Whoa, folks, slow down a bit...
The revision of DSM-IV has been underway since 1999, though the Work Groups weren't convened until 2007 and not announced until May 2008.
I've been putting out information on the forthcoming revisions of ICD-10 and DSM-V since the end of January, this year, on my website and via Co-Cure.
Understand that in the US, you are not on the same version of the WHO's ICD as we are in the UK, Europe and some other parts of the globe - we are on ICD-10.
It is
ICD-10 that is being revised...
...but don't stop reading...
The US is currently on
ICD-9 CM (Clinical Modification)
See the different versions set out here:
http://en.wikipedia.org/wiki/History_of_chronic_fatigue_syndrome#ICD-10-CM
The revision process towards ICD-11 started in 2007 and ICD-11 is timelined for approval and dissemination in 2014/15.
But the US will be shifting onto
ICD-10-CM (Clinical Modification) in October 2013 not onto
ICD-11 when we do, in the UK (and elsewhere).
So in the US, initially, you need to be relating to your advocacy organisations and to the US body responsible for your US Clinical Modification of ICD and you need to be focussing on your version of ICD (due to be adopted in October 2013) and how DSM-V will be relating to that version.
In the UK and other parts of the globe currently using ICD-10 we need to relate to WHO Geneva.
You will have seen from my latest report that in its 10 December press release, the APA wrote:
APA will continue to work with the WHO to harmonize the DSM-5 with the mental and behavioural disorders section of the ICD-11. Given the timing of the release of both DSM-5 and ICD-11 in relation to the ICD-10-CM, the APA will also work with the CDC and CMS to propose a structure for the U.S. ICD-10 CM that is reflective of the DSM-5 and ICD-11 harmonization efforts. This will be done prior to the time when the ICD-10-CM revisions are “frozen” for CMS and insurance companies to prepare for the October 1, 2013, adoption.
So although the US is shifting up to ICD-10-CM in 2013, the revision of DSM still needs close watching in the context of ICD-11.
We will not know for sure until the ICD-11 Alpha Draft is issued in 2010 whether the WHO is intending to review the current taxonomy for PVFS and ME. But the WHO's Dr Robert Jakob has written informally that the WHO has no current plans to revise the classifications and codings for PVFS and ME.
Some proposals for ICD-11 have already been received via the ICD Update and Revision Platform. But the work of populating the Content for ICD-11 and reviewing proposals has not long been in progress.
The revision of ICD-11 also has Work Groups - called "Topic Advisory Groups" (TAGs) led by TAG chairs and Managing Editors (TAGMEs) and there is a Work Group for Chapter V (Mental and Behavioural Disorders) and for Chapter VI (the Neurological Section).
We now have the names of the members of these ICD Revision Topic Advisory Groups (TAGs) and they are published on my site.
I was told, a couple of months ago, by the co-ordinator for the revision of Chapter V, that it was intended to issue a proposal form for Chapter V and Chapter VI which could be used by anyone to make proposals for these two chapters, backed up by citations.
This proposal form has yet to materialise.
The revision process towards ICD-11 will be a more transparent process than the revision of DSM. The documents, style guides, content models etc are being made accessible to the public here:
https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents
The revision will be undertaken via a wiki-like authoring platform which is intended to be visible to members of the public but has not yet launched.
See this series of YouTubes here for how it is going to operate: ICD Revision iCamp YouTube videos: http://www.youtube.com/user/WHOICD11
Each Chapter of ICD-11 will have a “Start-up list” which, according to ICD Revision documentation, will include current ICD-10 content, input from ICD clinical modifications and WHO affiliate organisations, proposals already received via the ICD Update and Revision Platform and this should be evident from the iCAT platform.
So we should be able to monitor the progress of the revision more closely than for DSM-V. An Alpha Draft of ICD-11 is scheduled for May 2010, followed by consultations, then a Beta Draft and field trials.
Assuming that ICD-11 does not have plans for proposing any changes to the current classification and codings for PVFS and ME, that leaves us with three issues:
1] How much content will be included for these two terms and what that content will be.
2] What will ICD-11 do with the term "Chronic fatigue syndrome"?
3] How much content will be included for "CFS" and what that content will be.
Again, please note that the US codes currently proposed for ICD-10-CM for 2013 are not identical to ICD-10 and CFS is not coded the same as for PVFS and ME:
http://en.wikipedia.org/wiki/History_of_chronic_fatigue_syndrome#ICD-10-CM
But for the UK and other regions that are currently using ICD-10 the situation is this:
There are two volumes of ICD-10 that have relevance to this specific issue:
Volume 1: The Tabular List and
Volume 3: The Alphabetical Index.
There is currently no classification or coding in ICD-10 for "Chronic fatigue syndrome" in Volume 1.
But "Chronic fatigue syndrome" has been included in
Volume 3: The Alphabetical Index and given the coding
G93.3 - the same coding currently given to PVFS and ME.
(The issue of whether CFS should be split from PVFS and ME, or whether PVFS and ME should even be coded at the same code each other, is beyond the scope of this posting.)
As far as ICD-11 goes, the question of what the WHO revision will do with "Chronic fatigue syndrome" remains hanging.
Volume 1 and Volume 3 will need to fully integrate within the structure of ICD-11, so either the coding for "Chronic fatigue syndrome" will need to be formalised by pinning it to G93.3 (assuming no change to PVFS and ME) in Volume 1 or it will need to be coded elsewhere OUTSIDE Chapter V (Mental Health), or not given any code at all (which seems unlikely).
Under WHO taxonomy rules you cannot have the same disease/disorder classified in two places - so in theory, WHO cannot code for "Chronic fatigue syndrome" in say Chapter VI, but also code it in Chapter V (Mental and Behavioural Disorders).
This is a very important rule.
I have set out on my site what we know so far about the
"Somatic Distress Disorders" Work Group (SDD WG) proposals - and it looks as though things may still be pretty chaotic but we won't know what their latest proposals are until early next year.
The DSM-V Task Force is expected to publish its most recent proposals in January for a two month consultation period, followed by field trials. Whether it will be ready to do so remains to be seen. There is already a document on the DSM-V site setting out how to go about submitting proposals for the revision of DSM-IV but I would think that a specific document will be published for the Alpha Draft - so my advice would be to wait until we have more information, in the New Year.
The DSM SDD Work Group have been discussing getting rid of the term
"medically unexplained symptoms" in order to eliminate the interface between psychiatric and general medical disorders. The conceptual framework the Work Group were proposing, in June, would:
…allow a diagnosis of somatic symptom disorder in addition to a general medical condition, whether the latter is a well-recognized organic disease or a functional somatic syndrome such as irritable bowel syndrome or chronic fatigue syndrome."
Under this framework everyone is stuffed! But then liaison psychiatry and psychosomatics has been stealthily colonising the entire spectrum of diseases and disorders for years.
Since "chronic fatigue syndrome", IBS, FM and a number of other disorders and conditions are lumped under the
"functional somatic syndrome" umbrella, we need to be scrutinising proposals for how
"functional somatic syndromes" are to be accounted for in DSM-V.
At the moment, they do not seem able to even agree on what to rename this section, let alone how it might be restructured or what might sit on what Axis.
Additionally, DSM-V have committed, as far as possible, to strive for harmonization between DSM-V and Chapter V of ICD-11 - so the sections for what are currently categorised under
"Somatoform Disorders" (which in DSM-V will likely be renamed) should, in theory, be broadly comparable between the two systems.
So that means that we all need to be watching whether and to what extent the
"Somatoform Disorders" section of DSM-V will be mirrored by ICD-11's Chapter V.
Those of you in the US have already got "Chronic fatigue syndrome" coded in ICD-10-CM (or at least a proposed coding) - but you should still keep a close watch, until the ICD-10-CM (Clinical Modification) is "frozen".
So I have made
no claims that DSM is attempting to have PVFS or ME classified in DSM-V. Nor have I claimed that DSM-V is attempting to allocate a specific code to CFS in the section that is currently called
"Somatoform Disorders". I don't personally think DSM-V are planning to allocate a code specifically for CFS, or specific codes for IBS or for FM - it's more subtle and insidious.
The issue is how the so-called
"functional somatic syndromes" are going to be represented within DSM-V and the implications for
"dual-diagnosis" as in
"...a diagnosis of somatic symptom disorder in addition to a general medical condition, whether the latter is a well-recognized organic disease or a functional somatic syndrome such as irritable bowel syndrome or chronic fatigue syndrome."
not just for CFS, IBS, FM, CS, CI, GWS etc but for
all medical conditions.
So I urge those in the US, if you aren't already doing so, to start discussing these issues with your patient orgs, advocates and professional advocates (and by these I mean your ME and CFS friendly clinicians, psychologists and researchers), now, before the draft proposals are released, early next year - the consultation period for this alpha draft is only two months.
It's a complex issue.
