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DSM-5 proposals revised on 14 January: New category: Simple Somatic Symptom Disorder

Discussion in 'Action Alerts and Advocacy' started by Tammie, Jan 16, 2011.

  1. Tammie

    Tammie Senior Member

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    Woodridge, IL
    re DSM V....another new possible (bad) somatic category

    This is pretty long and I haven't even read all of it, but from what I have read, there is another proposed new somatic symptoms disorder category for the upcoming DSM and it's even worse than the complex one already most likely to get approval....the diagnostic criteria for the new one (Simple Somatic Disorders) pretty much ensures that anyone with any illness lasting longer than one month is likely to get an additional psych diagnosis - it is beyond ridiculous.

    These are the criteria (they are in the article, but in case you can't read the whole thing, I am putting them here, too):

    To meet criteria for Simple Somatic Symptom Disorder, criteria A, B, and C
    are necessary.

    A. One or more highly distressign [sic] and disabling somatic symptoms

    B. One of the following symptoms from CSSD (i.e. Disproportionate and
    persistent concerns about the medical seriousness of one's symptoms; high
    level of health-related anxiety; or excessive time and energy devoted to
    these symptoms or health concerns)

    C. Symptom duration is greater than 1 month


    my thoughts:

    -only one symptom necessary for DX is crazy - every other psych diagnosis requires more than one symptoms, and that should be even more necessary if the symptom comes from a medical (physical) diagnosis

    -"high level of anxiety" is highly subjective and who with a chronic disabling illness is not going to be anxious about it

    -"excessive time and energy devoted..." is even worse - if someone who is chronically ill and disabled by it chooses to ignore that illness, does not want to learn anything about it or how to try to manage it as well as possible, etc, then he/she is in a lot worse shape (physically and psychologically) than someone who actually tries to be informed and spends time on health related concerns,

    not to mention that by definition if something is disabling, it disrupts ones life dramatically and is impossible to ignore or to fail to devote time to just in order to accomplish the most basic activities of daily life

    -"disproportionate and persistent concerns about the medical seriousness..." again subjective and also sounds suspiciously like the way many Wessely, et all statements re ME/CFS are worded

    -one month - seriously??!!??!! if someone receives a new disabling DX, it should take at least a month to begin to process all that the DX entails - people do not adjust to major life changes that fast unless they are in denial (& thus have not truly adjusted at all)....and any chronic illness will last longer than one month


    May be reposted if posted in full and source credited

    From Suzy Chapman


    16 January 2011

    A formatted version of this information will be published on my DSM-5 and
    ICD-11 Watch site ( dxrevisionwatch.wordpress.com ) in the next day or so.


    The page for existing DSM-5 proposals for the "Somatoform Disorders"
    section of DSM-IV was updated on January 14, 2011 with a new category
    proposal called "Simple Somatic Symptom Disorder".

    Note this proposal is in addition to the existing proposal for the category
    proposed by the Somatic Symptom Disorders Work Group called "Complex
    Somatic symptom disorder (CSSD)" and does not replace "CSSD".

    As I have been highlighting for some time now, under these proposals, all
    medical conditions, whether "established" general medical conditions and
    disorders or conditions presenting with "somatic symptoms of unclear
    etiology", have the potential for qualifying for an additional diagnosis of
    a somatic symptom disorder.

    There have also been revisions and additions to some of the text of the
    "Disorder descriptions" document dated "DRAFT January 29, 2010" that was
    first published by the DSM-5 Task Force on February 10, 2010 when draft
    proposals were posted on the APA's DSM-5 website.

    Note the key document: "Justification of Criteria-Somatic Symptoms DRAFT
    1/29/10" which is associated with the proposals of the Somatic Symptom
    Disorders Work Group does not appear to have been update since February
    2010 and is still available on the APA's DSM-5 Development site here:

    http://www.dsm5.org/Documents/Somatic/APA DSM Validity Propositions 1-29-2010.pdf


    Under "Somatoform Disorders Not Currently Listed in DSM-IV"

    are now listed two proposals:

    "Complex Somatic Symptom Disorder"

    (which was discussed last year when the DSM-5 draft proposals were first
    released) and a new proposal:

    "Simple Somatic Symptom Disorder"


    So the page at:

    http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx

    now reads:

    Somatoform Disorders

    Please find below a list of disorders related to the diagnostic category,
    Somatoform Disorders. The Somatic Symptom Disorders Work Group has been
    responsible for addressing these disorders. Among the work group's
    recommendations is the proposal to rename this category Somatic Symptom
    Disorders. Because the current terminology for somatoform disorders is
    confusing and because somatoform disorders, psychological factors affecting
    medical condition, and factitious disorders all involve presentation of
    physical symptoms and/or concern about medical illness, the work group
    suggests renaming this group of disorders Somatic Symptom Disorders. In
    addition, because of the implicit mind-body dualism and the unreliability
    of assessments of "medically unexplained symptoms," these symptoms are no
    longer emphasized as core features of many of these disorders. Since
    somatization disorder, hypochondriasis, undifferentiated somatoform
    disorder, and pain disorder share certain common features, namely somatic
    symptoms and cognitive distortions, the work group is proposing that these
    disorders be grouped under a common rubric called complex somatic symptom
    disorder. We appreciate your review and comment on these disorders.

    *Somatoform Disorders Not Currently Listed in DSM-IV

    Complex Somatic Symptom Disorder [link]
    Simple Somatic Symptom Disorder [link]

    *Somatoform Disorders Proposed for Possible Reclassification in Another
    Diagnostic Category

    300.7 Body Dysmorphic Disorder [link]

    *Somatoform Disorders Proposed to be Subsumed Under Other Diagnoses
    (No DSM-5 Criteria Proposed)

    300.81 Somatization Disorder [link]
    300.82 Undifferentiated Somatoform Disorder [link]
    307.80 Pain Disorder Associated With Psychological Factors [link]
    300.7 Hypochondriasis [link]
    307.89 Pain Disorder Associated With Both Psychological Factors and a
    General Medical Condition [link]
    Pain Disorder [link]

    Somatoform Disorders

    300.11 Conversion Disorder [link]
    300.82 Somatoform Disorder Not Otherwise Specified [link]

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

    URL for the new page for the proposal "Simple Somatic Symptom Disorder":

    http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=491


    Below is the full text available from the various child pages at that link:

    Simple Somatic Symptom Disorder

    Updated January-14-2011


    See Tab: Proposed Revision:
    http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=491#


    Simple (or abridged) Somatic Symptom Disorder (e.g. pain)

    To meet criteria for Simple Somatic Symptom Disorder, criteria A, B, and C
    are necessary.

    A. One or more highly distressign [sic] and disabling somatic symptoms

    B. One of the following symptoms from CSSD (i.e. Disproportionate and
    persistent concerns about the medical seriousness of one's symptoms; high
    level of health-related anxiety; or excessive time and energy devoted to
    these symptoms or health concerns)

    C. Symptom duration is greater than 1 month

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

    See Tab: Severity:

    [Ed: This is presented in tabular format.]

    http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=491#


    PHQ Somatic Symptom Short Form (PHQ-SSS)

    During the past SEVEN (7) DAYS how much have you been bothered by...

    [Ed: fields are scored from 1-5]

    Not at all; A little bit; Somewhat; Quite a bit; Very much

    1.Stomach or problems going to the toilet?
    2.Pain in your back?
    3.Pain in your arms, legs, or joints
    4.Headaches?
    5.Chest pain or getting out of breath?
    6.Dizziness?
    7.Feeling tired or having low energy?
    8.Trouble sleeping?

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

    See Tab: DSM-IV:

    This disorder is not listed in DSM-IV; therefore DSM-IV criteria for this
    disorder does not exist.

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

    See Tab: Rationale:
    http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=491#

    Please see full disorder descriptions here. [link opens to revised PDF
    document]

    http://www.dsm5.org/Documents/Somatic/Somatic Symptom Disorders description January 14 2011.pdf


    DRAFT January 14, 2011

    Somatic Symptom Disorders

    [Ed: This document is a revised text of the document published by the DSM-5
    Task Force in February 2010. That document is no longer available on the
    DSM-5 site pages but for comparison, a PDF copy is archived on my own site
    here or contact me for a copy of the original text:

    dxrevisionwatch.wordpress.com


    [Full text version follows which includes notes by Suzy Chapman identified
    as "Ed" indicating revisions and additions to the original text.]

    http://www.dsm5.org/Documents/Somatic/Somatic Symptom Disorders description January 14 2011.pdf

    2010 American Psychiatric Association. All Rights Reserved. See Terms &
    Conditions of Use for more information

    DRAFT January 14, 2011

    Somatic Symptom Disorders


    Introduction

    This group of disorders is characterized predominantly by somatic symptoms
    or concerns that are associated with significant distress and/or
    dysfunction. Somatic symptoms are common in every day life and medical
    practice. Such symptoms may be initiated, exacerbated or maintained by
    combinations of biological, psychological and social factors. The
    diagnostic criteria are applicable across the lifespan, even though
    developmental differences in the presentation and phenomenology of somatic
    symptom disorders may exist.

    These disorders typically present first in non-psychiatric settings and
    somatic symptom disorders can accompany diverse general medical as well as
    psychiatric diagnoses. 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.

    [Ed: Note that Chronic Fatigue Syndrome is not specified in this revised
    text and CFS had not been specified in the original text of the February,
    2010 document.]

    Conversely, having somatic symptoms of an established disorder (e.g.
    diabetes) does not exclude these diagnoses if the criteria are otherwise
    met.

    [Ed: The para above is new text. ***Note: as I have been highlighting for
    some time now, under these proposals, all medical conditions - whether
    "established" general medical conditions and disorders or conditions
    presenting with "somatic symptoms of unclear etiology" - have the potential
    for qualifying for an additional diagnosis of a somatic symptom
    disorder.***]

    There are other psychiatric disorders, which may present with prominent
    somatic symptoms such as depression or panic; therefore, not all
    presentations with somatic symptoms would qualify for these diagnoses.

    The presentation of these symptoms may vary across the lifespan. A
    corroborative historian with a life course perspective may provide
    important information for both the elderly and for children.

    [Ed: The 2 paras above are new text.]


    I. Psychological factors affecting medical condition (#316).

    The essential feature of this disorder is the presence of one or more
    clinically significant psychological or behavioral factor that adversely
    affects a somatic symptom or medical condition by increasing risk for
    suffering, death, or disability. These factors can adversely affect the
    medical illness by influencing its course or treatment, by constituting an
    additional health risk factor, or by exacerbating the physiology that is
    related to the medical illness.

    Psychological or behavioral factors include psychological distress,
    patterns of interpersonal interaction, coping styles and maladaptive health
    behaviors such as denial of symptoms or poor adherence to medical
    recommendations. Common clinical examples are: anxiety exacerbating asthma,
    denial of need for treatment for acute chest pain, manipulating insulin in
    order to lose weight.

    This diagnosis should be reserved for situations where the effect of the
    psychological factor on the medical condition is evident, and the
    psychological factor has clinically significant effects on the course or
    outcome of the medical condition. Abnormal psychological or behavioral
    symptoms that develop in response to a medical condition are more properly
    coded as an adjustment disorder (a clinically significant psychological
    response to an identifiable stressor).

    PFAMC can occur across the lifespan. Particularly with young children,
    corroborative history from parents or school can assist the diagnostic
    evaluation.

    [Ed: The para above is new text.]

    To meet criteria for Psychological Factors Affecting Medical Condition,
    both criteria A and B are necessary.

    A. A general medical condition is present.

    B. Psychological or behavioral factors adversely affect the general medical
    condition in at least one of the following ways:

    1. the factors have influenced the course of the general medical condition
    as shown by a close temporal association between the psychological factors
    and the development or exacerbation of, or delayed recovery from, the
    general medical condition

    2. the factors (e.g. poor adherence) interfere with the treatment of the
    general medical condition

    3. the factors constitute additional health risks for the individual

    4. the factors influence physiology to precipitate or exacerbate symptoms
    of the general medical condition


    II. Complex Somatic symptom disorder (CSSD) (#XXX)

    This disorder is characterized by a combination of distressing (often
    multiple) symptoms and an excessive or maladaptive response to these
    symptoms or associated health concerns. The patient's suffering is
    authentic, whether or not it is medically explained. Patients typically
    experience distress and a high level of functional impairment. The symptoms
    may or may not accompany diagnosed general medical disorders or psychiatric
    disorders. There may be a high level of medical care utilization, which
    rarely alleviates the patient's concerns. From the clinician's point of
    view, many of these patients seem unresponsive to therapies, and new
    interventions or therapies may only exacerbate the presenting symptoms or
    lead to new side effects and complications. Some patients feel that their
    medical assessment and treatment have been inadequate.

    [Ed: Previously read: The hallmark of this disorder is disproportionate or
    maladaptive response to somatic symptoms or concerns. Patients typically
    experience distress and a high level of functional impairment. In severe
    cases, they may adopt a sick role. Sometimes the symptoms accompany
    diagnosed general medical disorders or psychiatric disorders, and sometimes
    the disorder occurs alone. There may be a high level of health care
    utilization, which rarely alleviates the patient's concerns. From the
    clinician's point of view, many of these patients seem unresponsive to
    therapies, and new interventions or therapies may only exacerbate the
    presenting symptoms or lead to new side effects and complications. Some
    patients feel that their medical assessment and treatment have been
    inadequate.]

    Patients with this diagnosis typically have multiple, current, somatic
    symptoms that are distressing; sometimes, they may have only one severe
    symptom. 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 (e.g., bad taste in one's mouth).
    Health-related quality of life is frequently severely impaired.

    [Ed: Previously read: Patients with this diagnosis typically have multiple,
    current, somatic symptoms that are distressing; rarely, they may have only
    one severe symptom. 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 or multiple symptoms). The symptoms
    sometimes represent normal bodily sensations (e.g., orthostatic dizziness),
    or discomfort that does not generally signify serious disease (e.g., bad
    taste in one's mouth) or are incompatible with known pathophysiology (e.g.
    seeing double with one eye closed). Such patients often manifest a poorer
    health-related quality of life than patients with other medical disorders
    and comparable symptoms.]

    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.

    [Ed: Previously read: Patients with this diagnosis tend to have heightened
    levels of health-related anxiety and a low threshold for alarm about the
    presence of illness. They appraise their bodily symptoms as particularly
    threatening, harmful, or troublesome and have a tendency to assume the
    worst about their health. They believe in the medical seriousness of their
    symptoms despite evidence to the contrary. Health concerns are diffuse and
    may assume a central role in their lives, becoming a feature of their
    identity, a way of responding to stressful events, a topic of interpersonal
    communication, or a basis for interpersonal relationships]

    If all of the somatic symptoms are consistent with another psychiatric
    disorder (e.g. panic disorder), and the diagnostic criteria for that
    disorder are fulfilled, then that psychiatric disorder should be considered
    as an alternative or additional diagnosis. If the patient has worries about
    health but no somatic symptoms, he/she may be more appropriately considered
    for an anxiety disorder diagnosis.

    In the elderly somatic symptoms and comorbid medical illnesses are more
    common, and thus a focus on criteria B becomes more important. In the young
    child, the "B criteria" may be principally expressed by the parent.

    CSSD is a disorder characterized by chronicity, symptom burden, and
    excessive or maladaptive response to symptoms. When patients do not meet
    criteria for these domains, other diagnoses should be considered such as
    Simple Somatic Symptom Disorder (SSSD).

    [Ed: All 3 paras above are new text.]

    Complex somatic symptom disorder (includes 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). To meet criteria for
    CSSD, criteria A, B, and C are necessary.

    A. Somatic symptoms:

    One or more somatic symptoms that are distressing and/or result in
    significant disruption of daily life.

    [Ed: Previously read: A. Somatic symptoms: Multiple somatic symptoms that
    are distressing, or one severe symptom]


    B. Excessive thoughts, feelings, and behaviors related to these somatic
    symptoms or associated health concerns: At least two of the following are
    required to meet this criterion:

    (1) Disproportionate and persistent concerns about the medical seriousness
    of one's symptoms.

    (2) High level of health-related anxiety

    (3) Excessive time and energy devoted to these symptoms or health concerns

    [Ed: Previously read: B. Misattributions, excessive concern or
    preoccupation with symptoms and illness: At least two of the following are
    required to meet this criterion: (1) High level of health-related anxiety.
    (2) Normal bodily symptoms are viewed as threatening and harmful (3) A
    tendency to assume the worst about their health (catastrophizing). (4)
    Belief in the medical seriousness of their symptoms despite evidence to the
    contrary. (5) Health concerns assume a central role in their lives]

    [Ed: According to the DSM-5 website "Criteria B is still under active
    discussion"]

    C. Chronicity: Although any one symptom may not be continuously present,
    the state of being symptomatic is chronic (at least 6 months).

    For patients who fulfill the CSSD criteria, the following optional
    specifiers may be applied to a diagnosis of CSSD where one of the following
    dominates the clinical presentation:

    XXX.1 Predominant somatic complaints (previously, somatization disorder)

    XXX.2 Predominant health anxiety (previously, hypochondriasis) If patients
    present solely with health-related anxiety with minimal somatic symptoms,
    they may be more appropriately diagnosed as having Illness Anxiety Disorder
    (see V.B below).

    XXX.3 Predominant Pain (previously pain disorder). This classification is
    reserved for individuals presenting predominantly with pain complaints who
    also have many of the features described under criterion B. Patients with
    other presentations of pain may better fit other psychiatric diagnoses such
    as adjustment disorder or psychological factors affecting a medical
    condition.

    [Ed: Previously read: C. Chronicity: Although any one symptom may not be
    continuously present, the state of being symptomatic is chronic and
    persistent (at least 6 months). The following optional specifiers may be
    applied to a diagnosis of CSSD where one of the following dominates the
    clinical presentation: XXX.1 Multiplicity of somatic complaints
    (previously, somatization disorder) XXX.2 High health anxiety (previously,
    hypochondriasis) {If patients present solely with health-related anxiety in
    the absence of somatic symptoms, they may be more appropriately diagnosed
    as having an anxiety disorder.} XXX.3 Pain disorder. This classification is
    reserved for individuals presenting predominantly with pain complaints who
    also have many of the features described under criterion B. Patients with
    other presentations of pain may better fit other psychiatric diagnoses such
    as major depression or adjustment disorder.]

    For assessing severity of CSSD, metrics are available for rating the
    presence and severity of somatic symptoms (see for instance PHQ, Kroenke et
    al, 2002). Scales are also available for assessing severity of the
    patient's misattributions, excessive concerns and preoccupations (see for
    instance Whiteley inventory, Pilowsky , 1967).


    [Ed: New proposal "Simple (or abridged) somatic symptom disorder" is
    inserted here and subsequent sections are renumbered.]

    *************************************************

    III. Simple (or abridged) somatic symptom disorder [xxxxxxxx] e.g. pain (#
    XXX)

    To meet criteria for SSSD, criteria A, B, and C are necessary.

    A. One or more highly distressing and disabling somatic symptoms

    B. One of the following symptoms from CSSD (i.e. Disproportionate and
    persistent concerns about the medical seriousness of one's symptoms; High
    level of health-related anxiety; or Excessive time and energy devoted to
    these symptoms or health concerns)

    C. Symptom duration >1 month.

    *************************************************

    [Ed: This category is proposed (14.01.11) to replace 300.7 Hypochondriasis.

    See:
    http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=10 ]

    IV. Illness Anxiety Disorder

    This disorder is characterized by high illness anxiety that is distressing
    and/or disruptive to daily life with minimal somatic symptoms. The
    following 5 criteria must be met.

    A. Preoccupation with having or acquiring a serious illness. If a general
    medical condition or high risk for developing a general medical condition
    is present, the illness concerns are clearly excessive.

    B. Somatic symptoms are not present or, if present, are only mild in
    intensity.

    C. The person performs related excessive behaviors (e.g. checking one's
    body for signs of illness, seeking reassurance from the internet or other
    sources), or exhibits maladaptive avoidance (e.g. avoiding traveling far
    from one's doctor, avoiding triggers of illness fears such as exercise or
    visits to those who are ill).

    D. Although the preoccupation may not be continuously present, the state of
    being preoccupied is chronic (at least 6 months)

    E. The illness-related preoccupation is not better accounted for by the
    symptoms of another mental disorder such as complex somatic symptom
    disorder, panic disorder, generalized anxiety disorder, or obsessive
    compulsive disorder.

    *************************************************

    V. Functional Neurological Symptoms (previously, Conversion disorder
    (#300.11)

    The essential feature of this disorder is neurological symptoms that are
    found, after appropriate medical assessment, to be incompatible with a
    general medical condition. The symptoms include weakness, events resembling
    epilepsy or syncope, abnormal movements, sensory symptoms (including loss
    of vision and hearing), or speech and swallowing difficulties. In addition,
    the diagnosis will usually be supported by evidence of internal
    inconsistency or incongruity with neurological disease. This evidence may
    include physical signs (such as, Hoover's sign of functional weakness) or
    diagnostic investigations (such as seizure-like behaviour in the absence of
    simultaneous non-convulsive activity on EEG). The symptoms may be acute or
    chronic. Whilst psychological factors may be noted to be associated with
    the onset of symptoms, they are not essential for the diagnosis. Co-morbid
    neurological disease may also be present and does not exclude the
    diagnosis.

    If there is evidence that the symptoms are intentionally feigned, the
    condition is not conversion disorder but rather either factitious disorder
    or malingering. When the symptom is limited to pain, fatigue, dizziness,
    cognitive symptoms or to a disturbance in sexual functioning, it is
    typically coded elsewhere in the DSM (a different Somatic Symptom Disorder
    diagnosis or in the Sexual Disorders Section).

    [Ed: Previously read (as "III. Conversion disorder"): Patients with
    conversion disorder typically present with neurological symptoms that are
    found, after appropriate medical assessment, to be incompatible with a
    general medical condition. These presentations may be acute or chronic.
    Typical symptoms include weakness, events resembling epilepsy or syncope,
    abnormal movements, sensory symptoms, dizziness, speech and swallowing
    difficulties. In addition, the diagnosis will usually be supported by
    confirmatory physical signs or diagnostic investigations consistent with
    the diagnosis (such as, Hoover's sign). Psychological factors may be
    associated with the onset of symptoms, but are not essential for the
    diagnosis. If there is evidence that the symptoms are intentionally
    feigned, the condition is not conversion disorder but rather either
    factitious disorder or malingering.]

    Criteria A, B, C and D must all be fulfilled to make the diagnosis:

    A. One or more symptoms of altered voluntary motor, sensory function,
    cognition, or seizure-like episodes

    B. The symptom, after appropriate medical assessment, is not found to be
    due to a general medical condition, the direct effects of a substance, or a
    culturally sanctioned behavior or experience.

    C. Physical signs or diagnostic findings that provide evidence of internal
    inconsistency or incongruity with recognized neurological or medical
    disorder.

    [Ed: Previously read: Criteria A, B, and C must all be fulfilled to make
    the diagnosis: A. One or more symptoms are present that affect voluntary
    motor or sensory function. B. The symptom, after appropriate medical
    assessment, is found not to be due to a general medical condition, the
    direct effects of a substance, or a culturally sanctioned behavior or
    experience. C. The symptom causes clinically significant distress or
    impairment in social, occupational, or other important areas of functioning
    or warrants medical evaluation.]

    D. The symptom causes clinically significant distress or impairment in
    social, occupational, or other important areas of functioning or warrants
    medical evaluation.

    [Ed: Criteria D above is new text.]


    IV. Factitious disorder #300

    Factitious disorders entail long-term,persistent problems related to
    illness perception and identity. They can be associated with unexpected
    and/or unexplained symptoms. Individuals with Factitious Disorders falsify
    medical and/or psychological impairment in themselves and/or others. The
    diagnosis requires demonstrating that the patient is taking surreptitious
    actions to cause or simulate illness in the absence of obvious rewards.
    While an underlying condition may be present, the deceptive behavior
    associated with this disorder causes others to view such individuals
    (and/or their proxy) as more ill or impaired than they are and can lead to
    excessive clinical intervention.

    Those with Factitious Disorder by Proxy have been known to falsify illness
    in children of any age, adults, and pets. The victim (or proxy) is not
    given the diagnosis of Factitious Disorder by Proxy. When a Factitious
    Disorder leads to abuse of another or other criminal behavior, V code
    designations for the victim may be indicated.

    Malingering, defined as intentional reporting of symptoms for personal gain
    (e.g. money, time off work, etc) is not a psychiatric disorder.

    IV A. Factitious Disorder on Self (#300.X)- To make this diagnosis, all 4
    criteria must be met.

    1. A pattern of falsification of physical or psychological signs or
    symptoms, associated with identified deception.

    2. A pattern of presenting oneself to others as ill or impaired.

    3. The behavior is evident even in the absence of obvious external rewards.

    4. The behavior is not better accounted for by another mental disorder such
    as delusional belief system or acute psychosis.

    IV B. Factitious Disorder on another (#300.X) To make this diagnosis, all 4
    criteria must be met. Note that the perpetrator, not the victim, receives
    this diagnosis.

    1. A pattern of falsification of physical or psychological signs or
    symptoms in another, associated with identified deception.

    2. A pattern of presenting another (victim) to others as ill or impaired.

    3. The behavior is evident even in the absence of obvious external rewards.

    4. The behavior is not better accounted for by another mental disorder such
    as delusional belief system or acute psychosis.


    [Ed: Section V. Somatic symptom disorder, NOS (# XXX) is omitted from this
    revised document.]


    [Ed: The section VII Pseudocyesis that follows is an addition to the text.]

    VII Pseudocyesis

    The patient has a false belief of being pregnant that is associated with
    objective signs of pregnancy, which may include abdominal enlargement,
    reduced menstrual flow, amenorrhea, subjective sensation of fetal movement,
    nausea, breast engorgement and secretions, and labor pains at the expected
    date of delivery. While endocrine changes may be present, the syndrome
    cannot be explained by a general medical condition that causes endocrine
    changes (e.g., a hormone-secreting tumor).


    Body dysmorphic disorder

    This disorder is being reviewed by the Anxiety Disorders workgroup.
    Depending upon criteria and evidence, it may be relocated to the Anxiety
    Disorders section of DSM or may be incorporated into CSSD.

    [Text of PDF ends]

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


    Please also see:

    http://www.dsm5.org/ProposedRevisio...itionsThatMayBeaFocusofClinicalAttention.aspx

    Please find below a list of diagnoses related to the diagnostic category,
    Other Clinical Conditions that May Be a Focus of Clinical Attention. The
    Somatic Symptoms Disorders Work Group has been responsible for addressing
    these disorders. This diagnostic category also includes conditions related
    to psychosocial and environmental problems, such as whether a patient is
    having housing or economic problems or problems with his/her primary
    support group. In addition, this category contains a listing of movement
    disorders related to medication use. The work groups are still discussing
    whether DSM-5 will contain any revisions to these conditions and diagnoses.
    We appreciate your review and comment on these disorders.

    Psychological Factors Affecting Medical Condition

    316 Mental Disorder Affecting Medical Condition [link]
    316 Psychological Symptoms Affecting Medical Condition [link]
    316 Personality Traits or Coping Style Affecting Medical Condition [link]
    316 Maladaptive Health Behaviors Affecting Medical Condition [link]
    316 Stress-Related Physiological Response Affecting Medical Condition
    [link]
    316 Other or Unspecified Psychological Factors Affecting Medical Condition
    [link]
    316 Psychological Factors Affecting Medical Condition [link]

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

    Acccording to the DSM-5 Timeline:

    March - April 2011: Revisions to Proposed Criteria. Based on results from
    the first phase of field trials, the DSM-5 Task Force and Work Group
    members will make revisions to the proposed DSM-5 diagnostic criteria and
    dimensional measures. These revised criteria and measures will be tested in
    a second phase of field trials.

    April - May 2011: Review of Revised Criteria. Revised proposed criteria
    will be subjected to internal review, including a review by the DSM-5 Task
    Force and Research Group and by other relevant work groups.

    May-July 2011: Online Posting of Revised Criteria. Following the internal
    review, revised draft diagnostic criteria will be posted online for
    approximately one month to allow the public to provide feedback. This site
    will be closed for feedback by midnight on June 30, 2011.

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


    Suzy Chapman
    _____________________
  2. Dx Revision Watch

    Dx Revision Watch Suzy Chapman dxrevisionwatch.com

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    There are already a number of DSM-5 related threads on these forums, few of which have been updated since around May, last year, so I'm starting a new one. I will add links to the existing threads in a second post.

    [Content superceded by third draft May 2, 2012.]
  3. Esther12

    Esther12 Senior Member

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  4. WillowJ

    WillowJ Senior Member

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    are there no rational medical persons objecting to this on the basis that medicine is not omniscient?

    these are clearly dustbin diagnoses like Esther said. Is there any lobby out there in the rest of the world doing something about the APA wanting to psychiatrize the entire population?
  5. Sean

    Sean Senior Member

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    Oh brother, what utter garbage. A totally untestable, and hence of course, unaccountable excuse to dismiss patients with difficult problems that the doctor can't deal with. The perfect non-diagnosis.

    "Psychological or behavioral factors include psychological distress, patterns of interpersonal interaction, coping styles and maladaptive health behaviors such as denial of symptoms or poor adherence to medical recommendations."

    Coz we all know that doctors never, ever give the wrong medical recommendations.

    If this drivel is formally accepted then the relevant pages of the DSM will be waved in patient's faces in consulting rooms across the world to justify withholding proper diagnostic investigations and treatment, and practising mistreatment including outright abuse. And when patients, completely legitimately, refuse to participate in this destructive fraud, they will then get blamed for their situation and punished.

    Just when you think psychs couldn't sink any lower. Truly despicable stuff.
  6. Dx Revision Watch

    Dx Revision Watch Suzy Chapman dxrevisionwatch.com

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    I started a thread yesterday for this:

    http://forums.aboutmecfs.org/showth...-New-category-Simple-Somatic-Symptom-Disorder

    DSM-5 proposals revised on 14 January: New category proposed: "Simple Somatic Symptom Disorder"

    Could a mod please combine the two?



    Suzy
  7. Dx Revision Watch

    Dx Revision Watch Suzy Chapman dxrevisionwatch.com

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    Previous threads on the issue of the APA's DSM-5 proposals:


    http://forums.aboutmecfs.org/showth...-date-to-2013&highlight=DSM-5 proposals draft

    APA moves DSM-5 Publication date to 2013

    December 10th, 2009

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

    http://forums.aboutmecfs.org/showth...ICD-in-the-US&highlight=DSM-5 proposals draft

    psych lobby strikes again: DSM-5 v. WHO's ICD in the US

    December 22nd, 2009

    (18 pages)

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

    http://forums.aboutmecfs.org/showth...o-Reevesville&highlight=DSM-5 proposals draft

    DSM5 - Ticket back to Reevesville

    February 12th, 2010

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

    http://forums.aboutmecfs.org/showth...onse-to-DSM-5&highlight=DSM-5 proposals draft

    The MEA's response to DSM-5

    April 21st, 2010

    ---------------------------
  8. Dx Revision Watch

    Dx Revision Watch Suzy Chapman dxrevisionwatch.com

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    [Content superceded by third draft, May 2, 2012]
  9. Dx Revision Watch

    Dx Revision Watch Suzy Chapman dxrevisionwatch.com

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    Contacted in UK:

    Heather Walker, Action for M.E.
    Neil Riley, Chair, Board of Trustees, ME Association
    25% ME Group
    Invest in ME
    Jane Colby, The Young ME Sufferers Trust

    Contacted in US:

    Dr Alan Gurwitt, Massachusetts Chronic Fatigue and Immune Dysfunction Syndrome/Myalgic Encephalopathy and Fibromyalgia Association (Mass. CFIDS/ME & FM)
    Dr Kenneth Friedman, IACFS/ME
    Jennie Spotila, CFIDS Association of America

    Dr Lenny Jason

    International

    ESME (European Society for ME - ESME)
    Dr Ellie Stein, Canada

    If anyone has contacted other organisations or key individuals I'd be pleased if you could let me know (PM if preferred).


    Suzy
  10. Enid

    Enid Senior Member

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    What a load of .............. Thanks for all you are doing Suzy.
  11. Tammie

    Tammie Senior Member

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    not to mention that it's completely no-win....deny symptoms and you must have this dx; bring up your symptoms and you could be showing too much "anxiety" about them, showing "persistent concern", and/or expressing too much interest in the "medical seriousness" of them - either way they can say that you fit this
  12. Dx Revision Watch

    Dx Revision Watch Suzy Chapman dxrevisionwatch.com

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    Psychologists sought for DSM-5 field trials

    http://www.apapracticecentral.org/update/2011/01-13/field-trials.aspx

    Practice Update | January 2011

    Psychologists sought for DSM-5 field trials

    Psychologists are needed to assess feasibility and utility of proposed criteria modifications for the DSM-5

    By Practice Research and Policy Staff

    January 13, 2011 A new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, will be released in May 2013. The psychiatric organization is conducting field trials to assess the practical use of proposed criteria in clinical settings, and psychologists are being sought for the trials.

    Full article here
  13. Enid

    Enid Senior Member

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    Whole thing sounds utterly phoney - whoever "wants" to be ill. Does "modification" sound a little promising ? - and can the APA genuinely see.
  14. Dx Revision Watch

    Dx Revision Watch Suzy Chapman dxrevisionwatch.com

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    [Content superceded by third draft May 2, 2012.]
  15. Dx Revision Watch

    Dx Revision Watch Suzy Chapman dxrevisionwatch.com

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    [Content superceded by third draft May 2, 2012.]
  16. SilverbladeTE

    SilverbladeTE Senior Member

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    Somewhere near Glasgow, Scotland
    The lunatics ARE running the asylum :/

    seriously, do these quacks understand or care for "The SScientific Method" or Human Beings?

    Said before elsewhere, 70 years ago, we didn't go nearly far enough *****slapping the evil, callous, lunatic nitwits in the medical and other professions and areas, sigh
    they weren't some alien unique monstroisty of that period, merely what happens when they arelet run riot.
    A PHd or MD and well off upbringing are no magical barrier from turning out bloody evil, ya know? :/
  17. pictureofhealth

    pictureofhealth XMRV - L'Agent du Jour

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    Haven't yet seen any comment from the ME Association about this? Did I miss it?
  18. Dx Revision Watch

    Dx Revision Watch Suzy Chapman dxrevisionwatch.com

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    Neil Riley, Chair of the ME Association Board of Trustees, has been sent a copy of this information. I have received no response as yet, from Mr Riley.

    When the DSM-5 draft proposals were published, last year, all national UK patient organisations were alerted by me to the public review process and asked whether they intended to submit a response and whether they would be making any response public.

    A response was submitted to the DSM-5 SSD Work Group by Dr Ellen Goudsmit, psychologist, who at the time was acting as psychological adviser to the ME Association.

    In March, last year, Mr Riley confirmed to me that the MEA Board of Trustees was endorsing this brief response that had been submitted by Dr Goudsmit in February, shortly after the draft criteria had been published, but that it did not intend submitting a response of its own.

    Dr Goudsmit's response to the draft proposals can be read on this page of my site (4 submissions down the page):

    http://dxrevisionwatch.wordpress.com/dsm-5-proposals/dsm-5-proposals-sub-page-3/

    I am no longer prepared to contribute to the MEA's Facebook site and have not posted a copy (or links to) this latest information about DSM-5 on the MEA's Facebook Wall or Discussion pages.

    I understand that Dr Goudsmit has made a reference to the information that I put out on Co-Cure on 16 January, on the MEA's Facebook Wall where she is a regular poster.

    Since Dr Goudsmit does not give permission for her Facebook Wall and Discussion posts and comments to be reposted on other platforms, I am not able to quote from her comment.

    The MEA's Facebook site is a public site, so you should be able to view the comment, in situ, which was posted by Dr Goudsmit on Monday, 17 January.

    Suzy
  19. WillowJ

    WillowJ Senior Member

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    the APA is defunct. if it was up to them, there would be no one who was not a phsychiatric patient. there will be no reason or rationality from that quarter
  20. Dx Revision Watch

    Dx Revision Watch Suzy Chapman dxrevisionwatch.com

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    Opinion: Washington Examiner

    http://washingtonexaminer.com/blogs/opinion-zone/2011/01/corrupting-psychiatry

    Corrupting Psychiatry

    TAGS:
    American Psychiatric Association
    APA
    corruption
    Max Borders
    rent seeking
    Comments (0)

    By: Max Borders 01/18/11 10:22 AM

    The American Psychiatric Association (APA) has gone crazy -- like a fox.

    There was a time when we could be more charitable about the vagaries in the APAs Bible, the DSM. But not anymore. If youve never heard of the DSM, its the Diagnostic and Statistical Manual series the APA publishes. Psychiatrists all over the world use the DSM as a guidebook for treating people with some form of mental illness. But the APA may test credulity with its upcoming edition.

    Read on

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