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"Bodily Distress Disorders" to replace "Somatoform Disorders" category for ICD-11?

Discussion in 'Action Alerts and Advocacy' started by Dx Revision Watch, Feb 19, 2012.

  1. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    There is already a thread on the monitoring of ICD-11 that I started a couple of years ago, but I think this merits a new thread. When I have located it, I will insert the link for the existing thread, for ease of reference.

    19 February 2012

    This is a longish post but it contains an important update on proposals for ICD-11 Chapter 5: Mental and behavioural disorders

    Permission to republish, if published in full and with source and website attribution. A version of this report is published on Co-Cure Listserv and a version will be published on Dx Revision Watch later today.



    In an interview with Tom Sullivan, last week, for Health Care Finance News, Christopher Chute, who chairs the ICD-11 Revision Steering Group, intimated a possible delay for completion of ICD-11 from 2015 to 2016. Nevertheless, an ICD-11 Beta drafting platform remains scheduled to launch in May, this year.

    The Beta draft will take the form of a publicly viewable browser platform similar to the Alpha drafting platform that has been in the public domain since last May.

    You can view the entry pages for the Alpha Drafting Browser here:

    Foundation Component view:

    http://apps.who.int/classifications/icd11/browse/f/en

    Morbidity Linearization view:

    http://apps.who.int/classifications/icd11/browse/l-m/en

    A User Guide is here:

    http://apps.who.int/classifications/icd11/browse/Help/en


    The various ICD Revision Topic Advisory Groups (TAGs) are carrying out their work on a separate, more complex, multi-author drafting platform.

    When the Beta drafting platform is launched, interested stakeholders will be invited to register for increased access for interacting with the drafting process by submitting comments and suggestions on the draft.

    It is also possible to register for increased access to the Alpha drafting platform and to download PDFs of drafts for the "Print Versions for the ICD-11 Alpha Morbidity Linearization" for each chapter of ICD-11.


    Caveats

    I'm going to reiterate the ICD-11 Alpha Browser Caveats because it's important to understand that the ICD-11 Alpha draft is a work in progress:

    The draft is updated on a (usually) daily basis; when you view the Alpha Browser, you are viewing a "snapshot" of how the publicly viewable draft stood at the end of the previous day; not all chapters are as advanced as others for organization and completion of content; the draft is incomplete and may contain errors and omissions; the codes and "sorting labels" assigned to ICD parent classes and child categories may change as work on the draft progresses and according to the reorganization of chapters; the Alpha draft has not yet been approved by the Topic Advisory Groups, Revision Steering Group or WHO and content in the draft may not progress to the Beta drafting stage.

    We may have a clearer idea of what is being proposed when the Beta drafting platform is released, but at the moment, the Alpha lacks clarity; not all of the textual content has been generated and added to this section of the draft; not all of the 13 "Content Model" parameters display in the public version of the draft, and for those that do, not all have been populated with definitions and other textual content.

    The two chapters of most relevance to us are Chapter 5: Mental and behavioural disorders and Chapter 6: Disorders of the nervous system (the Neurology chapter). (ICD-11 is dropping the use of Roman numerals.) I'm not going to discuss Chapter 6 in this post but I will do a follow up post for Chapter 6 in a few days, again there is a lack of clarity and requests for clarification from the chair TAG Neurology and the lead WHO Secretariat for TAG Neurology have met with no response.

    ICD-10 Chapter 5 "Somatoform Disorders"

    This is the section that corresponds with the current "Somatoform Disorders" section in DSM-IV.

    You can compare the current DSM-IV "Somatoform Disorders" categories with the current ICD-10 "Somatoform Disorders" categories in this (simpified) table which lists only the category terms, not the criteria:

    [​IMG]


    For those not aware of DSM-5 proposals: The DSM-5 "Somatic Symptom Disorders" Work Group proposes to rename its "Somatoform Disorders" section to "Somatic Symptom Disorders" and to roll a number of existing disorders within this section into a brand new category, "Complex Somatic Symptom Disorder" (which would include the previous diagnoses of somatization disorder [DSM IV code 300.81], undifferentiated somatoform disorder [DSM IV code 300.81], hypochondriasis [DSM IV code 300.7], as well as some presentations of pain disorder [DSM IV code 307]) and the more recently proposed, "Simple Somatic Symptom Disorder," which requires a somatic symptom duration of just one month, as opposed to six months to meet the CSSD criteria.

    You can view the criteria for CSSD and SSSD as they stood last May, at the second public review and comment exercise, here on my site:

    http://dxrevisionwatch.wordpress.com/dsm-5-proposals/dsm-5-proposals-sub-page-1/dsm-5-drafts-2/


    Up until recently, the ICD-11 Alpha draft listings for the Chapter 5: Somatoform Disorders section were little changed from those in ICD-10, with the exception of what appears to be a new category called "05A08.06.01 Chronic pain disorder with somatic and psychological factors" which doesn't appear in ICD-10 Version: 2010 under F45.4.

    (That might be problematic for Fibromyalgia patients.)


    When I checked the Alpha Browser on 17 February, this section for "Somatoform Disorders" has been reorganized.


    "Bodily Distress Disorders" to replace "Somatoform Disorders" category for ICD-11?

    Please study this screenshot:

    [​IMG]


    and this page on the Alpha Browser (click the little arrows to display the dropdown child categories):

    http://apps.who.int/classifications/icd11/browse/l-m/en#/http://who.int/icd#F45

    If you can't view the images that section looks like this:

    05A08 BODILY DISTRESS DISORDERS

    05A08.00 Mild bodily distress disorder
    05A08.01 Moderate bodily distress disorder
    05A08.02 Severe bodily distress disorder
    05A08.03 Somatization disorder
    05A08.04 Undifferentiated somatoform disorder
    05A08.05 Somatoform autonomic dysfunction
    05A08.06 Persistent somatoform pain disorder
    05A08.06.00 Persistent somatoform pain disorder
    05A08.06.01 Chronic pain disorder with somatic and psychological factors
    05A08.07 Other somatoform disorders
    05A08.08 Somatoform disorder, unspecified


    Continued in next post
     
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  2. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    Continued from previous post


    Instead of "Somatoform Disorders" at parent class 05A08 we see "BODILY DISTRESS DISORDER" and three new categories: 05A08.00 Mild bodily distress disorder; 05A08.01 Moderate bodily distress disorder; 05A08.02 Severe bodily distress disorder.

    Hypochondriacal disorder (ICD-10 F45.2) is no longer listed, but it may appear under another parent class or is possibly proposed to be subsumed into "bodily distress disorder."

    Because no "Change Notes" or "Change history" records display in this version of the Alpha Drafting browser, it isn't possible to determine whether ICD-11 is proposing to introduce three new categories: 05A08.00 Mild bodily distress disorder; 05A08.01 Moderate bodily distress disorder; 05A08.02 Severe bodily distress disorder in addition to retaining the categories 05A08.03 thru 05A08.08.

    Because the draft is a work in progress, it isn't possible to determine whether the categories currently sitting at 05A08.03 thru 05A08.08 are destined to be subsumed into the three Bodily distress disorder categories in a similar fashion to the subsuming of a number of existing DSM-IV categories into "Complex Somatic Symptom Disorder."

    None of the three new categories have any textual content displaying for them yet on the right hand side of the browser page, so again, one cannot determine what disorders ICD-11 intends would be captured by these three new categories.

    I am attempting to establish what these three new categories being proposed for ICD-11 are intended to categorize, what their criteria would be, and what their relationship is with the existing categories listed between 05A08.03 thru 05A08.08.

    Without more information one cannot determine what the intentions might be or how enthusiastic ICD-11 TAG MH might be about this proposal. There may be pressure from Fink, Creed and Goldberg but the RSG, TAG MH and Geneva classification experts to whom the TAGs report may not welcome the construct or consider "Bodily distress disorder" a valid replacement for the MUS element of the existing Somatoform Disorders section of ICD-10 and this proposal may not survive to make it into the Beta drafting platform.


    Update: I have established that what was Hypochondriacal disorder [ICD-10 F45.2] is now listed as Illness Anxiety Disorder under

    http://apps.who.int/classifications/icd11/browse/l-m/en#/http://who.int/icd#F45.2

    ID : http://who.int/icd#F45.2

    05A04 ANXIETY AND FEAR-RELATED DISORDERS

    > 5A04.05 Illness Anxiety Disorder



    Continued in next post
     
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  3. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    Continued from previous post


    According to this July 2011 document: http://www.wpanet.org/detail.php?section_id=19&content_id=1082

    There is an ICD-11 Revision Working Group on Somatoform Disorders (led by O. Gureje).

    -------------

    According to this page: http://www.medicine.manchester.ac.uk/staff/FrancisCreed

    Prof Francis Creed is listed as a "Member, WHO ICD-11 working group on Bodilly [sic] distress disorders."


    Has the ICD-11 working group had a change of name or is this an additional working group?

    -------------


    According to this article: http://www.cfha.net/blogpost/739496/132376/Whats-in-a-Name.htm

    [...]

    "In the WONCA chapter, Dr. Ivbijaro's peer review committee (which included Professor Sir David Goldberg) recommended a change in terms from "medically unexplained symptoms" to "bodily distress syndrome." In the peer review feedback, the committee recommended this change "which takes away from the therapeutic nihilism suggested by the term medically unexplained symptoms and better supports patient engagement." Dr. Goldberg is using the term bodily distress syndrome in his draft of the Primary Health Version of ICD-11."

    ------------


    According to this article:

    http://www.nzdoctor.co.nz/in-print/2011/june-2011/15-june-2011/'heartsinks'-and-weird-symptoms.aspx

    15 June 2011

    [...]

    Classification no-man's land
    Stranded between organic medicine and psychiatry, functional and somatic syndromes struggle to be classified logically and hence subjected to logic when it comes to treatment. In clinical practice, it is impossible to divide patients who suffer from functional syndromes into those having a medical functional somatic syndrome, such as fibromyalgia, and those having a mental disorder, such as neurasthenia and somatisation disorder.

    The various somatic syndromes may partly be a result of medical specialisation. For example, fibromyalgia as a diagnosis has come from rheumatology, while the irritable bowel syndrome diagnosis is a consensus definition of gastroenterologists.

    There is considerable overlap in symptoms for the different syndromes and clusters of typical complaints. Many patients with irritable bowel syndrome, for example, also meet the diagnostic criteria for chronic pelvic pain or fibromyalgia, and vice versa.

    While GPs know many patients have multiple symptoms from different organ systems, recent epidemiological studies still support the existence of separate somatic syndromes and they are thus most appropriately seen as a family of closely related disorders that share common aetiological factors, pathophysiological mechanisms and psychological characteristics.

    Given that similar treatment strategies have proved effective for various functional syndromes, a unified approach to classifying and managing these conditions seems a promising way to improve patient care.

    "Bodily distress syndrome" to the rescue
    Recently, bodily distress syndrome (BDS) has been introduced as an empirically based term and diagnosis that may help resolve the problems to do with illogical classification.2 The hallmark of BDS is that the patient suffers from various physical symptoms of bodily distress.

    The BDS diagnosis is defined by positive criteria and is not a diagnosis of exclusion. A diagnosis of BDS can be made on the basis of symptoms from a single organ system, for example, single-organ type with arousal symptoms from heart, respiratory and circulatory system, or from symptoms from muscles and joints, or from a number of different organ systems. An outline of different symptom groups contributing to the diagnosis is provided in Panel 1.

    [...]

    Table

    Bodily distress syndrome - symptom groups (Panel 1)

    More than three symptoms persisting for more than a month are required for a diagnosis of bodily distress syndrome

    Cardiopulmonary/autonomic arousal symptoms
    Palpitations/heart pounding, precordial discomfort, breathlessness without exertion, hyperventilation, hot or cold sweats, trembling or shaking, dry mouth, churning in stomach/"butterflies", flushing or blushing

    Gastrointestinal arousal symptoms
    Abdominal pains, frequent loose bowel movements, feeling bloated/full of gas/distended, regurgitations, constipation, diarrhoea, nausea, vomiting, burning sensation in chest or epigastrium

    Musculoskeletal tension symptoms
    Pains in arms or legs, muscular aches or pains, pains in the joints, feelings of paresis or localised weakness, backache, pain moving from one place to another, unpleasant numbness or tingling sensations

    Three general symptoms
    Concentration difficulties, impairment of memory, excessive fatigue, headache, dizziness

    Four symptoms from one of the above groups

    ------------


    This workshop took place in Sept 20 2011 at a Symposium in Buenos Aries:

    http://www.wpa-argentina2011.com.ar/tuesday_september_20.htm

    [...]

    14.45-16.15 Regular Symposium RS36

    PROPOSALS FOR THE ICD-11 CLASSIFICATION OF MENTAL DISORDERS IN PRIMARY CARE

    Chairperson: G. Reed (Switzerland) (TAG MH Co-ordinator)

    RS36.1 The diagnosis and management of depression and anxiety in primary care: the need for a different framework
    K.S. Jacob (India)

    RS36.2 Emotional distress in primary care in Brazil: idioms, patterns and classification
    S. Fortes (Brazil)

    RS36.3 Developing a classification system for primary care: ICD-11PC
    L. Gask (UK)

    RS36.4 Bodily distress disorders
    M. Rosendal (Denmark)

    Discussant: L.F. Tofoli (Brazil)

    ------------


    There is this slide in this presentation:

    http://www.nwlcbttraining.net/documents/120206HealthAnxiety.pdf

    Medically Unexplained Symptoms

    What are medically unexplained symptoms?
    Is it the same as Hypochondriasis?
    Body Distress Disorder ICD-11

    ------------


    I have reported several times on the work of the EACLPP MUS Study Group (Creed, Per Fink, Henningsen et al), and the book that came out last year, that appears to have been born out of the MUS Study Group.

    Notes from EACLPP Workgroup meeting in Budapest July 2011:

    http://www.eaclpp.org/tl_files/cont...ically_Unexplained_Symptoms_Budapest_2011.pdf

    Report from Working group meeting on MUS/somatisation/bodily distress, Budapest July 1st 2011

    Extracts

    [...]

    (Ed: Like Per Fink, Professor Creed prefers the use of the term "Bodily
    Distress Disorder" over the term proposed by the DSM-5 Somatic Symptom
    Disorders Work Group - "Complex Somatic Symptom Disorder". Per Fink
    considers that Fibromyalgia, Multiple Chemical Sensitivity, Sick Building
    Syndrome and Chronic Fatigue Syndrome are all manifestations of the same
    condition and that the construct "bodily distress syndrome" succeeds "in
    capturing 10 diagnostic categories of functional somatic syndromes and
    somatoform disorders" [1].)

    [...]


    Organisation of services: Splitting or lumping? We are in danger of having
    separate clinics for chronic fatigue syndrome, chest pains, fibromyalgia
    etc etc. we need to develop best practice - and join up these different
    clinics and get them more centrally placed on the agenda - make them more
    visible to all specialists.

    [...]

    We should find out whether the WHO group for classification of somatic
    distress and dissociative disorders will provide a better diagnostic system
    for these disorders.

    -----------

    Continued in next post
     
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  4. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    Continued from previous post


    A reminder that Creed, Henningsen and Fink published a book last year that was born out of the EACLPP MUS Study Group called:

    "Medically Unexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services" Published by Cambridge University Press, 14 July 2011

    Some pages of this book can be read on Google Books at:

    http://books.google.com/books?id=UQjdZrkyWkoC&pg=PA1#v=onepage&q&f=false


    Extracts from the book:


    "They [unexplained bodily symptoms] form one of the most expensive categories of health care expenditure in Europe. This book makes the case for shifting some of this expenditure away from numerous investigations for organic disease and towards effective treatment of bodily distress." (Preface vi)

    "Since the traditional labels 'medically unexplained symptoms' or 'somatisation' are so unhelpful, we propose the term 'bodily distress' as a more useful term for these disorders..." (Preface vi)

    "ICD-10 included neurasthenia (chronic fatigue), as one of the somatoform disorders. This is considered here as chronic fatigue syndrome under the heading of functional somatic syndromes." (Page 8)

    Some discussion of functional somatic syndromes on Page 10-16.

    DSM-5 proposals for "CSSD" discussed briefly on Pages 43-45 with discussion of alternative terms (bodily distress disorder, functional somatic
    disorder/syndrome).

    -----------------


    In a June 2011 presentation to the International Congress of the Royal College of Psychiatrists, APA President, John M. Oldham, MD, MS, spoke of Negotiations in progress to harmonize DSM-5 with ICD-11 and to retro-fit these codes into ICD-10-CM and that DSM-5 would need to include ICD-10-CM F-codes in order to process all insurance claims beginning October 1, 2011.

    I hope that our professional advocates - our researchers and clinicians and our advocacy organizations will also be monitoring the progress of the ICD-11 Alpha and Beta drafts and participating in stakeholder interaction with the drafting process. I will update when more information on the release date of the Beta drafting platform becomes available and on any changes to the Alpha as it stood on 17 February 2012.

    The third and final draft for DSM-5 is scheduled for May, this year. I have no information about any changes to the criteria and categories for "Somatic Symptom Disorders" compared with how they stood in May, 2011, at the second public review and feedback exercise.


    References and related material:

    [1] 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: http://www.eaclpp.org/working_groups.html

    http://www.eaclpp.org/documents/Patientswithmedicallyunexplainedsymptomsandsomatisation_000.doc


    [2] 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 Psychosom Research: Volume 68, Issue 1, Pages 5-8 January 2010) discusses the deliberations of the EACLPP MUS study group. The Editorial also includes references to the DSM and ICD revision processes.
    http://www.ncbi.nlm.nih.gov/pubmed/20004295


    [3] Notes from EACLPP Workgroup meeting in Budapest July 2011.

    Report from Working group meeting on MUS/somatisation/bodily distress, Budapest July 1st 2011

    http://www.eaclpp.org/tl_files/cont...ically_Unexplained_Symptoms_Budapest_2011.pdf

    [4] "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. http://www.ncbi.nlm.nih.gov/pubmed/20403500


    [5] EURASMUS
    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. Co-convenors: Francis Creed, Peter Henningsen http://eurasmus.net/
     
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  5. merylg

    merylg Senior Member

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    How about scrap all of the above categories, and replace them with:

    I. Primary (ie Inherited) Mitochondrial Disorder
    II. Acquired Mitochondrial Disorder
    III. Inborn error of metabolism
    IV. Acquired error of metabolism

    (wherein it is possible to have I. or II. or III. or IV or any combination of the above) ???????????????????????
     
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  6. allyb

    allyb Senior Member

    All these people, all these hours, all that this must have cost!!!!!

    Thank you ME Agenda for your time and effort in this extensive thread to keep us up to date, which is so important with all we face.

    My comments are just my own personal thoughts and not intended to offended anyone in our community.


    1. How much money must this NAME CHANGE have cost?
    2. How might the money have been better spent?
    3. How will it change the suffering of those with ME/CFS and Fibromyalgia patients?


    Well this accounts for most of us then, though most of us do not present to the doctors or have long since given up asking for any tests for fear of being labeled with Somatisation Disorder, Conversion Disorder or for a change..... Bodily Distress Disorder."


    What about migratory symptoms, where do these fit?

    In terms of those suffering ME/CFS ....
    Whilst all these people get caught up in inventing a different name with which to placate, as always the focus (and money!!!) moves away from the physical symptoms as set out in the ICC (+ some) and bio medical research. Another massive diversion and distraction away from the truth. Just another blanket to smother the fire.

    "Unexplained of course being the clue, these bodily symptoms remain unexplained because such little money is being put into research of a biomedical nature. To identify the cause, then we can explain it, NOT just keep changing the name.

    This book makes the case for shifting the money into the pockets of the authors and takes us away from investigations into our organic disease.

    ..............and of course bodily distress disorder will be so much more helpful? How?

    functional somatic syndromes, functional as a label to be pondered, played with and changed.
    But nothing functionally about the way we are treat.


    My Conclusion
    As we push with every fiber of our being, our physical illness over to the world of science and exploration and biomedical research where it rightly belongs, psychiatry a none-science, is again, making a big noise, to retain its grip, attempting to look busy, look productive in order to claim dominance, unscientifically over an illness they clearly dont/don't want to understand.

    Merylg Superbly and succinctly put :thumbsup:

    allyb
     
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  7. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    I'd like to draw attention to this PDF document


    http://www.rcpsych.ac.uk/pdf/IPv8n1.pdf

    Journal of International Psychiatry

    Volume 8 Number 1 February 2011
    ISSN 1749-3676

    ?
    Journal affiliated to International Psychiatry: African Journal of Psychiatry


    (Editorial Board includes Rachel Jenkins, UK WHO Collaboration Centre, IoP)


    See page 1 Guest Editorial

    A revised mental health classification for use in general medical settings: the ICD11PHC

    David Goldberg

    Chairman, WHO Advisory Group for Classification in Primary Care


    A revised mental health classification for use in general medical settings: the ICD11PHC 1

    David Goldberg

    [...]

    "However, some of the ICD10PHC disorders were equivalent to existing categories in the parent classification, and did not take into account developments in diagnostic thinking. An interesting example of this concerns medically unexplained symptoms, which appear to have fallen out of favour with our GP colleagues, who have taken the view that even some medically explained symptoms can be abnormally prolonged and accentuated. Psychiatrists have taken a similar view: the new concept of complex somatic symptom disorder being field tested for DSMV also draws attention not to whether somatic symptoms can be explained, but to the cognitive components that may accompany them, whether they are part of a known physical disease or not.

    [...]

    Box 2 The 28 disorders to be field tested for ICD11PHC

    Childhood disorders

    1 Intellectual development disorder (was mental retardation)
    2 Autism spectrum disorder (new)
    3 Specific learning disability (new)
    4 Attention-deficit hyperactivity disorder (ADHD)
    5 Conduct disorder
    6 Enuresis, encopresis

    Psychotic disorders
    7 Acute psychosis
    8 Chronic psychosis
    9 Bipolar disorder

    Dysphoric disorders
    10 Anxious depression (new)
    11 Depressive disorder
    12 Anxiety disorder
    13 Distress disorder (replaces F42.2, F43, F48)
    14 Post-traumatic stress disorder (PTSD) (new)
    15 Panic/agoraphobia (was panic disorder)

    Body distress disorders
    16 Bodily distress syndrome (new was unexplained somatic complaints)
    17 Health preoccupation (new)
    18 Conversion disorder (was dissociative disorder)


    Bodily function disorders
    19 Sexual function disorder, male
    20 Sexual function disorder, female
    21 Sleep disorder
    22 Eating disorder

    Substance use disorders
    23 Alcohol use disorders
    24 Drug use disorders
    25 Tobacco use disorders

    Personality disorder
    26 Borderline personality (new)
    Acquired neurocognitive disorders
    27 Dementia
    28 Delirium

    [...]

    "A new category called bodily distress disorders will include conversion disorder (fairly common in some lower-income countries), health preoccupation (a new disorder similar to hypochondriasis) and the less severe bodily distress syndrome. In the syndrome, the patient is both distressed and concerned and has three or more somatic symptoms in one bodily system. This is diagnosed only if the patient does not have one of the three dysphoric disorders.

    [...]

    "These proposals are radical indeed, and by no means all of the proposed disorders will survive the field tests. Each proposed category will be commented upon by experts who are not part of the group, as well as by the main advisory group responsible for ICD11. Final amendments will be made by the primary care group before the revised classification is released for field tests. The field tests are likely to be quite extensive, and to involve studies in both high-income and low- and middle-income countries. A second set of revisions will be made after the field tests.


    "In our early discussions, many of the disorders in ICD10PHC are recommended to be retained often with suitable amendments but there have been several interesting new disorders suggested, as well as several disorders proposed for removal. Perhaps the most radical proposal is to abandon the distinction between anxiety disorders and mood disorders, and to gather them all under the single umbrella of dysphoric disorders. Within this important group, two innovations are proposed. First, some simple operational criteria will be tested in field trials to assess whether clinicians in the field find them useful; if they do not, we could return to diagnosis by descriptions of clinical prototypes. Even if they do like the operational criteria, we will need to recalibrate the point on the scale equivalent to what was previously described as MADD. The simple scales will allow a clinician to diagnose depression and anxiety on their own, or the combination of both to be called anxious depression. Second, where any of these three disorders achieve the severity required for a case, any somatic symptoms not part of a known physical disorder will be assumed to be related to the dysphoric disorder. Those whose symptoms fall short of the requirements for any of these three diagnoses, but who are distressed and disabled by their current symptoms (whether dysphoric or somatic), are to be given the residual diagnosis of distress disorder. Distress disorder replaces a motley collection of minor disorders, including neurasthenia (or chronic fatigue) and adjustment disorder..."


    This document is over a year old and the criteria suggested above may have since been modified in response to field trials and may not necessarily reflect the apparent proposals for Chapter 5 of ICD-11.

    Note that for DSM-5, the proposal for "Conversion Disorder" is to rename it to "Functional Neurological Disorder", though this name is still under discussion and to possibly locate it not under "Somatic Symptom Disorders" but under "Dissociative Disorders," where it currently sits in ICD.

    It's like the Pic 'n Mix counter at Woolworths.
     
  8. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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  9. Esther12

    Esther12 Senior Member

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    Thanks for these updates. I've not been able to keep on top of all of this stuff, even with Suzy doing most of the work. It's amazing how these highly political changes to the way in which the ill are treated could have slipped by so easily, and still may do so.
     
  10. allyb

    allyb Senior Member

    My point exactly because there are a lot of people, money and time being spent two make sure they do.
    (See my earlier post.)

    18 Conversion disorder (was dissociative disorder) (and before this, almost a century ago was conversion disorder) Prior to this was hysteria.

    I found this interesting
    http://voices.yahoo.com/neurological-disease-misdiagnosed-as-hysteria-7567832.html

    Over 45 years ago Dr. Slater documented the frequent misdiagnosis of neurological diseases as "hysteria". He published his findings in the British Medical Journal in 1965.
    Following 85 patients admitted to a mental hospital, nine years later 50% were dead or disabled; 50% were living independently; 22% were symptom free.
    The dead or disabled were found to have had vascular disease, epilepsy, vestibular lesions, angioma of the brain stem or neoplasms such as brain tumors.
    At least 50% of those patients admitted to a mental hospital had physical diseases yet were diagnosed as "hysterical ", the old way of saying "It's all in the head. "
    The idea that physical illnesses were manifestations of feelings and thoughts started with Charcot in the 1880's. His pupil, Freud, advanced that idea with a series of writings that have since been found to be largely fabricated.
    For instance, a man knocked unconscious for 5 days by a carriage was unable to speak, walk or remember the accident when he regained consciousness. Charcot diagnosed him as being hysterical because of the psychological trauma of the event.
    As Richard Webster says " - the classic example of a patient who supposedly suffered from traumatic hysteria, did not forget because he was frightened. He forgot because he was concussed. His various symptoms were not produced by an unconscious idea. They were the result of brain damage "
    When a 14-year old patient of Freud's died of abdominal cancer two months after he diagnosed her with "unmistakable hysteria " he claimed her hysteria had caused the tumor.
    Webster explains how hysteria, renamed conversion disorder, became so popular: " What made the resulting labyrinth of medical error all but inescapable was that practically every other physician had become lost within it. Over and over again, highly trained medical practitioners, confronted by some of the more subtle symptoms of epilepsy, head injury, cerebral tumours, multiple sclerosis, Parkinson ' s disease, Tourette ' s syndrome, autism, syphilis, encephalitis, torsion dystonia, viral hepatitis, reflux oesophagitis, hiatus hernia and hundreds of other common or uncommon conditions, would resolve their diagnostic uncertainty by enlarging the category of hysteria yet further. As a result medical misconceptions which sprang from one misdiagnosis would almost inevitably receive support, and apparent confirmation, from misdiagnoses made by other physicians. "
    After brain scans of patients suffering from chronic fatigue syndrome were shown to an expert scan reader in 1984, he said the punctate lesions he saw looked like the scans of AIDS patients. Months later the CDC issued its verdict. The town of Incline Village NV was suffering from mass hysteria.
    Misdiagnosis of neurological disease in 1890 or even in 1965 is understandable.
    It remains a mystery why the Centers For Disease Control , which places chronic fatigue syndrome research under the National Center for Emerging and Zoonotic and Infectious Diseases, the Chronic Viral Diseases Branch, has refused to research the viral associations with this illness and instead pursues hysteria as a diagnosis 26 years after those brain scans showed it to be a neurological disease.

    And here we are again :worried:


    allyb
     
  11. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    Part One of

    "Bodily Distress Disorders to replace Somatoform Disorders for ICD-11?

    is now posted at Dx Revision Watch at: http://wp.me/pKrrB-1Vx
     
  12. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    A clarification:

    In Post #7, I quoted from a document on proposals for the Primary Care version of ICD-11 (the ICD11PHC 1 for use in general medical settings).

    The document is dated February 2011 and those proposals may have since been subject to revision, following field trials, or to reflect proposals for the full version of ICD-11.


    The ICD11PHC 1 is a condensed version of the full ICD version.

    For context:

    From the UK "WHO Guide to Mental and Neurological Health in Primary Care" site (which is a UK adaptation publication and not an official WHO publication):

    http://www.whoguidemhpcuk.org/page_view.asp?c=16&did=2279&fc=021

    "Connections to ICD-10 and NHS clinical terms

    The first edition of this Guide [WHO Guide to Mental and Neurological Health in Primary Care] was based on the disorders included in the 'The ICD-10 PC Chapter V Mental Disorders Classification, Primary Care Version', is a user-friendly version of the 'Tenth revision of the International Classification of Diseases (ICD-10) Chapter V'. For practical reasons, the ICD-10 PC is a condensed version of 'ICD-10 Chapter V' for easy application in busy primary care settings. It has 23 categories instead of 457. It intends to cover the universe of mental disorders seen in primary care settings in adults. As a classification, it is jointly exhaustive and mutually exclusive. It may seem simplistic; however, it corresponds to the ICD-10 main volume. A chart that shows the grouping of the detailed specialty-adaptation categories into ICD-10 PC categories can be found below (Connections between ICD-10 PC and ICD-10 Chapter V)."

    http://www.whoguidemhpcuk.org/downl...s_between_icd_10_phc_and_icd_10_chapter_v.pdf

    Connections between ICD-10 PC and ICD-10 Chapter V

    [...]


    ICD-10PC:

    F45 Unexplained somatic complaints

    [for comparison]

    ICD-10 Chapter V:

    F45 Somatoform disorders

    F45.0 Somatization disorder

    F45.1 Undifferentiated somatoform disorder

    F45.2 Hypochondrical disorder

    F45.3 Somative autonomic dysfunction

    F45.4 Persistent somatoform pain disorder

    F45.8 Other somatoform disorders



    ICD-10PC:

    F48 Neurasthenia

    [for comparison]

    ICD-10 Chapter V:

    (F48 Other neurotic disorders)

    F48.0 Neurasthenia

    ----------------

    Note that the ICD-10 Primary Care version uses "F45 Unexplained somatic complaints" as the parent category for the ICD-10 Somatoform Disorders.

    So the Primary Care version of ICD-10 appears to be already using "F45 Unexplained somatic complaints" for the parent category which, in February 2011, Professor, Sir David Goldberg was proposing should be renamed to

    Body distress disorders

    or Bodily distress disorders


    So although the proposals for the full version of ICD-11 may be reflective of the proposals Prof Goldberg had made in early 2011, or since, they are not necessarily the same as what he lists in that document for the Primary Care version of ICD-11 (and we do not have sufficient information yet to know what the proposals are for ICD-11, only that it currently lists three new terms plus all the existing somatoform disorder terms, minus Hypochondriacal disorder).

    The final proposals for the ICD-11 Primary Care version are likely to be derivative of the final proposals for the full ICD-11 version. But at the moment, we do not have the most recent version of proposals for the Primary Care version of ICD-11 to compare.


    All that can be said at the moment is this:

    That in February 2011, Prof, Sir David Goldberg was proposing the following for the ICD-11 PC1:


    [...]

    "However, some of the ICD10PHC disorders were equivalent to existing categories in the parent classification, and did not take into account developments in diagnostic thinking. An interesting example of this concerns medically unexplained symptoms, which appear to have fallen out of favour with our GP colleagues, who have taken the view that even some medically explained symptoms can be abnormally prolonged and accentuated. Psychiatrists have taken a similar view: the new concept of complex somatic symptom disorder being field tested for DSMV also draws attention not to whether somatic symptoms can be explained, but to the cognitive components that may accompany them, whether they are part of a known physical disease or not."

    [...]

    Box 2 The 28 disorders to be field tested for ICD11PHC

    [...]


    Body distress disorders
    16 Bodily distress syndrome (new was unexplained somatic complaints)
    17 Health preoccupation (new)
    18 Conversion disorder (was dissociative disorder)


    [...]

    "A new category called bodily distress disorders will include conversion disorder (fairly common in some lower-income countries), health preoccupation (a new disorder similar to hypochondriasis) and the less severe bodily distress syndrome. In the syndrome, the patient is both distressed and concerned and has three or more somatic symptoms in one bodily system. This is diagnosed only if the patient does not have one of the three dysphoric disorders."


    -------------------

    That for ICD-11 full version as seen in the Alpha drafting Browser:


    05A08 BODILY DISTRESS DISORDERS (was Somatoform Disorders in ICD-10 full version)

    05A08.00 Mild bodily distress disorder
    05A08.01 Moderate bodily distress disorder
    05A08.02 Severe bodily distress disorder
    05A08.03 Somatization disorder
    05A08.04 Undifferentiated somatoform disorder
    05A08.05 Somatoform autonomic dysfunction
    05A08.06 Persistent somatoform pain disorder
    05A08.06.00 Persistent somatoform pain disorder
    05A08.06.01 Chronic pain disorder with somatic and psychological factors [not in ICD-10]
    05A08.07 Other somatoform disorders
    05A08.08 Somatoform disorder, unspecified

    ----------

    Note that all the existing ICD-10 categories remain listed under "05A08 BODILY DISTRESS DISORDERS" apart from Hypochondriacal disorder [ICD-10 F45.2], which may be intended to be classified under another parent class or possibly proposed to be subsumed into the "bodily distress disorder" categories. It is not possible to determine on the basis of current information.

    In ICD-11 Alpha drafting Browser, "05B60 Dissociative [conversion] disorders" are listed under "Neurotic, stress-related and somatoform disorders" although there appears to be a new section called "05A07 DISSOCIATIVE DISORDERS". It may be that the "Dissociative [conversion] disorders" are also undergoing reorganization, and proposals for locations may become clearer in time.


    For DSM-5, "Conversion disorder" is proposed to be renamed to "Functional Neurological Disorder" (though the name is still under discussion) and also under discussion is the proposal to locate "Functional Neurological Disorder" under "Dissociative disorders" rather than under "Somatic Symptom Disorders" (which was originally proposed by the DSM-5 to be called "Somatic Distress Disorders").

    ----------

    That current proposals for DSM-5 are:

    to rename Somatoform Disorders to Somatic Symptom Disorders and to roll a number of existing somatoform disorders into a new category, which it proposes to call Complex Somatic Symptom Disorder.

    Complex Somatic Symptom Disorder (CSSD) would include the previous DSM-IV diagnoses of somatization disorder [DSM IV code 300.81], undifferentiated somatoform disorder [DSM IV code 300.81], hypochondriasis [DSM IV code 300.7], as well as some presentations of pain disorder [DSM IV code 307].

    There is a more recently proposed, Simple Somatic Symptom Disorder (SSSD), which requires somatic symptom duration of just one month, as opposed to the six months required to meet the CSSD criteria.

    ----------

    Hope the above provides better clarification.

    When the ICD-11 Beta drafting platform is released, and the third and final DSM-5 draft released I will do a comparison chart so these two sections of DSM-5 and ICD-11 can be more easily compared.

    Suzy Chapman
     
  13. Sing

    Sing Senior Member

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    Thank you, Suzy, for relaying this nightmare classification system, and also allyb for your insightful responses, in which I am very much in agreement. The irresponsibility of putting all this energy into classifying what these people neither understand or are able or willing to help is breathtaking!

    What is this? Throwing a roomful of lawyers at ignorance? Classifying the responses of torture victims, without ever considering releasing the victim and relieving the pain? What intellectual fun they are having--games of logic and definition, a dance of superiority via abstraction and logic. These people need the sack--a cut in their funding--let the air out of their tires!

    It is irresponsible to classify what you don't understand. Where are the categories of
    1. We Don't Know.
    2. We Haven't Researched This Yet.
    3. For Political Reasons There Is No Funding.
    4. Get Rid Of All These Patients Who Are Complaining

    ?
     
    allyb likes this.

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