Since the Coyne PLOS blog discusses the Fink et al BDS construct and also touches on DSM-5's SSD, I thought I would collate four key documents in this thread for reference, now that they are all public domain.
(I may also open a new thread for this important issue.)
(1) Bodily distress disorder in ICD-11: problems and prospects
Oye Gureje, GM Reed, Sept 2016 Open access
http://onlinelibrary.wiley.com/doi/10.1002/wps.20353/pdf
This is the most recent report from the ICD-11
Somatic Distress and Dissociative Disorders Working Group (S3DWG), which, among other tasks, has been asked to propose revisions to the Somatoform disorders categories in ICD-10.
This external working group is chaired by Oye Gureje. Frances Creed* is a member. I have the names of a couple of other members but the full S3DWG membership list is not in the public domain.
The paper published in September describes the proposals for the
"Bodily distress disorder" construct as defined and entered into the ICD-11 Beta draft.
It is an SSD-like construct and SSD has been inserted in the Beta draft under "Synonyms" to "BDD" - as you can see here:
http://apps.who.int/classifications/icd11/browse/f/en#/http://id.who.int/icd/entity/767044268
http://apps.who.int/classifications/icd11/browse/l-m/en#/http://id.who.int/icd/entity/767044268
There are three proposed severities: Mild; Moderate; Severe, and for each a Definition has been entered into the draft.
As defined by ICD-11 core version, "BDD" shares all the problems inherent in DSM-5's
Somatic symptom disorder.
Furthermore, it proposes to use a term that is already being used in the field, interchangeably, for Fink et al's "BDS" construct, despite the fact that "BDS" is differently conceptualized, has different criteria and potentially captures different (though to an extent overlapping) patient groups.
The divergence between the "BDS" construct and the "SSD" construct has been acknowledged by DSM-5's Dimsdale and by Fink, Creed and Henningsen.
*Although Francis Creed was a member of the DSM-5 work group, he does not like the SSD construct or the name. He favours the BDS construct, although he is on the ICD-11 working group that is proposing an SSD-like construct. So it doesn't surprise if Creed is holding out for the term "Bodily distress disorder" as it is already often used for Fink's BDS.
The PCCG group also proposes to use the term "Bodily Distress Disorders" but as a section header under which the categories "Bodily Stress Syndrome" and "Health anxiety" (which replaces "Hypochondriasis") would sit.
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(2) An alternative construct has been proposed by the (external)
Primary Care Consultation Group (PCCG) for use in the ICD-11 PHC.
The ICD-11 PHC is being developed in parallel with the core ICD-11 and is an abridged version of the Mental disorders chapter for use in Primary Care and low resource settings. It is expected to comprise 28 of the "most common" mental health disorders found in Primary Care.
The PCCG is chaired by Prof Sir David Goldberg; the membership list is in the public domain.
The PCCG's most recent paper is:
Multiple somatic symptoms in primary care: A field study for ICD-11 PHC: WHO's revised classification of mental disorders in primary care settings
David P. Goldberg, D.M., Geoffrey M. Reed, Ph.D. et al
https://www.researchgate.net/profile/Geoffrey_Reed/publication/308959165_Multiple_somatic_symptoms_in_primary_care_A_field_study_for_ICD-11_PHC_WHO%27s_revised_classification_of_mental_disorders_in_primary_care_settings/links/581f399f08aea429b298d6f2.pdf
The
Primary Care Consultation Group proposes to call its recommended construct
"Bodily Stress Syndrome" (BSS), which, as already noted, would sit under a section heading, "
Bodily Distress Disorders."
Their initial proposed construct had been for a close adaptation of Fink et al's (2010)
Bodily distress syndrome (BDS).
From the most recent paper:
"...The ICD-10 PHC [1] contained a category called ‘medically unexplained somatic complaints’, defined by negative physical investigations and frequent visits to the PCP despite these negative findings. The development of the ICD-11 PHC provided an opportunity to re-think this description, drawing in part on research conducted in Denmark by Fink and colleagues [7,8], including a recommendation that three or more symptoms was a useful threshold for primary care populations [9].Fink and his colleagues proposed a conceptualization of Bodily Distress Syndrome that emphasized the co-occurrence of symptoms falling into cardiopulmonary, musculoskeletal, and gastrointestinal clusters and explicitly linking these symptom clusters to ‘functional’ syndromes of non-cardiac chest pain, fibromyalgia, and irritable bowel syndrome. This conceptualization was subsequently expanded to include an additional cluster of ‘general’ symptoms (e.g., concentration difficulties,memory impairment, fatigue) theorized as corresponding to chronic fatigue syndrome [7,9]. Support for the notion that apparently distinct collections of somatic symptoms are united by underlying common features has been provided by a number of empirical studies [10–19]."
The most recent paper states:
"As a concept, BSS brings together under a common rubric allegedly
different patterns of symptoms variously described as constituting
different ‘functional’ syndromes (e.g., fibromyalgia, irritable bowel syndrome)."
Within the proposed criteria for the
Primary Care Consultation Group's proposed "BSS", there is no listing of "Chronic fatigue syndrome" under "Exclusion" or "Differential diagnosis", see Page 86-87 Appendix 2 [1].
The original proposed "BSS" criteria, based on symptom clusters from body systems, and closely adapted from Fink et al (2012) and are set out in Appendix 2 (Pages 86-87) of the Lam et al paper in reference [1] at the end of this report.
In the most recent paper it says:
"The version of the Bodily Stress Syndrome diagnosis used in this
study was adapted for use in primary care settings from the proposed
diagnosis of Bodily Distress Disorder proposed for the main ICD-11
[24] by creating a specific cutoff of at least three symptoms not explained
by no known medical pathology that were associated with distress
or impairment and eliminating the requirement that the PCP make
a judgment about whether the attention devoted to the symptoms is
‘excessive’. Patients with fewer than three symptoms are very common
in primary care setting. Our focus group study [6] had indicated that
PCPs preferred a specific symptom cutoff point and were reluctant to
make a judgment about the subjective degree of attention paid by the
patient to the symptoms."
and
"One purpose of the present study was to examine the importance of
the specific symptoms clusters emphasized by Fink and colleagues
based on work in Denmark [7,8,9]. While clusters of cardiopulmonary,
musculoskeletal, gastrointestinal, and ‘general’ symptoms can be identified
in the current data, in the current clinical sample their significance
for diagnosing BSS is less clear given that the most common symptom
pattern was three or more symptoms in multiple clusters (57.9%;
CI95% = 53.8–62.0) and the average number of somatic symptoms
among this groupwasmore than 15, and nearly 11 in the overall sample
(see Table 3). Only in China was single symptom cluster BSS the most
common pattern (44.4%; CI95%=32.0–56.8). Therefore, for the ICD-11
PHC description of BSS, the best course would seem to be to describe
these common patterns but not to require that symptom presentations
conform to them in assigning a diagnosis."
No psychobehavioural responses are required to meet the Fink "BDS" criteria. But for "BSS" there is a nod, potentially, towards BDD's and SSD's requirement for psychobehavioural responses.
Note that like SSD, the core version's proposed "BDD" can be applied to any symptom(s) - if the clinician decides the response to the symptom(s) is "excessive". So that means BDD, like SSD, could be applied as an additional diagnosis to diagnosed cancer patients, coronary heart disease patients, patients with MS, diabetes, CFS, ME, IBS, FM etc.
Whereas in the PCCG's "BSS" (in common with Fink's "BDS") -
"If the symptoms are accounted for by a known physical disease this is not BSS." [1]
ICD Revision expects there to be construct/disorder congruency between the disorders to be included in the Primary Care version and the corresponding disorders in the Core version and all this has been discussed with ICD Revision's, Dr Geoffrey Reed.
Some time ago, I requested Exclusions for PVFS, BME and CFS under "BDD". Dr Reed has said that he cannot request Exclusions until the missing G93.3 legacy terms have been restored to the Beta draft, "but at such time, he would be happy to do so."
Note: The recommendations of external work groups are advisory and approval of proposals is the responsibility of the Joint Task Force (JTF) and the ICD classification experts.
ICD's Robert Jakob gave assurances, last June, that he can be “crystal clear” that there is no proposal or intention to classify the ICD-10 G93.3 legacy terms under the Mental and behavioural disorders chapter.
Think of it as a continuum, with the "pure" Fink BDS on the far left, and the "pure" DSM-5 SSD on the far right:
Operationalised BDS ----
proposed BSS ----
proposed BDD ----
published SSD
Add to that the fact of the S3DWG's proposing to call its construct by the same name that is often seen used in the literature and in the field for "BDS" and you don't need me to spell out the scope for disorder creep and the potential difficulty for maintaining construct integrity within and beyond ICD-11; nor the implications for all patients.
For an expansion on this see my document below (which was written before the two new papers were published):
Comment submitted to TAG Mental Health in May re: Bodily distress disorder (May 2015)
https://dxrevisionwatch.files.wordpress.com/2015/06/chapman-bdd-submission-may-2015.pdf
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(3) Here is the 2013 MASTER PROTOCOL for the ICD-11 PHC field trials:
MASTER PROTOCOL Depression, Anxiety and Somatic Symptoms in Global PC Settings: A Field Study for the ICD-11-PHC
http://www.psychiatryresearchtrust.co.uk/protocols/WorldHealth14.pdf
In the Lam et al (2013) paper, below, there is also discussion of the pilot field trials that took place in 2011 and the characterization and criteria, as were proposed in 2012, are set out in Appendix 2.
1 Full free:
Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study, Lam et al (2013)
http://fampra.oxfordjournals.org/content/30/1/76.full.pdf html
[Edited to add extracts and other comment]
