International ME/CFS and FM Awareness Day Is On May 12, 2018
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A New Term! - "Bodily Distress Syndrome"

Discussion in 'Latest ME/CFS Research' started by Dr. Yes, Apr 26, 2010.

  1. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    I'll check the page from time to time to see whether the

    "Preliminary programme and List of Participants"

    is made available.

  2. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    Thanks for the plug, Maarten, unfortunately there was insufficient space to insert "A hell of a woman" or "The woman from hell" or the names of both my sites, so I've had to settle for Suzy @ ME agenda.


    Chamfort (1741-1794):

    Almost all men are slaves, for the reason the Spartans gave to explain the servitude of the Persians, the inability to pronounce the syllable "No." Knowing how to pronounce this word and knowing how to live by oneself are the only two ways to preserve one's freedom and individuality.

    The Google auto translation was rough and offered the "bondage of Persians". Since this is a thread on BDS not BDSM, I've plumped for the version above.
  3. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    You'll be aware from an earlier post of mine in this thread (Post #2) that Frances Creed is also involved in this organisation which is administered out of Creed's University of Manchester office and linked to the Journal of Psychosomatic Research, for which Creed is co-editor:

    European Association of Consultation Liaison Psychiatry and Psychosomatics (EACLPP)

    Working Groups
    Medically Unexplained Symptoms and Somatisation

    which last year published this document:

    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 on behalf of the "EACLPP Medically Unexplained Symptoms study group"

    Henningsen and Creed are co-authors of the Editorial in the May issue of J Psycho Res: The genetic, physiological and psychological mechanisms underlying disabling medically unexplained symptoms and somatisation.

    Per Fink is also involved in the white paper. All three were members of the CISSD Project.

    Fink had been a co-author of the Extended Reattribution and Management model (TERM model)

    References to the EACLPP and to DSM and ICD revision in:

    Is there a better term than “Medically unexplained symptoms”? J Psychoso Res: Volume 68, Issue 1, Pages 5–8.



    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.

    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:

    see Post #2 for list

    There is this European forum too, which I stumbled across, last autumn - as you probably realise, Maarten, I am afflicted with SEAD (Search engine addiction disorder) for which the DSM-5 Task Force is proposing a new spanking new category just for me:

    "European policy initiative - the Mental and Physical Health Platform"

    I am prefacing links with this pertinent October '09 piece from the BBC website:

    Physical problems 'often mental'
    By Michelle Roberts
    Health reporter, BBC News

    14 October 2009

    Anxiety can manifest as physical problems

    The true burden of mental ill health is unrecognised since many "physical" problems, like cancer and obesity, are really "mind" problems, say experts.

    Most lung cancers are caused by addiction to smoking, and some obesity by a brain-driven compulsion to eat, says UK psychiatrist Dr Peter Jones.

    And to tackle such problems experts need to go back to delving the mind.

    He and other leading mental health experts are calling for a trebling of funding to 200m a year for research.

    The Research Mental Health initiative, along with public figures including Alistair Campbell, Jo Brand and Stephen Fry, are taking their declaration to Downing Street.

    We need to zip together physical and mental health. It is absurd to think that biological processes would stop at the neck

    Dr Peter Jones

    Mental illness in its "classic" sense, including depression and schizophrenia, affects one in four people in the UK each year but receives just 5% of total health research spending.

    Currently, around 74 million a year is spent on researching mental illness.

    Yet the economic, social and human cost of mental illness totals 100 billion a year in the UK alone.

    And many "physical" health problems involve a strong mental component, they say.


    Professor Peter Jones, head of psychiatry at the University of Cambridge, said: "Mental health and illness are seen as separate from physical health and disorders but it's becoming increasingly clear that is wrong.

    "Take smoking and lung cancer. People think of it as a physical illness but lung cancer is a behaviour disease due to smoking habit."

    Similarly, he said research showed that some cases of obesity could be explained by a hormonal deficiency that acts on the brain circuitry that tells the body when it is full or hungry.

    "We need to zip together physical and mental health. It is absurd to think that biological processes would stop at the neck."

    People with severe mental illnesses are nearly three times more likely to develop diabetes and other cardiovascular disease risk factors and, on average, die 25-30 years younger.

    Research Mental Health says more research investment is desperately needed to match the impact mental health has on people in terms of premature death and disability.

    Poor cousin

    "The long term aim must be to put mental health research on the same footing as that for physical illness," it says.

    Mental illness and cancer both account for about 15% of the total disease burden in the UK, yet cancer gets more than 25% of research investment, while mental health gets 5%.

    Andrew McCulloch, chief executive of the Mental Health Foundation, said: "Our understanding of mental illness is moving at a snail's pace.

    "Whilst treatments have improved, we have not yet seen the breakthroughs needed to significantly reduce the massive economic and social damage caused by mental illness."

    Meanwhile, experts and advocates in mental and physical health are working together for the first time in a European policy initiative - the Mental and Physical Health Platform - to improve the understanding of the interaction between body and mind in disease.

    The chairman of the initiative, John Bowis, said: "It is time to bridge the gap between mental and physical health by taking actions across policy areas and countries."


    Do note funding for this initiative from Bristol-Myers Squibb:

    Mental Health and Physical Health Platform 9 October workshop_report v 19122008.pdf

    9 October 2009 Workshop

    Towards a Holistic Approach on Mental Health & Physical Health

    An interactive workshop held on 9 October 2008 hosted by John Bowis MEP

    An initiative of the Mental Health & Physical Health Platform

    "A total of 20 participants attended the workshop at the European Parliament in Brussels, including members of the Mental Health and Physical Health Platform, invited national experts, representatives from the European Commission and Parliament, as well as representatives from Bristol-Myers Squibb.

    This initiative is supported by Bristol-Myers Squibb (BMS), a biopharmaceutical company that works with policymakers, patient groups and other stakeholders to achieve improved health care management. BMS focuses its research activities on major disease areas, including psychiatric disorders, to discover and develop innovative medicines that address unmet medical needs.. "

    See also: Green Paper recom.pdf

    See also: REPORT A6-2009-0034 0 DOC XML V0//EN



    The European Parliament, TA P6-TA-2009-0063 0 DOC XML V0//EN

    Texts adopted
    Thursday, 19 February 2009 - Brussels Provisional edition
    Mental Health P6_TA-PROV(2009)0063 A6-0034/2009

    European Parliament resolution of 19 February 2009 on Mental Health (2008/2209(INI))
  4. Dr. Yes

    Dr. Yes Shame on You

    I was wrong. This is the stupidest thing I have ever read:

    I may have found a new signature.

    (Btw Suzy: about your avatar blurb.. "hellion" will fit...)
  5. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    A somewhat disturbing article, yes?

    hellion (hlyn)

    A mischievous, troublesome, or unruly person.
    - someone who deliberately stirs up trouble

  6. Dr. Yes

    Dr. Yes Shame on You

    I cannot think of higher praise, nor someone more worthy of it. :Retro wink:
  7. Gerwyn

    Gerwyn Guest

    Yep that is the most stupid thing i have heard since the BS stuff.Are you sure he is not the founder member.the role of the cns and autonomic nervous system in causing disease is well documented.The have completely the wrong concept of mental health.neuroendocrine abnormalities dont imply poor mental health.
  8. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    I shall give your suggestion due consideration, Dr Yes.
  9. Angela Kennedy

    Angela Kennedy

    Essex, UK
    Also note the conflation of 'mind' and 'brain' in the writing, as if they were the same thing...
  10. Gerwyn

    Gerwyn Guest

    spot on angela disorder in the brain is not a mental really would be nice if psychos would learn some neuroscience instead of making stuff up
  11. Sunday

    Sunday Senior Member

    OK, on the basis of this, I've decided I can dub myself a scientist and name the whole, big problem. It's really very simple. I can even do it in that stylish acronym form:


    Death rate is 100%. No cure has been found.

    If we delude ourselves enough, though, maybe we can forget that.
  12. biophile

    biophile Places I'd rather be.

    Sometimes we hear from biopsychosocialists "there is no distinction between mind and body". That is probably the most amateurish statement I have heard regarding ME/CFS and the mind-body debate. Such statements are obviously meant to deflect criticism of their claims about psychosomatic functional illness. But psychobabble cloaked in the guise of physicalism is just biopsychobabble. Would they say "no distinction" to their Parkinson's disease patients with comorbid depression? Depression even precedes PD symptoms in many cases, more than 2-fold over what would be expected, but it is an early manifestation of PD pathophysiology.
  13. Dolphin

    Dolphin Senior Member

    I can't say I find this exciting at all. I just read it once - don't feel inclined to read it again so perhaps I'm missing something (but I doubt it in this case).

    I am not at all convinced that linking together such a mishmash of conditions is
    useful. Maybe they fancy themselves as being like physicists trying to create one unified theory?

    They claim that similar treatments work for them all but this is very
    They excluded out from the list of Functional Somatic Syndromes those
    "defined by one single symptom (e.g., tension headache)."

    So they pick out conditions that have at least a few symptoms associated
    with them and surprise-surprise, nearly all of these patients satisfy the
    bodily distress syndrome which requires patients to have at least 4 symptoms
    in total out of 30* symptoms (there are also more restrictive criteria but
    one can get in with 4 out of 30 for "Bodily distress syndrome, single-organ
    type" or alternatively with just 3 if they're in any one category).

    The 30 symptoms they picked out were also selected from the same cohort!

    The 30 symptoms come from 4 categories (see Appendix A):

    So "amazingly" CFS (Fukuda) patients who all have to have at least 5
    symptoms (fatigue plus 4 out of the 8 symptoms**) all satisfy the CISSD criteria (which requires at least 4 of the symptoms above). Will wonders never cease!


    * There are 2 measures for excessive fatigue (I think they are mental
    fatigue and physical fatigue - I don't have previous paper) and two for
    palpitations/heart pounding - each only counts for a maximum of 1.

    ** The 8 CDC symtpoms
  14. akrasia

    akrasia Senior Member

  15. biophile

    biophile Places I'd rather be.

    Imagine the irony if some of conditions under the "BDS" umbrella turn out to be unified by XMRV.
  16. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    Fink, Schröder, J Psychosom Res Fig 1

    Fink and Schröder dissing the SSD CSSD proposal (and setting out the CSSD "dual-diagnosis" construct):

    Fig 1:

    Fink, P, Schröder, A: One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res, Volume 68, Issue 5, Pages 415-426 (May 2010).

    Extract Page 416:


    "Although functional somatic symptoms form a continuum from few to many symptoms without clear cut-off to define the boundary of illness, one distinct bodily distress syndrome could be identified. Bodily distress syndrome could be divided into a severe, multiorgan type and a modest, singleorgan type with symptoms primarily from one organ system. The single-organ type was further divided into four subtypes; a cardiopulmonary (CP), a gastrointestinal (GI), a musculoskeletal (MS) and a general symptoms (GS) type (Fig. 1). Since these symptom profiles are in line with various other studies [13,20], the finding of bodily distress syndrome subtypes seems to be quite robust.

    We have previously hypothesized that bodily distress syndrome may replace most of the existing diagnostic categories of functional somatic syndromes and those of the somatoform disorders that are characterized by physical symptoms [21] (Fig. 1). This would be preferable to the approach proposed by the DSM-V workgroup on somatic symptom disorders which would entail two diagnoses: a psychiatric diagnosis on Axis I of complex somatic symptom disorder together with a medical diagnosis of a functional somatic syndrome on Axis III [22]. We believe that this proposed dual diagnosis solution would be a step backward in terms of attempting to unify the efforts of functional somatic syndrome research and to resolve the current dualistic diagnostic approach [23]. Very few previous studies have examined the overlap of the categories of the functional somatic syndromes and somatoform disorders, and no study to date has examined the unifying bodily distress syndrome approach against current diagnostic categories."


    [13] Simon G, Gater R, Kisely S, Piccinelli M. Somatic symptoms of distress: an international primary care study. Psychosomatic Med 1996;58:4818.

    [20] Gara MA, Silver RC, Escobar JI, Holman A, Waitzkin H. A hierarchical classes analysis (HICLAS) of primary care patients with medically unexplained somatic symptoms. Psychiatry Res 1998;81:7786.

    [21] Fink P, Rosendal M. Recent developments in the understanding and management of functional somatic symptoms in primary care. Curr Opin Psychiatry 2008;21:1828.

    [22] Dimsdale J, Creed F. The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IVa preliminary report. J Psychosom Res 2009;66:4736.

    [23] Schröder A, Fink P. The proposed diagnosis of somatic symptom disorders in DSM-V: two steps forward and one step backward? J Psychosom Res 2010;68:956.



    Neurasthenia is not classified within DSM-IV.
    Neurasthenia is classified in ICD-10 at F48.0.

    CFS is not classified within DSM-IV.
    Chronic fatigue syndrome is indexed in ICD-10 Volume 3: The Alphabetical Index to G93.3.
    Chronic fatigue syndrome is not classified in ICD-10 Volume 1: The Tabular List.

    For ICD-11, all three Volumes will integrate and will be electronically published.

    The Alpha Draft for ICD-11 is scheduled for release between 10 and 17 May and I shall be starting a new thread, shortly for information about the Alpha Draft.

    Current codes for PVFS, ME and CFS in ICD-10 are set out on these two pages on my website:

    Note also that Fibromyalgia is classified in ICD-10 in Chapter Chapter XIII: Diseases of the musculoskeletal system and connective tissue at M79.7 Fibromyalgia.

    Creed, Fink and Henningsen in their White paper of the EACLPP Medically Unexplained Symptoms study group refer to Fibromyalgia as "chronic widespread pain".

    White paper available here:

    or if glitchy download, direct from Suzy.


    In November '09, in Nevada, three DSM-5 Work Group members, Francis Creed, Lawson Wulsin and Joel Dimsdale (Chair, Somatic Symptom Disorders Work Group) gave presentations around Medically Unexplained Symptoms (MUS) and DSM-5, and on DSM-5 Work Group proposals.

    Slides are available for the first two presentations, with text for the third here: APM 2009 Annual Meeting Workshop: DSM-V for Psychosomatic Medicine: Current Progress and Controversies:




    Image source: Academy of Psychosomatic Medicine, Nevada, November 09 Annual Meeting slide presentation, Francis Creed, MD, FRCP: Can We Now Explain Medically Unexplained Symptoms?


    Current DSM-IV Codes and Categories for Somatoform Disorders and ICD-10 Equivalents


    Source: Mayou R, Kirmayer LJ, Simon G, Kroenke K, Sharpe M. Somatoform disorders: time for a new approach in DSM-V. Am J Psychiat. 2005;162:847855
  17. Angela Kennedy

    Angela Kennedy

    Essex, UK
    Ah - the old 'lumping or splitting' discussion. Rather like arguing how many angels can fit on a pinhead (LOL - is that the right reference?)
  18. Ecoclimber

    Ecoclimber Senior Member

    To the gods of Psychobabble

    You flatlanders amaze me with your hand wrapped around your brain like that and clicking you boots and uttering your heil slogans to the gods of good science but then you turn around and unravel and offer yourselves up to the gods of psychobabble.

    These gods offer up a pot fermented in the juices of Freudian, Jungian, a dash of Rogerian, a little dash of Gestalt but finding the stew lacking some meat, these gods throw in a bunch of frontal lobotomies from years past and zap it with some good old electric shock therapy. Finding it lacking in some kick, they spice it up with some pop psych, "I'm OK, You're OK" or should it be "I'm not OK & Your Not OK", squeeze some 'Mars & Venus' juices and ignite it with some light energy therapy but Hold On!

    A thunderous voice from one of the gods speaks and all is still. Here's what I want, throw in some CBT and GET. Booms the voice from the god, Wessely but Wait is it from Prism? Yes, good because I only want the best booms Wessely as he read the recipe from NICE.

    Wessely stirs the pot. Wow did you see those vultures fly out of the pot. Don't worry about them, booms Wessely, that's what you call UNUM Vultures. They occasionally drop DSM manual shit everywhere. Search through the crap to find the latest psychobabble disorders so we can mix em in, he booms. Don't they need any scientific research for verification before they can come up with a disorder? Nope we just pull things out of the air and call it science and everyone believes the gods of psychobabble. We can make nothing into something and back into nothing.

    Remember the good ole days when we use to label people with Parkinson, Diabetes, MS, Polio, SIDS as psychiatric disorders? Then the gods of science ruined it by linking them to organic conditions. What a field day we had playing around in medicine without having to actually examine an organ at treatment? Psychiatry? You Bet! Making nothing into something and back into nothing squawks Wessely. We can't measure Serotonin, Dopamine, Noradrenaline but we can sure give you medication but amount we don't know. We guesstimate. Is that science? To them it is. Heck, We don't take spect, pet, mri or fmri scans. It's really psychobabble between you and me...wink, wink. Yes and the medical profession must bow down to us the gods of psychobabble! Nothing into something and back into nothing, squawks Wessely.
  19. lansbergen

    lansbergen Senior Member

    :Sign Good one::thumbsup:
  20. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch


    Approach to Medically Unexplained Symptoms

    Jeffrey P Schaefer MSc MD FRCPC
    Rocky Mountain Conference of General Internal Medicine November 17, 2007


    "Body Distress Syndrome"

    cites a 2007 Fink paper.

    Fink also presented at this 2008 EACLPP/ECPR jolly:

    (Previously posted on ME agenda in April '09 in posting: )

    Advances in Liaison Psychiatry and Psychosomatics in Europe Conference

    Zaragoza, Spain June 25-28th, 2008

    [Selected sessions from the MUS and somatoform topic areas, which included sessions on adolescents with chronic fatigue syndrome]



    Chair/Discussant: Rosendal M (Denmark) [Ed: Co-author, TERM Model.]

    - Sharpe M, Butcher I, Carson A, Walker J, Cavanagh J, Williams C (Scotland-UK). The self rated clinical global impression (CGI) its use in a trial of CBT self help in patients attending neurology clinics with MUS

    - Christensen KS, Bech P, Fink P (Denmark). Responsiveness of screening questionnaires for mental disorders in primary care

    - Creed F (United Kingdom). Abdominal pain, health status or healthcare costs which outcome is relevant to a psychological treatment trial for irritable bowel syndrome patients?

    - Frostholm L (Denmark). Is the common-sense model of illness useful as an outcome measure in patients with functional somatic symptoms and disorders in primary care?

    - Fritzsche K, Schweickhardt A (Germany). Measuring emotional distress: response shift in relation to intervention



    Chair/Discussant: Rosmalen J (the Netherlands)

    - Fink P (Denmark). Bodily distress syndrome or disorder. An empirically based new diagnostic construct for somatisation and related disorders

    - Rosmalen J (the Netherlands). Validation of bodily distress disorder in a general population sample

    - Tak LM, Bakker SJL, Rosmalen JGM (the Netherlands). Dysfunction of the hypothalamic-pituitary-adrenal axis and somatization: A longitudinal cohort study

    - Kuzminskyte R (Denmark). Impaired Pain Processing in Multiple Functional Somatic Symptoms


    Chair/Discussant: Berardi D, Rigatelli M (Italy)

    - Collazzos (Spain). Cross-cultural CL Psychiatry and somatisation

    - Tarricone I, Morri M, Poggi F, Braca M, Pedrini E, Pompei G, Castellani A, Berardi D (Italy). Somatisation among migrants at the Bologna Transcultural Psychiatric Service in Bologna

    - zkan S (Turkey). Somatisation and Illness perception in different cultures

    - Ferrari S (Italy). Prevalence and risk factors of somatic distress: the Modena study


    Chair/Discussant: Risr MB (Denmark)

    - Risr MB (Denmark). The healing processes of persons with medically unexplained symptoms exploring qualitative approaches

    - Dowrick C, Salmon P (UK). Expanding horizons: improving qualitative investigation of MUS in primary care

    - Peters S, Graham CC, Dowrick C (UK). Psychological treatments for Medically Unexplained Symptoms (MUS) delivered by health professionals: Using qualitative methodologies to understand the story behind the numbers

    - Hansen HS (Denmark). Classification of medically unexplained symptoms in primary care



    Chair/Discussant: Sykes RD (United Kingdom)

    [Ed: Dr Richard Sykes PhD, Co-ordinator of the Action for M.E. administered CISSD Project.]



    Chair/Discussant: Hindley P (United Kingdom)

    - Vanderfaeillie J, Dick H, Willems D, Lampo A, Vandenplas Y (Belgium). Somatic symptoms in children: perception and recognition by the parents

    - Janssens KAM, Oldehinkel AJ, Rosmalen JGM (the Netherlands). Parental overprotection predicts the development of functional somatic symptoms in early adolescents

    - Van Cauwelaert K, Vanderfaeillie J, Lampo A, Vancoppenolle A, Meysmans M (Belgium). Evaluation of the relationship between cardiovascular exercise capacity, physical selfesteem and self reported fatigue in children with chronic fatigue

    - Dick H, Vanderfaeillie J, Marchand J, Lampo A (Belgium). Psychiatric disorders and specific personality aspects in adolescents with chronic fatigue syndrome and implications towards treatment.



    Chair/Discussant: Fink P (Denmark), Rief W (Germany)

    - Fink P (Denmark). Unmet need of care for the somatising and mentally ill patients in Primary Care

    - Rief W (Germany). Who seeks help because of bodily symptoms?

    - Henningsen P (Germany). Management of functional somatic syndromes

    - Sharpe M, Butcher I, Carson A, Walker J, Cavanagh J, Williams C (Scotland-UK). A randomised controlled trial of a guided self-help intervention for patients with medically unexplained neurological symptoms


    Note: Sykes, Sharpe, Rief and Henningsen were all members of the CISSD Project; Creed and Sharpe are members of the DSM-5 Somatic Symptoms Disorder Work Group.

    No information is available on the content of the Sykes' workshop "SOMATOFORM DISORDERS AND THE SIREN PSYCHOGENIC INFERENCE. HIDDEN PERILS AND SAFE ESCAPE ROUTES".

    In February '09, Dr Sykes had told me that he was continuing to work on the subject of symptoms and syndromes that are commonly regarded as unexplained.

    An Institute of Psychiatry FOI response disclosed that Dr Sykes Honorary Membership of the WHO Collaborating Centre ceased in 2007 and that he is now attached to the WHO Collaborating Centre as a Visiting Research Associate; that since 2008, Dr Sykes has been engaged on the London Medically Unexplained Physical Symptoms and Syndromes (MUPSS) Project for which he receives a research award of 27,000 per year from the Institute of Psychiatry; that the award for the MUPSS Project commenced in 2008 and is intended to cover all research and associated expenses e.g. travel, attendance at conferences; that the project is funded by a grant from the Hugh and Ruby Sykes Charitable Trust*. No other information was included about the MUPSS Project and there is no information available on the WHO Collaborating Centres website.

    *Sir Hugh is the brother of Dr Richard Sykes.

    The aims and objectives of the MUPSS Project have yet to be established, as does the nature and extent of the WHO Collaboration Centres involvement in the Project. It is not yet known whether a Work Group has been convened for the project (as in the case of the CISSD Project) or whether this Project is being undertaken solely by Dr Sykes.

    It is not known how this project is being carried out or who the stakeholders are, but is understood that Dr Sykes hopes a paper or papers may result out of the Project, which he has said has relevance to all conditions characterised by medically unexplained symptoms, not just CFS/ME.

    So very little is known at the moment other than that the MUPSS Project relates to what Dr Sykes perceives as medically unexplained symptoms (MUS) and that he includes within this category, CFS/ME.

    The CISSD Project, which has fed into both the DSM-5 and ICD-11 revision processes, had received funding of 62,750 during 2005-2008 from the Hugh and Ruby Sykes Charitable Trust.

    Dr Sykes, who is now in his late seventies, has published no public comment on the DSM-5 draft proposals.

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