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DSM 5 Refuses to Correct Somatic Symptom Disorder - Blog by DSM IV Leader

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
Psychology Today Blog, by Allen Frances
Bad News: DSM 5 Refuses to Correct Somatic Symptom Disorder

Many of you will have read a previous blog prepared by Suzy Chapman and me that contained alarming information about the new DSM 5 diagnosis 'Somatic Symptom Disorder.'

SSD is defined so over inclusively by DSM 5 that it will mislabel 1 in 6 people with cancer and heart disease; 1 in 4 with irritable bowel and fibromyalgia; and 1 in 14 who are not even medically ill.

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

It's quite a long piece and its not fair for me to quote it all, but a couple of his suggestions for change stood out for me, given some of the issues that are often raised about CFS:
[his proposed and rejected] new criteria set would have made it much clearer that the person's concern about physical symptoms had to be 'excessive', 'maladaptive', 'pervasive', 'persistent', 'intrusive', 'extremely anxiety provoking', 'disproportionate', and 'consuming enough time to cause significant disruption and impairment in daily life'.

And I also suggested adding these new items to the criteria set to reduce the most common sources of inappropriate over diagnosis of Somatic Symptom Disorder.

'If a diagnosed medical condition is present, the thoughts, feelings, and behaviors must be grossly in excess of what would be expected given the nature of the medical condition.'

• 'If no medical diagnosis has yet been made, a thorough medical work-up should be performed and be repeated again at suitable intervals to uncover possible medical conditions that may declare themselves with the passage of time.'
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
To Aussies may I suggest the refrain "I can feel a boycott coming on ..." to the tune of a well known beer advertising jingle. DSM-V is not demonstrated to be fit for purpose.

"The American Psychiatric Association has proven itself incompetent to produce a safe and scientifically sound diagnostic system."
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
Messages
3,061
Location
UK
I suggest a merger with the current, existing DSM-5 thread, which already has the link to Allen Frances' second commentary posted in it.

http://forums.phoenixrising.me/inde...apman-opposition-to-dsm-5-ssd-category.20848/

Dr Frances published part one of a series of three commentaries on the SSD criteria, here, in collaboration with me, on December 8:

Mislabeling Medical Illness As Mental Disorder: Allen J Frances, M.D., December 8, 2012:
http://www.psychologytoday.com/blog...2/mislabeling-medical-illness-mental-disorder

Additional coverage

Moving in the Wrong Direction: Dr Tiffany Taft, Ph.D., Northwestern University, December 13, 2012:
http://opbmed.blogspot.co.uk/2012/12/moving-in-wrong-direction.html

Proposed DSM-5 Criteria May Unfairly Label Physical Conditions as Psychological Disorders: IBS Impact, December, 2012:

http://ibsimpact.wordpress.com/2012...ysical-conditions-as-psychological-disorders/

Somatic Symptom Disorder could capture millions more under mental health diagnosis: Suzy Chapman, May 26, 2012: http://wp.me/pKrrB-29B

Suzy Chapman
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
And a refutation of the DSM-V is on BBC

http://www.bbc.co.uk/news/health-20986796

This has a BPS flavour at the end, but is otherwise right about the issues. More and more are noticing. With some increased coverage there might be a boycott of DSM-V, I know many are talking about it. I wonder what would happen if many diagnosed under DSM-V took action as DSM-V is not fit for purpose?
 

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
Psychology Today Blog, by Allen Frances
Bad News: DSM 5 Refuses to Correct Somatic Symptom Disorder



It's quite a long piece and its not fair for me to quote it all, but a couple of his suggestions for change stood out for me, given some of the issues that are often raised about CFS:

Thanks Simon :) I am confused as to the lack of effect the 'leader' has had on the panel. Is he without 'clout' or what?

I suggest a merger with the current, existing DSM-5 thread, which already has the link to Allen Frances' second commentary posted in it....

Suzy, thank you for this :)

When you have time :eek: would you be able to write a summary of how all of this is likely to affect people with our condition? With all the excellent coverage you have afforded, I've kind of got lost in the volume.

I realise that SSD will not embrace CFS but we are as 'at risk' for symptoms that will - theoretically - be picked up by DSM5 as the next person.

I would also like to know if clinicians can/will simply 'opt out' or not enforce/follow these new guidelines and what the ramifications of such a decision might be for clinician and patient. Also what all this might have to do with the UK.

And a refutation of the DSM-V is on BBC

http://www.bbc.co.uk/news/health-20986796

Thanks for the BBC link, Silverblade. It looks very helpful :)
 
Messages
646
Thanks Simon :) I am confused as to the lack of effect the 'leader' has had on the panel. Is he without 'clout' or what?
Allen Frances was the leader of the previous process - creation of DSM IV - he has no formal role in the current process which will produce DSM V. However given his role in DSM IV Frances' criticisms ought to give those producing DSM V pause for thought, however a new regime with new priorities is obviously now in place. Realistically I think the battle over DSM V is lost and the focus should be on questioning the validity of the APA and its publication as any basis for diagnosis - it can certainly be resisted outside of the US by insistence that local expertise be the guide to diagnosis not the failed DSM V.

IVI
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
@IVI, I thought the battle was lost a long time ago (the history of psychiatry is to pursue these things regardless of criticism), though continuing to fight is not about winning. Its about keeping resistance galvanized and further highlighting issues that can be refered to later. After the DSM-V is released is when the real action will happen. I agree it can be resisted, or at least that can be attempted. The best thing that can happen for the world in this, and for both psychiatry and medicine, is for DSM-V to be resoundingly rejected in the marketplace and lead to a financial loss. That would be the market giving its verdict. Unfortunately making the public aware of the issues, and making the whole medical profession plus medical bodies, is not going to be easy. Many are, particularly those already involved in psychiatry, but I do not know how widespread this is. What do doctors currently in Australia, Canada, India, or Malta know about this?