the reliability, validity, and prevalence of the new DSM 5 category “Somatic Symptom disorder” (SSD) defined by persistent somatic symptoms in conjunction with…

http://www.jpsychores.com/inpress

http://www.jpsychores.com/article/S0022-3999(13)00349-8/fulltext

Correspondence

Diagnosis of somatic symptom disorder requires clinical judgment

DOI: 10.1016/j.jpsychores.2013.09.009

Joel E. Dimsdale

Department of Psychiatry, University of California, San Diego, United States
[Ed: DSM-5 SSD Work Group Chair]

James Levenson

Department of Psychiatry, Virginia Commonwealth University, United States
[Ed: DSM-5 SSD Work Group Member]

In Press Corrected Proof Received 27 September 2013; accepted 27 September 2013. published online 01 November 2013.

The diagnosis of somatic symptom disorder (SSD) rests on the presence of 3 factors—1. distressing and impairing somatic symptoms, 2. that are persistent at least 6 months, and 3. that are associated…

http://www.jpsychores.com/inpress

http://www.jpsychores.com/article/S0022-3999(13)00378-4/fulltext

Correspondence

A commentary on: Somatic symptom disorder: An important change in DSM

DOI:10.1016/j.jpsychores.2013.10.012

Winfried Rief

Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany

Available online 1 November 2013

The songs of praise about DSM-5 and its innovations are disseminated through the media, and consequently, a positive evaluation of the new category of somatic symptom and associated disorders was published…

http://www.jpsychores.com/inpress

http://www.jpsychores.com/article/S0022-3999(13)00393-0/fulltext

Correspondence

Tradeoffs between validity and utility in the diagnosis of Somatic Symptom Disorder

DOI:10.1016/j.jpsychores.2013.10.015

Joel E. Dimsdale

Department of Psychiatry, University of California, San Diego, United States
[Ed: DSM-5 SSD Work Group Chair]

James Levenson

Department of Psychiatry, Virginia Commonwealth University, United States
[Ed: DSM-5 SSD Work Group Member]

Available online 31 October 2013

We appreciate the opportunity of responding to Professor Rief’s thoughtful letter concerning the thinking that guided our workgroup’s proposals for Somatic Symptom Disorder (SSD). When we started out…

in response to paper:

http://tinyurl.com/SSDPDFresearchgate [Download Free PDF from link on right of webpage.]

http://www.ncbi.nlm.nih.gov/pubmed/23972410

Somatic Symptom Disorder: An important change in DSM.

Dimsdale JE, Creed F, Escobar J, Sharpe M, Wulsin L, Barsky A, Lee S, Irwin MR, Levenson J.

J Psychosom Res. 2013 Sep;75(3):223-8. Epub 2013 Jul 25.

Abstract: http://www.jpsychores.com/article/S0022-3999(13)00265-1/abstract [Free]

Full text: http://www.jpsychores.com/article/S0022-3999(13)00265-1/fulltext

References: http://www.jpsychores.com/article/PIIS0022399913002651/references


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Commentaries on Somatic Symptom Disorder published in 2013 journal papers

In the June 2013 edition of Journal of Nervous and Mental Disorders, Allen Frances, MD, who chaired the Task Force for DSM-IV, discusses his concerns for the loosely defined DSM-5 category, Somatic Symptom Disorder, sets out his suggestions for revising the criteria prior to finalization, as presented to the SSD Work Group chair, in December 2012, and advises clinicians against using the new SSD diagnosis.

http://www.ncbi.nlm.nih.gov/pubmed/23719325

DSM-5 Somatic Symptom Disorder.

Frances A.

Department of Psychiatry, Duke University, Durham, NC.

J Nerv Ment Dis. 2013 Jun;201(6):530-1. doi: 10.1097/NMD.0b013e318294827c. No abstract available.

PMID: 23719325

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Commentary by Allen Frances, MD, and Suzy Chapman in the May 2012 issue of Australian and New Zealand Journal of Psychiatry. The paper discusses the over-inclusive DSM-5 Somatic Symptom Disorder criteria and the potential implications for diverse patient groups. The paper concludes by advising clinicians not to use the new SSD diagnosis.

http://www.ncbi.nlm.nih.gov/pubmed/23653063

DSM-5 somatic symptom disorder mislabels medical illness as mental disorder.

Allen Frances¹, Suzy Chapman²

1 Department of Psychiatry, Duke University 2 DxRevisionWatch.com

Aust N Z J Psychiatry. 2013 May;47(5):483-4. doi: 10.1177/0004867413484525. No abstract available.

PMID: 23653063

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The April 22, 2013 edition of Current Biology published a feature article on DSM-5 by science writer, Michael Gross, Ph.D. The article includes quotes from Allen Frances, MD, and Suzy Chapman on potential implications for patients for the application of the new DSM-5 Somatic Symptom Disorder. The article includes concerns for the influence of Somatic Symptom Disorder on proposals for a new ICD category – Bodily Distress Disorder – being field tested for ICD-11.

Current Biology 22 April, 2013 Volume 23, Issue 8

Copyright 2013 All rights reserved. Current Biology, Volume  23, Issue  8, R295-R298, 22 April 2013

doi:10.1016/j.cub.2013.04.009

Feature

Has the manual gone mental?

Michael Gross

Full text: http://www.cell.com/current-biology/fulltext/S0960-9822(13)00417-X

PDF: http://download.cell.com/current-biology/pdf/PIIS096098221300417X.pdf

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In a BMJ opinion piece, published March 2013, Allen Frances, MD, opposes the new Somatic Symptom Disorder, discusses lack of specificity, data from the field trials, and advises clinicians to ignore this new category.

PDF for full text

http://www.ncbi.nlm.nih.gov/pubmed/23511949

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

Frances A.

Allen Frances, chair of the DSM-IV task force

BMJ. 2013 Mar 18;346:f1580. doi: 10.1136/bmj.f1580. No abstract available.

PMID: 23511949

[PubMed – indexed for MEDLINE]

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Somatic Symptom Disorder is also included in Saving Normal: An Insider’s Revolt Against Out-Of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (pp. 193-6): Allen Frances, William Morrow & Company (May 2013).

Also Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 (Chapter 16): Allen Frances, Guilford Press (June 2013).

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Further reading

Objection to proposal to insert DSM-5′s Somatic symptom disorder into ICD-10-CM Suzy Chapman, Public submission, ICD-9-CM/PCS Coordination and Maintenance Committee Meeting September 18-19, 2013

APA Somatic Symptom Disorder Fact Sheet APA DSM-5 Resources

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 PDF for full text

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]

DSM-5 Somatic Symptoms Disorders work group publishes SSD field trial data

Post #272 Shortlink: http://wp.me/pKrrB-3ke

Update: Somatic Symptom Disorder: An important change in DSM. is now published in the September 2013 issue, J Psychosom Res. A subscription or payment is required to access this paper.

http://www.ncbi.nlm.nih.gov/pubmed/23972410

J Psychosom Res. 2013 Sep;75(3):223-8. Epub 2013 Jul 25.
Dimsdale JE, Creed F, Escobar J, Sharpe M, Wulsin L, Barsky A, Lee S, Irwin MR, Levenson J.

DSM-5 Somatic Symptoms Disorders work group publishes SSD field trial data…behind a paywall

Reports on the findings of the DSM-5 field trials have been slow to emerge.

Kappa results trickled out in dribs and drabs; work group chairs presented limited field trial data at the APA’s 2012 Annual Meeting. There remains a paucity of information on field trial study protocols, patient selection, field test results and analysis.

This is of particular concern where radical changes to DSM-IV definitions and criteria were introduced into DSM-5 and are now out there in the field.

A good example is the new DSM-5 “Somatic Symptom Disorder” category, where there is no substantial body of evidence for the reliability, validity, prevalence, safety, acceptability and clinical utility of the implementation of this new disorder construct – though that did not stop them barrelling it through to the final draft.

In its paper, the SSD Work Group acknowledges the “small amount of validity data concerning SSD”; that much “remains to be determined” about the utility and reliability of the specific SSD criteria and its thresholds when applied in busy, general clinical practice and that there are “vital questions that must be answered” as they go forward.

They don’t sound any too confident about what they’ve barrelled through; but neither do they seem overly concerned.

With remarkable insouciance, SSD Work Group Chair, Joel E Dimsdale, told ABC journalist, Susan Donaldson James, “…If it doesn’t work, we’ll fix it in the DSM-5.1 or DSM-6.” (ABC News, February 27, 2013).

Cavia15The implementation of SSD in the DSM-5 is a Beta trial; the public – adults and children – unwitting guinea pigs.

Members of the DSM-5 Somatic Symptoms Disorders Work Group have just published a report – Somatic Symptom Disorder: An important change in DSM.

APA owns the output of the DSM-5 work groups but this report isn’t posted on the APA’s DSM-5 Development site or on the Field Trials or DSM-5 Resources pages.

It’s being published (currently In Press) in the Journal of Psychosomatic Research, for which DSM-5 SSD Work Group member, James Levenson, is a Co-Editor and for which SSD Work Group member, Francis Creed, a past Editor.

Unless you are a subscriber to JPS or have institution access you will need to cough up $30 to access this paper.

DSM-5 Task Force’s Regier and Kupfer have been banging on for years about how transparent the development process for this most recent iteration of the DSM has been. Yet reports on field trial findings and analysis of studies cited in support of the introduction of radical new constructs for DSM are stuffed behind paywalls.

Why are DSM-5 work group reports not being published on the DSM-5 Development website or other APA platforms or published in journals under Creative Commons Licenses, for ease of public accessibility, professional and consumer stakeholder scrutiny and discussion, and for accountability?

The development of ICD-11 is also being promoted by WHO’s Bedirhan Üstün as an open and transparent process.

But emerging proposals from the two working groups charged with making recommendations for revision of ICD-10′s Somatoform Disorders (the Primary Care Consultation Group, chaired by Prof Sir David Goldberg and the WHO Expert Working Group on Somatic Distress and Dissociative Disorders, chaired by Prof Oje Gureje) were also published, last year, in subscription journals and subject to those journals’ respective copyright restrictions [1] [2].

1. Lam TP et al. Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study. Fam Pract. 2013 Feb;30(1):76-87. [Abstract: PMID:22843638]
2. Creed F, Gureje O. Emerging themes in the revision of the classification of somatoform disorders. Int Rev Psychiatry 2012;24:556-67. [Abstract: PMID: 23244611]

Why are ICD-11 working group progress reports on emerging proposals for potential new ICD disorders and focus group study reports not being published on platforms accessible, without payment, to all classes of ICD stakeholder?

The SSD Work Group paper is authored by Joel E Dimsdale (Chair), Francis Creed, Javier Escobar, Michael Sharpe, Lawson Wulsin, Arthur Barsky, Sing Lee, Michael R. Irwin and James Levenson.

[Although not a member of the SSD Work Group, Javier Escobar is Task Force liaison to the SSD work group and works closely with the group. Francis J Keefe (not included in the paper’s authors) is a member of the SSD Work Group. Nancy Frasure-Smith (not included in the paper’s authors) served as a member of the Work Group from 2007-2011 and was not replaced following withdrawal.]

The paper describes the DSM-5 Work Group’s rationale for the new SSD diagnosis (which replaces four DSM-IV categories); defines the construct, discusses field trial kappa data (inter-rater reliability), presents limited data for validity of SSD, clinical utility and potential prevalence rates, and briefly discusses tasks for future research, education and clinical practice.

http://www.jpsychores.com/

July 2013, Vol. 75, No. 1

In Press

Somatic Symptom Disorder: An important change in DSM

29 July 2013

Joel E. Dimsdale, Francis Creed, Javier Escobar, Michael Sharpe, Lawson Wulsin, Arthur Barsky, Sing Lee, Michael R. Irwin, James Levenson

Received 4 April 2013; received in revised form 27 June 2013; accepted 29 June 2013. published online 29 July 2013.

Corrected Proof

doi:10.1016/j.jpsychores.2013.06.033

Abstract: http://www.jpsychores.com/article/S0022-3999(13)00265-1/abstract [Free]

Full text: http://www.jpsychores.com/article/S0022-3999(13)00265-1/fulltext  [Paywall]

References: http://www.jpsychores.com/article/PIIS0022399913002651/references  [Paywall]


Commentaries on Somatic Symptom Disorder in recent journal papers

In the June 2013 edition of Journal of Nervous and Mental Disorders, Allen Frances, MD, who chaired the Task Force for DSM-IV, discusses his concerns for the loosely defined DSM-5 category, Somatic Symptom Disorder, sets out his suggestions for revising the criteria prior to finalization, as presented to the SSD Work Group chair, in December 2012, and advises clinicians against using the new SSD diagnosis.

http://www.ncbi.nlm.nih.gov/pubmed/23719325

DSM-5 Somatic Symptom Disorder.

Frances A.

Department of Psychiatry, Duke University, Durham, NC.

J Nerv Ment Dis. 2013 Jun;201(6):530-1. doi: 10.1097/NMD.0b013e318294827c. No abstract available.

PMID: 23719325

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Commentary by Allen Frances, MD, and Suzy Chapman in the May 2012 issue of Australian and New Zealand Journal of Psychiatry. The paper discusses the over-inclusive DSM-5 Somatic Symptom Disorder criteria and the potential implications for diverse patient groups. The paper concludes by advising clinicians not to use the new SSD diagnosis.

http://www.ncbi.nlm.nih.gov/pubmed/23653063

DSM-5 somatic symptom disorder mislabels medical illness as mental disorder.

Allen Frances¹, Suzy Chapman²

1 Department of Psychiatry, Duke University 2 DxRevisionWatch.com

Aust N Z J Psychiatry. 2013 May;47(5):483-4. doi: 10.1177/0004867413484525. No abstract available.

PMID: 23653063

+++

The April 22, 2013 edition of Current Biology published a feature article on DSM-5 by science writer, Michael Gross, Ph.D. The article includes quotes from Allen Frances, MD, and Suzy Chapman on potential implications for patients for the application of the new DSM-5 Somatic Symptom Disorder. The article includes concerns for the influence of Somatic Symptom Disorder on proposals for a new ICD category – Bodily Distress Disorder – being field tested for ICD-11.

Current Biology 22 April, 2013 Volume 23, Issue 8

Copyright 2013 All rights reserved. Current Biology, Volume  23, Issue  8, R295-R298, 22 April 2013

doi:10.1016/j.cub.2013.04.009

Feature

Has the manual gone mental?

Michael Gross

Full text: http://www.cell.com/current-biology/fulltext/S0960-9822(13)00417-X

PDF: http://download.cell.com/current-biology/pdf/PIIS096098221300417X.pdf

+++

In a BMJ opinion piece, published March 2013, Allen Frances, MD, opposes the new Somatic Symptom Disorder, discusses lack of specificity, data from the field trials, and advises clinicians to ignore this new category.

http://www.ncbi.nlm.nih.gov/pubmed/23511949

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

Frances A.

Allen Frances, chair of the DSM-IV task force

BMJ. 2013 Mar 18;346:f1580. doi: 10.1136/bmj.f1580. No abstract available.

PMID: 23511949

[PubMed – indexed for MEDLINE]

+++
Somatic Symptom Disorder is also included in Saving Normal: An Insider’s Revolt Against Out-Of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (pp. 193-6): Allen Frances, William Morrow & Company (May 2013).

Also Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 (Chapter 16): Allen Frances, Guilford Press (June 2013).

+++

Further reading

APA Somatic Symptom Disorder Fact Sheet APA DSM-5 Resources

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]

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

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