Allen Frances with Suzy Chapman - opposition to DSM-5 SSD category

[Dx Revision Watch]

Full commentary: http://www.psychologytoday.com/blog...2/mislabeling-medical-illness-mental-disorder

Please click through to Psychology Today for full article, rather than repost in full as Dr Frances and I want thousands of hits on this commentary on the DSM-5 SSD criteria.

December 09, 2012

Today, Allen Frances, MD, who chaired the Task Force responsible for DSM-IV, published his concerns for the potential harm to all illness groups if DSM-5 Somatic Symptom Disorder (SSD) criteria go ahead as they stand.

In the DSM-5 field trials, one in six patients with serious diseases like cancer, heart disease and diabetes met the criteria for an additional diagnosis of "Somatic Symptom Disorder". Over 25% of the "functional somatic" field trial study group (irritable bowel and chronic widespread pain) were coded with 'SSD'.

For his last DSM-5 commentary (December 02), Dr Frances received a staggering number of hits and link backs on media sites and blogs.

To demonstrate to the SSD Work Group and DSM-5 Task Force the strength of concern for the implications of the SSD criteria I would like as much exposure and traffic to this new SSD blog post as we can muster.

The DSM-5 manual texts have not yet been finalized for the publishers and it's not too late to put pressure on the Work Group to reconsider their proposals.

The SSD criteria will impact all patient groups and families with children with chronic medical diseases and conditions; also the elderly, in which there are higher rates of cancer, heart disease and age-onset diabetes - all three diseases cited by the SSD Work Group as candidates for a diagnosis of a mental health disorder if the patient also meets the criteria for "SSD'.

Please circulate the link for Dr Frances' opposition to these SSD criteria far and wide on ME, CFS and FM forums, Facebook, Twitter, blogs and websites and all health and patient advocacy platforms - especially US sites.

Please forward the link to your contacts and ask them to forward on to others and to flag up Dr Frances' Psychology Today blog post link wherever they can. We want thousands of hits on this post.

We also need to reach IBS, GWI, cancer, heart disease, diabetes and health advocacy sites for all medical conditions, since all patient groups stand to be hurt by these DSM-5 SSD proposals, also mental health advocacy platforms and medical professionals.

It is expected that a version of Dr Frances' commentary may also be published on Huff Po and several other platforms.

Here is the link for the Psychology Today Blog and with thanks, in advance, for your help with publicising Dr Frances' SSD commentary:


Psychology Today
DSM5 in Distress blog

The DSM's impact on mental health practice and research

Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke.

http://www.psychologytoday.com/blog/dsm5-in-distress/201212/mislabeling-medical-illness-mental-disorder
Mislabeling Medical Illness As Mental Disorder
The eleventh DSM 5 mistake needs an eleventh hour correction.

Allen J Frances MD | December 9, 2012

Allen Frances said, "...Adding to the woes of the medically ill could be one of the biggest problems caused by DSM 5. It will do this in two ways: 1) by encouraging a quick jump to the erroneous conclusion that someone's physical symptoms are 'all in the head'; and 2) by mislabeling as mental disorders what are really just the normal emotional reactions that people understandably have in response to a medical illness..."

Suzy Chapman said, "...the requirement of 'medically unexplained' symptoms is replaced by much looser and more subjective 'excessive thoughts, behaviors and feelings' and the clinician's perception of 'dysfunctional illness belief' or 'excessive preoccupation' with the bodily symptom.

"That, and a duration of at least six months, is all that is required to tick the box for a bolt-on diagnosis of a mental health disorder – Colorectal cancer + SSD; Angina + SSD; Type 2 diabetes + SSD; IBS + SSD..."

Full commentary: http://www.psychologytoday.com/blog...2/mislabeling-medical-illness-mental-disorder

 

[Firestormm]

This is a very good round-up I think. I read it earlier and commented on BS after noticing it on Facebook:

I've haven't followed all of Suzy's work on this but was aware that it was taking place. Again the issue [of relevance] of somatisation is encapsulated within the article.

However:

Allen Francis:

The boundary between medical and psychiatric illness is inherently difficult to draw, especially since many psychiatric disorders do present with prominent somatic symptoms that are often mistaken for medical illness.

Granted. We are talking about long term chronic conditions whose 'organic' nature is acknowledged, e.g. cancer but also acknowledged is patients difficulty in living with such a long term condition. So there is a crossing of boundaries. Why does this matter? Forgive my lack of understanding.

Also germane to this thread perhaps:


Suzy Chapman:

The Work Group is not proposing to classify Chronic Fatigue Syndrome, Irritable Bowel Syndrome, and Fibromyalgia within the DSM-5 'Somatic Symptom Disorders' section, but these patients and others with conditions like chronic Lyme disease, interstitial cystitis, Gulf War illness and chemical injury will now become particularly vulnerable to misdiagnosis with a DSM-5 mental health disorder. In the field trials, more than one in four of the irritable bowel and chronic widespread pain patients who comprised the 'functional somatic' study group were coded for 'Somatic Symptom Disorder.'

 

[GracieJ]

Glad to hear the "work group" is NOT proposing an SSD diagnosis with our conditions on this site... but this whole thing just makes my blood run cold. It is just such a teeny, tiny leap of misunderstanding to add SSD to everything anyway, and another teeny, tiny leap to all the wrong conclusions we are dealing with now already only on a much larger scale. This just has to go!

 

[Dreambirdie]

Thanks for all your ongoing work on this, Suzy. I just LIKED the article on my FB page and SHARED it to pass it along.

 

[Dx Revision Watch]

Thanks for all your ongoing work on this, Suzy. I just LIKED the article on my FB page and SHARED it to pass it along.

Thanks, Dreambirdie.

We need hundreds of links for this commentary on

Twitter
Facebook personal pages
Facebook group and cause pages (for all illness and disability groups)
Facebook support and advocacy pages
Blogs
Blog comments
Mention the commentary with date, title, author and location ( and post a link if links are accepted) in the comment sections of recent media coverage on DSM-5.

There is a list of recent media coverage in this post on my site:

Media coverage: American Pyschiatric Association Board of Trustees approves final DSM-5 diagnostic criteria: http://wp.me/pKrrB-2xF

 

[Esther12]

Thanks Suzy.

 

[justinreilly]

Awesome, Suzy!

 

[beaker]

Fantastic work Suzy! I am humbled by all the amazing work you have done on this matter that effects so very many. I don't know what your personal health status is, but you give so much of what I imagine to be a limited amount of energy.
Thank you.

with sincere regards,

 

[Dx Revision Watch]

Fantastic work Suzy! I am humbled by all the amazing work you have done on this matter that effects so very many. I don't know what your personal health status is, but you give so much of what I imagine to be a limited amount of energy.
Thank you.

with sincere regards,

Thank you, beaker, for your kind words. A batch of carefully considered responses to this Psychology Today blog commentary has been posted overnight. http://www.psychologytoday.com/blog...ling-medical-illness-mental-disorder/comments

As for my own situation: I am a carer/advocate for an adult who was diagnosed by an NHS paediatrician with ME in 1999, then aged nearly 13, who remains moderately affected. My own health is usually pretty good, but I've had problems this year and on Friday I go into hospital for surgery. So I won't have as much time as I would like this coming week to circulate this commentary.

Getting the link round ME, CFS and FM platforms isn't too onerous, but we are very keen to raise awareness of the SSD proposals with other patient groups and organizations, like cancer, heart disease, diabetes etc. The field trial study group for "diagnoses illness" used patients with cancer and severe coronary disease; diabetes has been cited by the Work Group as one of the diseases where patients might attract an additional diagnosis of "SSD" if the clinician considered the patient also met the criteria for "SSD" - though any illness over 6 months duration would qualify a patient, under the criteria as they had stood at the third draft.

(For the second draft, there had been a "Simple Somatic Symptom Disorder" proposed which required a chronicity of just one month's duration, but this was elimated from the third draft.) The "functional somatic" field trial study group had used "irritable bowel" and "chronic widespread pain" - a term used by Creed, Fink et al instead of fibromyalgia. So FM and IBS groups, too.

So I would be really grateful if those reading this thread who are able to spend some energy flagging up this commentary could also post a link on some platforms for other illness groups. Suzy

 

[Dx Revision Watch]

Around 4000 hits on the Allen Frances blog since Sunday. Please help make it 5000 by the end of today.

Many excellent comments, too - also comments from professionals. If you haven't already linked or visited this DSM-5 Somatic Symptom Disorder blog post please click now to:

http://www.psychologytoday.com/blog/dsm5-in-distress/201212/mislabeling-medical-illness-mental-disorder
Mislabeling Medical Illness As Mental DisorderThe eleventh DSM 5 mistake needs an eleventh hour correction.

by Allen J Frances MD

December 9, 2012

 

[Dx Revision Watch]

http://www.madinamerica.com/

Featured Blogs

Boycott The DSM-5: Anachronistic Before Its Time

Jack Carney, DSW

December 10, 2012

​

When plans for the DSM-5 were first announced about ten years ago, most folks’ reaction was “Why?”. Many of us asked that same question several times as the publication date for the new tome kept on getting pushed back. Finally, the curtain enshrouding the DSM-5 Task Force and its several committees began to part and proposed revisions/additions began to appear on its website. To our dismay, we found our question answered.

Full Article → [which includes quotes from my website post and the Allen Frances Psychology Today blog]:

http://www.madinamerica.com/2012/12/the-dsm-5-anachronistic-before-its-time-boycott-the-dsm-5/

 

[alex3619]

This is where I have been thinking its heading. Even as I wrote my commentary to APA on DSM-V I thought it would not be stopped, and the real fight was after it was released. This is not science or medicine as it should be practiced or as we want it to be practiced. I would like to see a clear message sent to the APA. Lets make this a collosal financial loss for them, and boycott it.

I posted this message first on a related thread.

 

[Dx Revision Watch]

Dr Ellie Stein has left a brief comment:

http://www.psychologytoday.com/blog...ling-medical-illness-mental-disorder/comments

If you haven't clicked on the blog yet, or forwarded on the link to others or posted the link on Facebook or Twitter - please, do, if you can manage it.

Suzy

 

[Dx Revision Watch]

A 25th comment from a Dr Robert Oppenheimer -

As a Psychologist with Chronic Fatigue Syndrome I am very concerned about this new Somatic diagnosis...

http://www.psychologytoday.com/blog...2/mislabeling-medical-illness-mental-disorder

 

[Dx Revision Watch]

This joint commentary has been published on Huff Po. There is a comment facility for Huff Po blog articles and well considered comments would be welcomed. Articles that receive significant numbers of comments are sometimes elevated to "featured posts."

We would still like hits and comments on the Psychology Today article, so if you are reading/commenting on the Huff Po version, I'd be grateful if you would also hit on the PT site (URL in post #13 above) and leave your comment there as well.

Many thanks,
Suzy


http://www.huffingtonpost.com/allen-frances/mislabeling-medical-illne_b_2265198.html

Allen Frances
Professor Emeritus, Duke University




Mislabeling Medical Illness As Mental Disorder: The Eleventh DSM-5 Mistake
Posted: 12/11/2012 6:00 pm

"Many readers of my previous blog listing the 10 worst suggestions in DSM 5 were shocked that I failed to mention an 11th dangerous mistake -- that DSM-5 will harm people who are medically ill by mislabeling their medical problems as mental disorder. They are absolutely right. I apologize for my previous failure to attend to this danger and hope it is not now too late to influence the process.

"Adding to the woes of the medically ill could be one of the biggest problems caused by DSM-5. It will do this in two ways: 1) by encouraging a quick jump to the erroneous conclusion that someone's physical symptoms are 'all in the head'; and 2) by mislabeling as mental disorders what are really just the normal emotional reactions that people understandably have in response to a medical illness..."

 

[Firestormm]

Quite a few comments on that blog Allen from professionals in agreement with what he and you have said, Suzy. Nice job

 

[Dx Revision Watch]

Quite a few comments on that blog Allen from professionals in agreement with what he and you have said, Suzy. Nice job

Yes, it's good to see this - nearly 50 comments when I checked this morning.

Also a comment from Ronald Pies MD.

I've just left the following:

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

I would like to thank patients, carers and professionals for taking the time to comment in response to Dr Frances' post.

Criteria for Somatic Symptom Disorder, as published in May for the third draft, can be viewed half way down this post on my site: http://wp.me/pKrrB-29B

Extract from the end of my submission to the SSD Work Group in response to the third DSM-5 draft [1]:

"...Has the Work Group projected for potential increase in law suits against clinicians and APA members for missed diagnoses, misdiagnoses, misapplication of inappropriate treatment regimes and iatrogenic disease that may result from incautious and inept application of its proposed criteria?

"It is a considerable concern that no clinicians from medical specialities beyond psychiatry and psychosomatics and no general practitioners were invited to sit on the Work Group to input into considerations for the clinical and medico-legal implications of the group's proposals.

"As an advocate, I have received disturbing accounts over the years of patients diagnosed with poorly understood chronic illnesses who have met with contempt and dismissal when presenting in A & E departments following accidents or medical emergencies, or sent home with symptoms uninvestigated. Broken ribs, initially dismissed as "catastrophising," where the patient has had to plead for X-rays to be carried out. Severe, disabling back pain, initially dismissed as "catastrophising" and for which CBT had been prescribed but where eventual scans identified insult to the spinal chord putting the patient at risk of paralysis had surgery not been carried out.

"As the patient herself wrote, "If someone is very ill and in pain is it not normal to feel distressed? How much distress is too much? Who decides what the right amount of distress for any given situation is? What does 'disproportionate' mean in such a situation?"

"What barriers to appropriate care and investigation might patients encounter when presenting for primary, specialist or emergency assessment with an additional diagnosis of "SSD" on their medical records?

"Dr Dimsdale concedes his committee has struggled from the outset with these B type criteria but feels its proposals are "a step in the right direction."

"Patients deserve better than this; science demands rigor.

"In the absence of a substantial body of independent evidence for the SSD construct as a reliable, valid and safe alternative, I urge the Work Group not to proceed with its proposals for the reorganization of the "Somatoform Disorders" categories in favour of the status quo, or to dispense altogether with this section of DSM. There can be no justification for replacing one set of dysfunctional, unreliable and unsafe categories with another."

1] http://wp.me/pKrrB-29B

 

[Shell]

Perhaps we should get those in the Autism camp onside and fight it together. Removing the dx of Aspergers looks more like trying to cut back on resources for those children and adults than a genuine belief that Aspies don't exist. It seems more than coincidence that after reports showing the expential rise on dx of austim and Aspergers the powers-that-be should remove a dx from the DSM.

We desperately need to have some honest science done instead of all this politics and follow-the-money stuff.

 

[Dx Revision Watch]

Please post the link to the Psychology Today commentary and a quote from the article or a brief alert on platforms for as many illness groups as you can.

I am going into hospital early tomorrow for an operation and will be limited over the next two or three days for circulating this commentary.

If you are leaving a comment on the PT site, please also consider posting your comment on the Huff Po version, too.

Many thanks,

Suzy

 

[Esther12]

Good luck with your operation Suzy. I hope everything goes well for you and you recovery quickly.