Review: 'Through the Shadowlands’ describes Julie Rehmeyer's ME/CFS Odyssey
I should note at the outset that this review is based on an audio version of the galleys and the epilogue from the finished work. Julie Rehmeyer sent me the final version as a PDF, but for some reason my text to voice software (Kurzweil) had issues with it. I understand that it is...
Discuss the article on the Forums.

Article: Coalition4ME/CFS Puts Out Call For Action on DSM-5 Proposal

Discussion in 'Phoenix Rising Articles' started by Phoenix Rising Team, Jun 2, 2011.

  1. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    That's excellent news, Neilk.

    Let's hope there'll be other submissions from clinicians.
  2. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    The reason I first started scrutinising and monitoring the progress of this SSD Work Group was because of the investigative work I was already doing, in early 2009, into the "CISSD Project" (not to be confused with SSD "CSSD" criteria) about which very little was known at that time.

    Kurt Kroenke is not a member of the SSD Work Group, but as reported on the existing thread back in late 2009, Kroenke had been US chair of the "Conceptual Issues in Somatoform and Similar Disorders (CISSD) Project".

    The project was an unofficial working group initiated and co-ordinated by philosopher and former Director of Westcare UK, Dr Richard Sykes PhD, between 2003 and 2007, for which Dr Sykes had been funded for three years through the Hugh and Ruby Sykes Charitable Trust (Sir Hugh Sykes being Richard's brother). The project was administered by UK patient organisation, Action for M.E., and AfME had agreed to "inherit" the role of Administrators for this personal project of Dr Sykes as part of the deal when AfME subsumed Westcare UK, and Dr Sykes ceased as its Director.

    Michael Sharpe was UK chair of CISSD Project

    Prof Michael Sharpe had been the UK CISSD Project Chair. AfME had (understandably) kept the lid very tightly on the nature of this project, the members of the work group and its aims and objectives for several years. But reports on the Project were finally placed in the public domain, in mid 2009, by Dr Sykes and then by Action for M.E., as a result of investigations and FOIs into the Project, undertaken by myself and others.

    Four of the CISSD Project workgroups members went on to become members of the DSM-5 SSD Work Group, and in the case of Javier Escobar, Task Force member and Task Force liaison to the SSD group.

    So Creed, Barsky, Levenson, Escobar, Kroenke and Sharpe and a number of others had all muscled in on this project which had originally been set up, according to Dr Sykes to keep CFS out of the DSM-5, but ended up being a general working group for international dialogue around "Somatoform and Similar Disorders" with many influential clinical researchers in the fields of US and international psychiatry and psychosomatics feeding into it.

    The published paper that eventually came out of this project barely mentioned CFS, at all. Although the Final Report for the Administrators does, but that report also claims, erroneously, that CFS does not appear in any volume of ICD-10 - a misconception which Dr Sykes has since acknowledged.

    Recommendations and proposals resulting out of the CISSD Project have informed the DSM-5 development process and also fed into the revision of ICD-10 Chapter V Mental and behavioural disorders and the review paper is listed in the References at the end of the SSD proposals "Rationale" document.

    (Full free copy of the 2007 Review authored by Kroenke, Sharpe and Sykes: )

    Dr Sykes' MUS Project

    Dr Sykes is currently engaged in a new project - the "London Medically Unexplained Physical Symptoms and Syndromes (MUPSS) Project", in association with the Institute of Psychiatry, Kings College London, as Project Administrators, through which funding is again provided by the Hugh and Ruby Sykes Charitable Trust. The nature, aims and objectives of this project have yet to be established.

    Since the CISSD Project ended in 2007, Dr Sykes has published no comment on the draft proposals by the SDD Work Group, which is interesting, given that he received several year's funding for a project that was intended to feed into the DSM-5 development process.

    Extract from a 2005 Kroenke paper:

    Prim Care Companion J Clin Psychiatry. 2005; 7(4): 148149.
    PMCID: PMC1192431

    Somatic Symptoms and Depression: A Double Hurt

    Kurt Kroenke, M.D.

    "...From a pragmatic standpoint, somatic symptoms are either clearly attributable to a distinct, usually medical disorder (e.g., dyspnea in the wheezing patient with asthma or sore throat in the patient with tonsillar exudates, adenopathy, and a positive throat swab for streptococcus) or not so readily explained. The latter symptoms can, in turn, be placed into 1 of 5 heuristic, albeit tenuous, categories: a somatoform disorder, another primary psychiatric disorder (often depression and/or anxiety), a functional somatic syndrome (e.g., irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome), a symptom only diagnosis (e.g., low back pain, nonmigrainous headache, idiopathic dizziness), or a partially explanatory medical disorder in which the symptoms are not responding to standard treatment and/or are disproportionate to the pathophysiological severity. For example, angina burden in cardiac patients may be as strongly correlated with psychological factors as with ischemic burden on objective tests.4

    "Because symptomatic patients in primary care commonly qualify for more than 1 of the 5 categories, because physical examination and diagnostic testing are often unremarkable or inconclusive, and because empirical treatments either are lacking or impart a high placebo response, overconfident differentiation among multiple, potentially causative psychological and physical factors should be discouraged."

    The SSD Work Group says since "medically unexplained" is "unreliable as a concept", "divisive between patients and clinicians", "results in stigma" and is "unacceptable to patients" they propose to de-emphasize "medically unexplained" as a concept.

    So, no matter whether the patient has a psychiatric disorder, or a condition of unknown etiology, or a so-called "Functional somatic syndrome" (IBS, FM, CFS and some others), or a single somatic symptom, like back pain, or a "well-recognized" organic disease or condition like diabetes or heart disease - if the somatic symptoms aren't considered to be related to a medical condition or are considered "disproportionate" for the medical condition, or considered to result from, or be perpetuated by "faulty illness beliefs", or if their anxieties about their bodily symptoms are considered "excessive" (or the parents' anxieties, in the case of children with somatic symptoms) or where their coping mechanisms are considered "inappropriate" or "maladaptive", they propose that an additional Dx of an SSD can be applied.

    They've retained and revised the criteria for Psychological Factors Affecting Medical Condition, which exists in DSM-IV; renamed "Conversion Disorder" to Functional Neurological Disorder (and I think we need to watch that one, too), done a mash-up of some existing, little-used categories and drawn up vague, very subjective and difficult to measure criteria for these new proposed categories of CSSD and SSSD.

    This way, they posit, no patient group is stigmatized, because all patients, from "hypochondriacs", to those labelled with what is currently called "somatization disorder", to the so-called "FSSs" to those with heart disease, diabetes or other "well-recognized conditions" could potentially attract this bolt-on of a "Somatic (bodily) symptom disorder" (and saddled with a mental health diagnosis).

    And thereby creeps psychiatry further and further into the domain of medicine.

    We've known about these proposals since mid 2009:

    In the June 09 Editorial published in the Journal of Psychosomatic Research, titled The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV a preliminary report, Joel E Dimsdale, and fellow DSM-5 Work Group member, Francis Creed, reported that by doing away with the controversial concept of medically unexplained symptoms, their proposed classification might diminish the dichotomy, inherent in the Somatoform section of DSM IV, between disorders based on medically unexplained symptoms and patients with organic disease.

    The conceptual framework the Work Group proposes (from the June 2009 editorial):

    "...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."​

    The latest version of the Disorders Description document says:

    "...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..."

    "...Patients with this diagnosis tend to have very high levels of health-related anxiety. They appraise their bodily symptoms as unduly threatening, harmful, or troublesome and often fear the worst about their health. Even when there is evidence to the contrary, they still fear the medical seriousness of their symptoms. Health concerns may assume a central role in the individual's life, becoming a feature of his/her identity and dominating interpersonal relationships."​

    DSM-IV already had the category "Psychological Factors Affecting a Medical Condition (PFAMC)", so that's not new, but these CSSD criteria are very similar to some of the dodgy CFS criteria, like Oxford.

    Patients with CFS, ME, FM if they have not got access to good ME specialists could be sitting ducks for a misdiagnosis or additional Dx with an SSD.

    There's another Kroenke paper here:

    The Interface Between Physical and Psychological Symptoms

    Kurt Kroenke, M.D. 2005

    "Dr. Kroenke serves as a consultant to Pfizer, Eli Lilly, and Wyeth and has received grant/research support from and serves on the advisory board for Eli Lilly and Wyeth."

    So the APA is happy, and the SSD Work Group members are (mostly) happy and Eli Lilly will be happy, too.

    If you look at the Reference list at the end of the "Rationale" document, many of the papers cited have been co-authored by SSD Work Group members (Creed and Levenson are also the co-editors of the Journal of Psychosomatic Research, a journal which has been used to publish papers, editorials and articles around the progress of the Work Group, for several years, and papers that have been authored by members of the Work Group.

    Some papers cited in the References to the "Rationale" document are unpublished papers; so the Work Group are citing many papers that the work group members have co-authored themselves. Sharpe is an Associate Editor and Wessely an Advisor to the Journal of Psychosomatic Research. It's all very, very incestuous.

    Editorial Board:

    Javier Escobar, MD, Director of the University of Medicine and Dentistry of New Jersey (UMDNJ) Robert Wood Johnson Medical School (RWJMS) Medically Unexplained Physical Symptoms (MUPS) Research Center, which has been supported with millions of $$$$ funding from the US National Institute of Mental Health (NIMH), is, as I have mentioned, a member of the DSM-5 Task Force, and works closely with the group.

    In 2008, he co-authored this Special Report for Psychiatric Times: Unexplained Physical Symptoms Whats a Psychiatrist to Do?


    If you haven't read this, it is worth a skim. All the illnesses and conditions listed in Table 1 as "Functional Somatic Syndromes" would likely be captured by CSSD or SSD.

    There's a bunch of CFS and DSM-5 related papers in this month's edition of Journal of Psychosomatic Research, just to cheer you up...
  3. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    June issue: Journal of Psychosomatic Research

    Journal of Psychosomatic Research
    Volume 70, Issue 6, Pages 493-624 (June 2011)


    Psychiatric classification in the setting of medical disease: Comparing the clinical value of different proposals, 16 December 2010
    Laura Sirri, Giovanni A. Fava, Thomas N. Wise
    pages 493-495
    Full Text | Full-Text PDF (75 KB)

    Differing perspectives on diagnostic proposals for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 18 January 2011
    Joel E. Dimsdale, James Levenson, Michael Sharpe
    pages 496-497
    Full Text | Full-Text PDF (66 KB)

    Chronic fatigue syndrome: Neurological, mental or both, 21 April 2011
    Michael Sharpe
    pages 498-499
    Full Text | Full-Text PDF (66 KB)

    Special Article

    Chronic fatigue syndrome: Labels, meanings and consequences, 11 April 2011
    Wojtek Wojcik, David Armstrong, Richard Kanaan
    pages 500-504
    Abstract | Full Text | Full-Text PDF (113 KB)


    Letter to the Editor

    Is chronic fatigue syndrome a neurological condition? A survey of UK neurologists, 11 April 2011
    Wojtek Wojcik, David Armstrong, Richard Kanaan
    pages 573-574
    Full Text | Full-Text PDF (66 KB)
  4. drjohn

    drjohn Senior Member

    [At Suzy's suggestion, my submission re-posted here. Sorry for any inconvenience. I give permission to anyone to re-post this anywhere here, on any site and delete a duplicate if that makes things easier]

    Submission to review proposals to create new category CSSD for M.E. in DSM-5, 7 June 2011


    To read a submission from Dr John Greensmith

    Short link

    May I urge as many individuals, or organisations representing people with M.E., as are able to submit a contribution before the closing date of 15 June 2011.

    Go to to register or log in and leave your comment here

    Please do not leave it to others, It is too important to miss.

    Follow us on Twitter!/MeFreeForAllOrg

    Join us for a mix of serious and fun stuff on Facebook!/profile.php?id=100000948699086

    Dr John H Greensmith
    ME Free For All. org
  5. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    Thanks, John.

  6. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    (Note: The Journal of Psychosomatic Research is the official organ of the EACLPP.)

    Preliminary program of the annual meeting of the European Association of
    Consultation-Liaison Psychiatry and Psychosomatic Medicine (EACLPP)

    June 30 - July 2, 2011, Budapest, Hungary
    Semmelweis University

    "Interventions in Consultation-Liaison Psychiatry and Psychosomatic Medicine

    THURSDAY, JUNE 30, 2011

    9.00-12.30 Pre-conference Courses

    Course 1. Introduction to clinical epidemiology (David Streiner)
    Course 2. Psychotherapy Effectiveness (Paula Ravitz, Jon Hunter)
    Course 3. CALM therapy (Gary Rodin)
    Course 4. Psychopharmacology (James Levenson)
    Course 5. Consultation-Liaison Psychiatry the interface of psychiatry and somatic medicine (Albert Diefenbacher, George Fulop)

    9.00-12.30 EACLPP Board meetings
    9.00-10.30 Board meeting
    11.00-12.30 Extended board with the national representatives
    14.00-14.30 Opening addresses
    14.30-16.00 Plenary session 1.

    - Psychodynamic interventions in CL-Psychiatry: a conceptual and scientific perspective (Fritz Stiefel)

    - Focused psychodynamic psychotherapy in liaison psychiatry: Clinical experience and empirical research with patients suffering from medically unexplained symptoms (Elspeth Guthrie)
    - Focused psychodynamic psychotherapy in C-L psychiatry and psychosomatics - Clinical experience from an RCT with depressed breast cancer patients (Manfred Beutel)

    16.00-16.30 Break
    16.30-18.00 Parallel sessions (A)

    - Sleep disorders (Colin Shapiro, Adam Moskowitz)
    - Body image, eating disorders (Ferenc Tury)
    - Primary care (Thomas Ungar, Peter Torzsa)
    - Outcomes and quality control in the C-L setting (Albert Leentjens)
    - Psychodynamic aspects in C-L psychiatry and psychosomatics (Sylvia Krenz "Psychodynamic interventions in CL-Psychiatry: conceptual, scientific and clinical aspects", Fritz Stiefel, Wolfgang Sllner case presentations with interaction)

    18.00 Wine and cheese - Welcome reception
    18.30-20.30 General Assembly (for EACLPP members only)
    20.30 Early carrier social program, network meeting, concert at night

    FRIDAY, 1 JULY, 2011

    8.30-10.00 Parallel sessions (B)
    - Organ Transplantation (Susan Abbey, Sheila Jowsey)
    - Update on bodily distress (Frances Creed- Evidence for changes away from MUS, J Levenson-DSM V)

    - Stress management (Adrienne Stauder)
    - Sexual problems in medically ill patients (Janos Vizi)
    - Psychooncology
    - Psychosomatic aspects in CVD OR Chronic fatigue OR Psychodermatology (Wolfgang Sllner)

    10.00-10.30 Break
    10.30-12.00 Plenary session 2.

    - Treating Depression and Pain - Practical Findings from Clinical Trials (Kurt Kroenke)
    - Facing the End: Psychotherapeutic Interventions in Patients with Advanced Disease (Gary Rodin)

    12.00-13.00 Lunch break
    Lunch with the expert sessions (expert list finalized later)

    13.00-14.00 Poster session 1. (with poster tour)
    14.00-15.30 Parallel sessions (C)

    - Psychonephrology (Istvan Mucsi, Marta Novak)
    - Gender issues (Maria Kopp)
    - One case, different views

    - Psychopharmacology: including "The SAD Triad: Managing Patients with Somatic, Anxiety, and Depressive Symptoms" (Kurt Kroenke)

    - Attachment (Paula Ravitz)

    15.30-16.00 Break
    16.00-17.00 EACLPP working groups

    Workgroup 1: CL psychiatry in primary care
    Chair: D. Berardi

    Workgroup 2: Medically unexplained symptoms
    Chair: F. Creed

    Workgroup 3: Child and adolescent CL psychiatry
    Chair: P. Hindley

    Workgroup 4: Procedural guidelines in consultation psychiatry
    Chairs: A.F.G. Leentjens and A. Diefenbacher

    - Session of the INTERMED workgroup
    - Psychosomatic aspects in cardiovascular disease
    - Early carrier event, junior Balint Group

    17.15-18.30 Poster session 2. (with poster tour)
    19.30 Conference dinner (Boat tour on Danube)

    SATURDAY, 2 JULY, 2011

    8.30-10.00 Plenary session 3.
    - Gender and Health (Maria S. Kopp)
    - Attachment in physical illness (Jon Hunter)

    10.00-10.30 Break
    10.30-11.30 Plenary session 4.

    - Selected countrywise presentations: C-L Psychiatry and Psychosomatic Medicine in Eastern Europe (Chair: A. Leentjens)

    11.30-12.30 Plenary session 5.

    Panel discussion, with 5 minute presentations: Future of Psychosomatic Medicine and
    CL Psychiatry (Albert Lentjeens, Wolfgang Sllner, Per Fink)

    12.30-13.00 Closing Ceremony

    Best poster and best oral presentation awards, closing remarks, preview of Aarhus (DK) 2012 meeting.

    January 27, 2011 - Organisers
  7. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    (I'll be putting this out on Co-Cure tomorrow.)

    Here's another PDF of a brochure:

    "The Mental Health Research Network is part of the National Institute for Health Research and our mission is to help make research about mental health happen within the NHS in England.

    We offer research teams very practical support to help get studies up and running, and can introduce you to people with experience of mental health problems, their family members and mental health professionals who are interested in advising or collaborating on projects. We employ dedicated teams of staff to help recruit participants to MHRN-supported studies through services run by about 60 NHS trusts.

    Our specialist e-science officers can support information technology needs of each project.

    The Mental Health Research Network is led by the Institute of Psychiatry at Kings College London and the University of Manchester."

    6-8 April 2011 Cambridge

    NHS National Institute for Health Research

    Mental Health Research Network

    Developmental and youth mental health research

    MHRN 2011 National
    Scientific Meeting

    Organised by the MHRN East Anglia Hub

    Page 5

    Parallel session 2 | room LG18

    13.15: Improving our treatment of bodily distress syndromes

    Chair: Professor Francis Creed
    University of Manchester

    (Ed: Note the term "bodily distress" is the term being peddled by Creed's colleague, Per Fink.)

    Note also, that although the forthcoming edition of DSM is referred to in this meeting brochure as "DSM-V", the APA did confirm, last year, that the use of Roman numerals has been dropped and that the next edition will be known as "DSM-5" and that updates, post publication in 2013, are planned to be styled as "DSM-5.1", "DSM-5.2" (as patches and fixes are released :eek:p).


    Professor Peter White
    Queen Mary, University of London

    Professor Chris Williams
    University of Glasgow

    Dr John McBeth
    Keele University

    Professor Francis Creed
    University of Manchester


    Page 19

    Parallel session 2

    13.15: Improving our treatment of bodily distress syndromes
    (room LG18)

    Chair: Professor Francis Creed
    professor of psychological medicine, University of Manchester and honorary
    NHS consultant at Manchester Mental Health and Social Care Trust

    Francis Creeds research interests include the aetiology and treatment of bodily
    distress and other psychological disorders associated with medical disorders.
    He is European editor of the Journal of Psychosomatic Research (1999-) and
    past president of the European Association of Consultation-Liaison Psychiatry
    and Psychosomatics. He is a member of the DSM-V Workgroup on Somatic
    Symptom Disorders (2007-) and was a member of the NICE guideline
    development group concerning treatment of depression in people with
    chronic physical health problems (2008-9). He is an elected Fellow of the
    Academy of Medical Sciences (2000) and was awarded the Hackett Award
    for lifetime achievement in consultation-liaison psychiatry from the Academy
    of Psychosomatic Medicine, USA (2009).

    (Ed: Note: this is a Mental Health scientific meeting.)

    PACE trial results: how should we treat chronic fatigue syndrome?

    Professor Peter White
    professor of psychological medicine, Barts and the London Medical School,
    Queen Mary, University of London

    Peter Whites research background has focused on both understanding the
    aetiology and improving the management of chronic fatigue syndrome, using a
    biopsychosocial and integrative approach. The PACE trial compares interventions
    based on this approach.

    The PACE trial (Pacing, Activity and Cognitive behaviour therapies: a
    randomised Evaluation) is a randomised, controlled, multi-centre trial
    that compares four essentially non-pharmacological treatments in over
    600 secondary care patients attending six clinics in England and Scotland.
    All participants received specialist medical care, three arms also received
    a therapy: adaptive pacing therapy, cognitive behaviour therapy and
    graded exercise therapy. This presentation will give the main results
    of benefits and harms up to 12 months after randomisation.

    The epidemiology of multiple somatic symptoms and implications for DSM-V

    Professor Francis Creed
    professor of psychological medicine, University of Manchester
    (see biography above).

    The data presented in this talk come from nine population-based surveys
    of somatic symptoms including our own from Manchester. These studies
    were brought together using an American Psychiatric Association grant
    to support the work of the DSM-V Somatic Symptom Disorders Workgroup.
    The data support two important changes to the previous DSM somatoform
    definitions and the creation of the new diagnosis of complex somatic symptom
    disorders DSM-V 1. It is reasonable to move away from medically unexplained
    symptoms as a principal diagnostic criterion. High healthcare use can now
    be regarded as an outcome, rather than as a diagnostic criterion, as limited
    prospective data demonstrate that multiple somatic symptoms and health
    anxiety predict future healthcare use even after adjustment for anxiety and
    depression. It is hoped that the new diagnoses will have greater clinical utility
    than their predecessors.

    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 Jun;66(6):473-6.

    Common and unique risk factors for unexplained chronic widespread pain and chronic fatigue

    Dr John McBeth
    reader in chronic pain epidemiology, Arthritis Research UK Primary Care
    Centre, Primary Care Sciences, Keele University

    Dr McBeth graduated from Dundee University with a first class honours in
    psychology. He was awarded a PhD from the University of Manchester based
    upon a prospective population-based study of psychological risk factors for the
    onset and chronification of chronic widespread pain/fibromyalgia. Over the past
    10 years, he has identified stress-related physiological mechanisms that mediate
    the risk of developing chronic widespread pain in high risk populations, described
    the co-occurrence of common unexplained disorders, and the long-term outcome
    of those disorders.

    The General Practice Symptoms Study, a cross-sectional population-based study
    in a randomly selected sample of 1,443 individuals, was designed to determine
    whether chronic widespread pain and chronic fatigue share common risk
    factors, and to identify the effect of concurrent psychiatric disorder. Many
    risk factors were associated with both disorders including being separated,
    widowed or divorced, psychological abuse during childhood, and recent
    threatening experiences. Other factors were uniquely associated with an
    individual disorder: a recent illness in a close relative, neuroticism, depression
    and anxiety scores were all uniquely associated with chronic fatigue. Risk
    factors with a common effect were associated with both disorders only
    when there was concurrent anxiety/depression. This was not so for risk
    factors without a common effect. Understanding the aetiology of these
    syndromes requires disentangling risk factors associated with and without
    concurrent anxiety and depression.


    Poster 32

    Medically unexplained symptoms and liaison psychiatry service:
    case report, evidence-based treatments and integrated pathway with
    role of liaison psychiatry service

    Dr M Wong, Dr V R Badrakalimuthu, Dr C Morrison and Dr C Walsh
    Liaison Psychiatry, Addenbrookes Hospital, Cambridge, and Department
    of Engineering, University of Cambridge, Cambridge

    Medically unexplained symptoms (MUS): About 1020 per cent of patients
    who present physical symptoms in primary care, can be diagnosed with MUS
    and have poor quality of life. Empowering explanations from doctors and
    psychological treatments are associated with good prognosis and can reduce
    healthcare contacts. This presentation involves a case report and discussion
    on how liaison psychiatry can influence and integrate patient pathway.
    Developing integrated care pathway for MUS: From considering the case
    studies of a range of patients and mapping out possibilities, we identified four
    themes that need to be considered in entrance, treatment and exit stages:
    education/supervision; patient acceptance; integration/continuity; data.
    Liaison psychiatry: Liaison psychiatry is the sub-specialty which provides
    psychiatric treatment to patients attending general hospital and deals
    with the interface between physical and psychological health. Thus, it is
    ideally placed with skills, resource and knowledge to link with acute and
    primary care in assessing and managing patients with MUS as well as
    developing services. Role for liaison psychiatry includes: 1. act as a hub
    for knowledge and skills in assessing and treating MUS, and in this role
    can provide education, training and supervision to patients, carers and
    services; 2. provide assessment and bio-psycho-social treatments for the
    most challenging patients with MUS; 3. provide guidance on developing
    integrated patient journey pathways by identifying criteria for referrals and
    management across the health sector, based on clinical presentation as well
    as skills of teams; 4. act as an advocate for patients with MUS to receive timely
    and appropriate psychosocial interventions.
  8. insearchof

    insearchof Senior Member

    Neilk, great news!

    Thanks Dr John.

    Thanks Suzy for all the information and reference material.....great work!

    Absolutely......which is why all persons, iLL or not, should be very concerned about the extent of what is being proposed.

    What astounds me is that this group seems to have trotted theses proposals in on the you rightly point out they refer to their own reference materials, together with unpublished and incomplete studies.....citing such to introduce these sweeping changes and then....they commission studies as the proposals develop that surprisingly support the need for these reforms! I.e :The epidemiology of multiple somatic symptoms and implications for DSM-V Professor Francis Creed.

    Further, given the questionable data on the extent of prevalence of somatoform disorders. (which also questions one of the rationales for the reforms) appears questionable and it would be a joke if the consequences were not so serious.

    Absolutely. And irrespective of whether legitimacy is bestowed on XMRV or not, having this diagnosis will not make you bullet proof from these reforms. In fact, if it takes a little time for XMRV to be accepted (or if it is not but remains on your medical file) then this information in the hands of the wrong doctor might suggest that the patient fits the CSSD criteria nicely. Especially if the patient has been trying ARV, which is currently frowned upon outside ME CFS specialist care.

    I am surely not the only person who can see this ...yet what I fail to understand is, why there is not and has not been more interest and concern expressed over these matters here in this forum and generally so in the ME CFS community.

    You can grumble all you like about the questionable studies the psyche put out, but there will be a whole lot more of them relating to CFS under CSSD.....which will be employed (as DSMs are) for research purposes. Therefore, it seems to make more sense to devote time and resources on CSSD DSM 5 reforms than criticizing studies that might flow from them.
  9. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    I am advised by Mary Schweitzer that a response has been submitted based on her response last year, which can be read here:

    Submission for 2011 from UK advocate, Peter Kemp, via Co-Cure


    Complex Somatic Symptom Disorder is unmistakably intended to be a diagnosis of mental illness. Yet it risks enveloping patients with undiagnosed disease and injury, new and emerging human diseases and diseases lacking laboratory established biomarkers.

    The proposed revision gives every appearance of having been designed for the specific purpose of including those with Chronic Fatigue Syndrome (CFS) which would clearly lead to mistreatment of patients.

    Szasz (1973) writes: "...the physician confronted with a person without demonstrable bodily illness is often baffled: should he consider such a person a 'patient'? Should he 'treat' him, and if so, for what? In the past, the physician tended to believe that such people ought to submit to the ministrations of either medicine or theology. Now he tends to believe that they ought to submit to the ministrations of either medicine or psychiatry."

    And: "What, then, should the physician do when confronted with a 'patient' without demonstrable bodily illness? How should he classify and treat him? From the standpoint of a dignified medical ethic - respecting equally the patient's and the physician's rights to self-definition and self-determination - the examiner may satisfy his need for the classification by categorizing his professional role or the result of his diagnostic interventions; but he should not impose a categorization on the patient against his will."

    Szasz makes an important point of ethics. If a physician does not know what is ailing a competent sick person with the right of self-determination, assigning a diagnosis is unethical unless the diagnosis is made with the agreement of the patient. This is particularly so because diagnosis is an inextricable aspect of treatment and may be expected to dictate or at least influence the ongoing investigation and treatment of the patient. Assigning a meaningless diagnosis made for the purposes of avoiding the physician's discomfort at not being able to help or the patient's disappointment at being left in uncertainty, would be unethical without patient and physician agreement.

    Thus categorizing an illness in a way that would predictably be objected to by patients that would be affected by such categorization would also be unethical. The categorization of CFS as a Complex Somatic Symptom Disorder whether by design or accident, would be an insupportable move towards certainty and away from the ethical prosecution of medicine.


    Szasz, Thomas. 1973. The Manufacture of Madness. Paladin. Herts.

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  10. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    All published submissions that I am currently aware of are now collated on my site on a dedicated page, here:

    For last year's (February - April 20, 2010) public review submissions, you need this page:

    If you are aware of submissions by other patient organizations, please let me know, via PM.

    If you are submitting as a patient or patient advocate and would like your comment published on my site, please send a formatted or plain text copy by PM or by email direct to

    Please state, clearly, how you would like to be described, for example:

    Pippi Longstocking, patient (US)

    or if you chose not to be identified, for example:

    Carer of young person with ME, (UK)

    No email addresses will be published.

    Please redact any email addresses, street addresses and other personal details from the text of your response that you do not want published.

    If your response runs to more than around four sides of A4, I may post the first paragraph and place the full response in a Word file or PDF instead.

    I reserve the right to omit content which I consider potentially actionable or otherwise unsuitable for publication on my site.


  11. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    EURASMUS appears to have grown out of the workshop

    "Understanding The Genetic, Physiological And Psychological Mechanisms Underlying Disabling Medically Unexplained Symptoms And Somatisation"

    European Science Foundation Exploratory Workshop - EMRC
    Setting Science Agendas for Europe
    Standing Committee for the European Medical Research Councils (EMRC)
    Munich (Germany), 10-12 September 2009

    Convened by: Peter Henningsen (DE), Francis Creed (UK)

    On January 23, I had posted the text of a PDF of a report on this workshop in Post # 61 of this thread:

    A New Term! - "Bodily Distress Syndrome"

    Professor Francis Creed is

    Past President of the European Association of Consultation-Liaison Psychiatry & Psychosomatics (EACLPP).

    Co-editor (with Dr James Levenson, MD) of the Journal of Psychosomatic Research (official organ of the EACLPP).

    Member of the American Psychiatric Association (APA) DSM-5 Work Group for "Somatic Symptom Disorders".

    Had been a member of Dr Richard Sykes' CISSD Project (The Conceptual Issues in Somatoform and Similar Disorders Project, Administrators: Action for M.E., funded by The Hugh and Ruby Sykes Charitable Trust).

    Member of the EACLPP MUS workgroup; co-author of:
    "Patients with medically unexplained symptoms and somatisation -a challenge for European health care systems," A white paper of the EACLPP Medically Unexplained Symptoms study group by Peter Henningsen and Francis Creed.
    Download copy from this page:

    Founding Member of European Research Association for Somatisation and Medically Unexplained Symptoms (EURASMUS) 2010*

    *Ed: I had not come across "EURASMUS" before. It has a webpage.


    "The multidisciplinary European Research Association for Somatisation and Medically Unexplained Symptoms (EURASMUS) was formed to study the genetic, psychological and physiological mechanisms underlying bodily distress.

    "The research focuses on several biological and psychological processes that occur across all types of bodily distress, e.g.:

    - heightened sensitivity to pain
    - tendency to experience and worry about numerous bodily symptoms
    - marked fatigue"​


    1. Francis CREED
    Manchester Royal Infirmary
    United Kingdom


    2. Peter HENNINGSEN
    Klinikum rechts der Isar
    der Technischen Universitt Mnchen

    ESF Representative:

    3. Janos Rthelyi
    Department of Psychiatry and Psychoterapy
    Semmelweis University


    4. Hans KNOOP
    Radboud University Nijmegen Medical Centre
    The Netherlands

    5. Per Klausen FINK
    The Research Clinic for Functional Disorders and Psychosomatics
    Aarhus University Hospital

    6. John MCBETH
    Arc Epidemiology Unit
    University of Manchester
    United Kingdom

    Trimbos Intituut/ Netherlands institute of Mental Health and Addiction
    The Netherlands

    8. J.G.M. ROSMALEN
    Interdisciplinary Center for Psychiatric Epidemiology
    University Medical Center Groningen
    The Netherlands

    9. Ralph MAGER
    Universitre Psychiatrische KlinikenBasel (UPK)

    10. Lukas VAN OUDENHOVE
    Secretary of Liaison Psychiatry
    University Hospital Gasthuisberg

    11. Bernd LWE
    Institut und Poliklinik fr Psychosomatische Medizin und Psychotherapie
    Universittsklinikum Hamburg-Eppendorf

    12. Kari Ann LEIKNES
    Institute of Basic Medical Sciences,
    Department of Behavioural Sciences in Medicine
    Faculty of Medicine
    University of Oslo

    13. Wendy THOMSON
    arc Epidemiology Unit
    School of Translational Medicine
    Epidemiology Research Group
    Stopford Building
    University of Manchester
    United Kingdom

    14. Kenji KATO
    School of Nursing and Rehabilitation
    International University of Health and Welfare
    Kanagawa 250-8588

    15. Peter D WHITE
    Barts and the London School of Medicine and Dentistry,
    Queen Mary University of London
    St Bartholomew's Hospital
    United Kingdom

    16. Nancy PEDERSEN
    Karolinska Institutet
    Department of Medical Epidemiology and Biostatistics

    17. Judith PRINS
    Radboud University Nijmegen Medical Centre
    The Netherlands

    18. Winfried RIEF
    Klinische Psychologie und Psychotherapie
    Universitt Marburg

    19. Harald GNDEL
    Klinische Psychiatrie und Psychotherapie
    Medizinische Hochschule Hannover

    20. Thomas TLLE
    Klinikum rechts der Isar der Technischen Universitt Mnchen
    Neurologische Klinik

    21. Karl-Heinz LADWIG



    Additional information:

    1] Understanding The Genetic, Physiological And Psychological Mechanisms Underlying Disabling Medically Unexplained Symptoms And Somatisation

    European Science Foundation Exploratory Workshop - EMRC
    Setting Science Agendas for Europe
    Standing Committee for the European Medical Research Councils (EMRC)
    Munich (Germany), 10-12 September 2009

    Convened by: Peter Henningsen (DE), Francis Creed (UK)
    Report on workshop:
    Info on ESF:

    2] "One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders." Psychosom Res. 2010 May;68(5):415-26. Fink P, Schrder A. The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8000 Aarhus, Denmark.
  12. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    The following response has been submitted by Dr John L Whiting, Brisbane. It was circulated via the Co-Cure mailing list, yesterday, and is published on this page of my site, with permission of the author, under "Submissions by medical, allied health and other professional stakeholders":

    Submission by Dr John L Whiting, Specialist Physician in Internal Medicine and Infectious Diseases, Brisbane, Australia

    CSSD the creation of a new weapon, a new law!

    Like the invention of the machine gun and its use in WWI so many wasted peoples lives. The ones who pulled the trigger never met eye to eye with their so many victims. So easy for the trigger finger and also, so much unimaginable devastation. But what a wonder weapon of war: I believe that CSSD will be much the same as the machine gun to those who have created it. They will never be able to imagine the suffering that their pet ideology will have created, if they do not correct what they are making.

    We can think of the definition of CSSD in other terms too: what of the rules that allowed doctors selections at train terminals in various locations in Europe during WWII? Who saw what was really coming when each new law was allowed in Germany prior to the war? The outcome was expedient efficiency, but who foresaw that? To add to each deceit prior to the war, we also saw these train station selections were made to appear so innocent to each group of newcomers, but in truth, they were not. CSSD is like a selection system: so innocent looking but in reality, so potentially dangerous!

    The problem with the definition of CSSD is its apparent vagueness. It is a weapon but not everyone sees it as such. We dont like giving guns to babies, but I fear that those who know little about CFS/ME are like these babies. We do not know exactly who these childlike triggermen will be when they have their new toy to play with but we can imagine the consequences of their actions; and we can see the ultimate outcomes of the indiscriminate selections that this CSSD definition permits.

    If we knew with certainty that the definition would be used intelligently, by the best, by those who genuinely cared for patients, we might feel more comfortable. And if we knew that if, by chance, an alternative diagnosis to CSSD was found, the diagnosis of CSSD could be removed without long term stigmatization, then perhaps we might feel even a bit more comfortable about CFFD.

    But I fear that this will not be the case. When should there be a need to make a diagnosis of CSSD? This is the big question. We know that Holocaust victims somatise more often than say well balanced controls but so what? Should they be outcasted once again? The reason for this new definition is not to re-stigmatise these unfortunate victims of the past. In todays world, who will profit the most from this new weapon of mass destruction? Medical insurance companies perhaps? Surely, their hit men will enjoy their new found powers of selection. CBT is not the true rationale for diagnosing CSSD. CBT is simply a front. The real purpose for creating CSSD is for the liquidation of CFS patients and similar undesirables. How can we allow such power to pass into the hands of those who are least likely to use it appropriately?

    CFS/ME is a medical condition. Some patients with CFS/ME somatise, but so do patients distressed by many other medical conditions. How can this committee overgeneralise by stating that if somatisation is present amongst CFS/ME patients, then the condition as a whole is one of somatisation as well? Moreover, whilst psychiatry is an essential and noble profession, psychiatrists are usually the least qualified to make judgements on matters that are purely medical.

    But who is the final arbiter? Who is the final authority to whom the DSM-5 committee for somatoform disorders answerable? If they are only answerable to themselves, heaven forbid!

    Dr John L Whiting
    Specialist Physician in Internal Medicine and Infectious Diseases
    Brisbane, Australia


    Dr Ellen Goudsmit has stated on ME Association Facebook that she has submitted this year; no copy is currently available. Last year, the ME Association did not submit a response but endorsed a submission of Dr Goudsmit. Dr Shepherd has said that he will be attending to the matter of a submission, this week.
  13. Cort

    Cort Phoenix Rising Founder

    Powerful stuff from a physician - and a really good point about how easy it may be for people ignorant in ME/CFS to throw it into another pigeonhole.
  14. sleepy237

    sleepy237 Senior Member

    All i can say from experience and not an attack on one individual is that psychiatry the doctors of the MIND are the most NARROW MINDED OF ALL! DISAPPOINTED.
  15. Nielk


    What a powerful letter by Dr. John Whiting!
    Who are the people on the panel of the ADA holding our future in their hands? Does anyone know?
    Who will benefit from this ridiculous addition?
    Are they there to benefit patients or the insurance agencies.
    Do we pay them with our tax money?
    What power they have in their hand to affect the future of millions of sick people. How did they even come to think this diagnosis up?
  16. justinreilly

    justinreilly Senior Member

    NYC (& RI)
    I left comments on CSSD and SSSD. Thanks everyone who has been on top of this!
  17. insearchof

    insearchof Senior Member


    You might find these articles of interest


    And an interesting short video " The DSM Inventing Mental Illness"
  18. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    The following comment by Angela Kennedy is published on my site under the category "Submissions by medical, allied health and other professional stakeholders"

    Copies of last year's submissions here:

    Copies of this year's submissions here:


    Submission by Angela Kennedy, sociology lecturer (UK)

    I am writing to address the potential revision of the American Psychiatric Associations (APA)s Diagnostic and Statistical Manual for Mental Disorders (DSM-5), specifically related to the diagnoses that denote psychogenic explanations for somatic (physical) illnesses of uncertain aetiology, and their proposed reshuffling.

    I write as a sociology lecturer and researcher, who as part of her research has been critically evaluating psychogenic explanations somatic (physical) illnesses of uncertain aetiology, and as a parent and carer of a woman who suffers from an organic illness that still is subject to uncertainties in knowledge of aetiology.

    Psychiatry, and medicine generally, has historically been dogged by the fundamental problem (indeed, fallacy) of inserting a god of the gaps theory into areas where medical knowledge about somatic processes is limited. This sadly has not changed just because medical knowledge has increased, especially as, any reasonable person would acknowledge, medical knowledge is not yet complete, and may never be: therefore gaps in knowledge remain, and unfortunately these are often filled, discursively, with psychogenic explanations.

    In particular, the new categories of Complex Somatic Symptom Disorder (CSSD) and Simple Somatic Symptom Disorder (SSSD), and the diagnoses it may replace, result from a fallacy of assuming that, just because presenting somatic illnesses are not easily explained by immediately obvious organic processes, they are therefore medically unexplained, and, by default, psychogenic in nature. It denotes a fallacious belief in the doctor that an illness is not organic, but resulting from metaphysical processes based on abstract constructs (beliefs, lies, delusions). These metaphysical processes are conflated with confused beliefs that the patient is doing one or more of the following: malingering; imagining impairment that is not present; hypochondria (having abnormal or inappropriate chronic anxiety about ones health); or an assumption of mind over bodyprocesses, denoting a belief that behavioural problems, negative attitudes or emotional tension cause the body to develop impairments, accompanied by a belief that one can think oneself better, actually reduce or eliminate physiological impairment, by the positive power of the mind.

    Therefore, far from overcoming the problems of the concept and term of medically unexplained illness, which I understand has been claimed as an advantage of the new diagnostic categories in the various editorials in psychological, psychiatric and medical journals, these proposed diagnoses will merely reify and re-jiggle the fallacious notions upon which they are based.

    My concerns are that, as a result, these diagnostic categories will lead to greater misdiagnosis (even than is already unfortunately occurring) of organic illness as psychogenic, leading to psychogenic dismissal of illness symptoms and signs, both in patients given diagnoses denoting illnesses of uncertain aetiology (such as, for example, but not limited to, Myalgic Encephalomyelitis or Chronic Fatigue Syndrome, or Fibromyalgia), and in patients with established uncontested illnesses, such as cancer, AIDS and diabetes. They will lead to further psychogenic dismissal of somatic signs and symptoms, and an epistemic laziness that will prevent doctors from working to elucidate and treat organic dysfunction that may be extremely disabling to a patient, placing that patient at risk of further harm or even death. They will also lead to increased stigmatising and other adverse effects of being assigned a psychiatric diagnosis, in this case based on a fallacy of reasoning.

    Viewing a patient through the prism of a belief they are psychogenically, not organically ill, leads to doctors and other mistaking a patients distress and other responses to the impact of organic illness (especially if difficult to diagnose) as causative of that illness, and indeed, all future illnesses that patient endures.

    There is copious evidence that the whole concept of somatoform disorders and their synonyms, signifying psychogenic explanations for illnesses of uncertain aetiology, have already led to these problems. The categories of CSSD and SSSD therefore will merely reify problematic and often dangerous medical practices that already exist.

    Both the new proposals of CSSD and SSSD, and those diagnostic categories that they are proposed to replace, signify the problem as described by Thomas Szasz (1997:23)

    "In the days of the Malleus, if the physician could find no evidence of natural illness, he was expected to find evidence of witchcraft: today, if he cannot diagnose organic illness, he is expected to diagnose mental illness."

    They may indeed fill the discursive space left inadequately explained by medical accounts (Newton, 1999: 244). But their usefulness in the filling of discursive space of medicine, they are based on fallacious reasoning and cause iatrogenic effects.

    While it is to be hoped that, in time, advances in psychiatric and medical reasoning will eventually render the current DSM categories, associated with default psychogenic explanations for illnesses of uncertain aetiology, defunct, the insertion of CSSD and SSSD into the new DSM is extremely worrying because those who propose these new diagnoses clearly believe their propositions already denote advances in psychiatric thinking, when they do not. It therefore means erroneous confidence in their use may well be high. Their insertion is also likely to facilitate an even greater risk of irrational black-boxing of alleged but un-elucidated and therefore unsafely assumed psychogenic processes, so that doctors would not be required to robustly defend the logic or rationality of their diagnosis, even to themselves, increasing the risk of misdiagnosis and its adverse effects.

    These problems also apply to the proposal to re-brand "Conversion Disorder" as "Functional Neurological Disorder". Here a field where knowledge remains relatively limited (neurology) is particularly at risk of psychogenic explanations by default in the wake of uncertainty in medical knowledge about neurological signs and symptoms. The use of the term functional here- where one of the definitions of the term is not due to discernible organic disease according to the Oxford English Dictionary- means the bedrock of this diagnosis is uncertainty of aetiology leading to a fallacious default psychogenic diagnosis. Medical use of the term in this way is demonstrated by Stone et al (2005).

    Please do not hesitate to contact me if you have any further questions about or need for clarification of the points I have made here.

    Angela Kennedy


    Newton, T. Stress Discourse and Individualization in Feltham (1999) 241-251.

    Stone, J. et al Functional Symptoms in Neurology: Diagnosis and Management Advances in Clinical Neuroscience and Rehabilitation vol. 4 no. 6 (2005) pp 8-11.

    Szasz, T. The Manufacture of Madness: a Comparative Study of the Inquisition and the Mental Health Movement (1997) Syracuse University Press, New York.

  19. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch


    Nielk, I'm going over ground which was covered, last year, in the original DSM-5 thread, started in late 2009, and I am up to my eyes fielding enquiries around DSM-5, so I'll keep this brief:

    There is a DSM-5 Task Force and 13 Work Groups. The names of the members of the Task Force and the various work groups were published by the APA, via a News release, in May 2008, following criticism about lack of transparency. The Work Groups were assembled in 2007.

    The DSM-5 "Somatic Symptom Disorders" Work Group (SSD WG) has responsibility for the revision of the existing DSM-IV "Somatoform Disorders" categories.

    This predominately US member Work Group includes two influential UK professors of psychological medicine and research, Professor Michael Sharpe and Professor Francis Creed.

    The members of the Work Group for "Somatic Symptom Disorders" are:

    Dimsdale, Joel E., M.D. (CHAIR)
    Barsky III, Arthur J., M.D.
    Creed, Francis, M.D.
    Frasure-Smith, Nancy, Ph.D.
    Irwin, Michael R., M.D.
    Keefe, Francis J., Ph.D.
    Lee, Sing, M.D.
    Levenson, James L., M.D.
    Sharpe, Michael, M.D .
    Wulsin, Lawson R., M.D.

    If you go to the link, and click on each name, you can pull up bios and Disclosures for each member. There are links for the APA's policies on COIs and work group members on this page:

    The four in bold had also been members of Dr Richard Sykes' unofficial "CSSD Project" which ended in 2007. Michael Sharpe was its UK chair; the US chair had been Kurt Kroenke.

    The CSSD Project has been extensively covered on my ME agenda website.

    Javier Escobar, MD, Director of the University of Medicine and Dentistry of New Jersey (UMDNJ) Robert Wood Johnson Medical School (RWJMS) Medically Unexplained Physical Symptoms (MUPS) Research Center, which has been supported with M$$$ funding from the US National Institute of Mental Health (NIMH), is a member of the DSM-5 Task Force.

    Escobar serves as Task Force liaison to the Somatic Symptom Disorders Work Group and works closely with this group. (In 2008, he co-authored a Special Report for Psychiatric Times: Unexplained Physical Symptoms Whats a Psychiatrist to Do? )

    In Table 1 of this document are listed many of the diseases and disorders that are likely to be captured by the proposed "CSSD" and "SSSD" categories.

    Creed is very influential in the MUS field, in Europe. He is also co-editor of the Journal of Psychosomatic Research (with DSM-5 SSD Work Group member, James Levenson).

    The journal has been used as a discussion platform for DSM-5 classificatory issues, for publishing editorials, articles and papers by SSD Work Group members and for expanding on the Work Group's two very sketchy progress reports that were published on the DSM-5 Development site, in 2009 (there are copies of these two reports archived on my site here: )

    The original name for the Work Group had been "Somatic Distress Disorders" Work Group.

    Creed and Per Fink favour the term "Bodily distress disorder" over "Complex somatic symptom disorder" and both already use the former term.

    I'm posting the material below, mainly for ISO, as I could not find it, last week:

    Extracted from Dx Revision Watch site:

    The Editorial: Is there a better term than Medically unexplained symptoms? Creed F, Guthrie E, Fink P, Henningsen P, Rief W, Sharpe M and White P (Journal of Psychosomatic Research: Volume 68, Issue 1, Pages 58 January 2010) discussed the deliberations of the EACLPP MUS study group. The Editorial also includes references to the DSM and ICD revision processes.

    References to DSM and ICD revision in:

    Is there a better term than Medically unexplained symptoms? J Psychoso Res: Volume 68, Issue 1, Pages 58.


    The European Association of Consultation Liaison Psychiatry and Psychosomatics (EACLPP) is preparing a [White paper of the EACLPP Medically Unexplained Symptoms study group by Peter Henningsen and Francis Creed] document aimed at improving the quality of care received by patients who have medically unexplained symptoms or somatisation [1]. Part of this document identifies barriers to improved care and it has become apparent that the term medically unexplained symptoms is itself a barrier to improved care

    The authors of this paper met in Manchester in May 2009 to review thoroughly this problem of terminology and make recommendations for a better term.The deliberations of the group form the basis of this paper


    Our priority was to identify a term or terms that would facilitate management that is it would encourage joint medical psychiatric/psychological assessment and treatment and be acceptable to physicians, patients, psychiatrists and psychologists.

    Criteria to judge the value of alternative terms for medically unexplained symptoms

    Ten criteria were developed in order to judge the value of potential terms which might be used to describe the group of symptoms currently referred to as medically unexplained symptoms. Obviously, this list of criteria does not claim to be exhaustive, but we believe that it captures the most important aspects. The criteria are that the term:

    1. is acceptable to patients
    2. is acceptable and usable by doctors and other health care professionals, making it likely that they will use it in daily practice.
    3. does not reinforce unhelpful dualistic thinking.
    4. can be used readily in patients who also have pathologically established disease
    5. can be adequate as a stand alone diagnosis
    6. has a clear core theoretical concept
    7. will facilitate the possibility of multi-disciplinary (medical and psychological) treatment
    8. has similar meaning in different cultures
    9. is neutral with regard to aetiology and pathology
    10. has a satisfactory acronym.

    Terms suggested as alternatives for medically unexplained symptoms

    The group reviewed terms which are used currently or have been proposed for the future. An extensive list was abbreviated to the following 8 terms or categories: The terms we reviewed were:

    1. Medically unexplained symptoms or medically unexplained physical symptoms
    2. Functional disorder or functional somatic syndromes
    3. Bodily distress syndrome/disorder or bodily stress syndrome/disorder
    4. Somatic symptom disorder
    5. Psychophysical / psychophysiological disorder
    6. Psychosomatic disorder
    7. Symptom defined illness or syndrome
    8. Somatoform disorder


    Implications for DSM-V and ICD-11

    There is overlap between the discussion reported here and the discussion currently under way towards the creation of DSM-V. Two of the authors (FC, MS) are also members of the working group on Somatic Distress Disorders of the American Psychiatric Association (APA), which is proposing a new classification to replace the DSM-IV somatoform and related disorders. In this working group, similar concerns about the use of the term and concept of medically unexplained symptoms have been raised [12]. The current suggestion by the DSM-V work group to use the term Complex somatic symptom disorder must be seen as step in a process and not as a final proposal. Unfortunately this term does not appear to meet many of the criteria listed above.


    One major problem for reforming the classification relates to the fact that the DSM system includes only mental disorders whereas what we have described above is the necessity of not trying to force these disorders into either a mental or physical classification. The ICD-10 system has a similar problem as it has mental disorders separated from the rest of medical disorders.

    The solution of interface disorders, suggested by DSM IV, is a compromise but it is unsatisfactory as it is based on the dualistic separation of organic and psychological disorders and prevents the integration of the disorders with which we are concerned here. This lack of integration affects the ICD classification also. For example functional somatic syndromes (e.g. irritable bowel syndrome) would be classified within the physical classification of ICD or Axis III in DSM (gastrointestinal disorders) and omitted from the mental and behavioural chapter entirely [13].

    [End Extract]

  20. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch


    While the forums have been offline, I have added a number of submissions to my site:

See more popular forum discussions.

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