DSM-5 proposals for Somatoform Disorders revised on April 27

[Dx Revision Watch]

There are now a number of existing threads on DSM-5 proposals but I am starting a new thread since proposals were revised a couple of days ago and these proposals supercede previous iterations. I am posting this content over several messages.

Caveat: Please note that the third stakeholder review has not yet been launched by the APA and that proposals as set out below and on my site may be subject to change between now and when the third draft is released, for which we have no firm date.


Part One

From Suzy Chapman for http://dxrevisionwatch.wordpress.com

29 April 2012


Dx Revision Revision Post #162 Shortlink: http://wp.me/pKrrB-24D

Although the American Psychiatric Association (APA) has still to announce the dates for its third review of proposals for revisions to DSM-IV categories and criteria, I noted yesterday, that proposals for the revision of the Somatoform Disorders had been updated on April 27.

The APAs third and final stakeholder review exercise is expected to launch by "end of May at the latest." This is the only information we currently have and the DSM-5 Development Timeline remains unspecific other than "Spring" and a comment period open for "for two months."

[Content edited on 9 June, 2012]

From the DSM-5 Development website

Revisions as of April 27, 2012 (J 04 Factitious Disorder was updated on March 22, 2012)

http://www.dsm5.org/proposedrevision/Pages/SomaticSymptomDisorders.aspx

Somatic Symptom Disorders



[Note that for the third draft the SSD Work Group proposes to merge the previously proposed category, "Simple Somatic Symptom Disorder" with "Complex Somatic Symptom Disorder" and is also considering dropping "Complex" from the name of the resulting disorder and instead, calling it "Somatic Symptom Disorder."]

[Note: Published with the first and second drafts there were two key PDF documents associated with the proposals for the "Somatic Symptom Disorders" - the "Disorders Description" document and "Rationale/Validity" document. Links for these have been removed from the webpages, presumably pending updating to reflect changes to proposals for this section of DSM-5. If and when these two documents are republished, I will update this thread. These updated proposal texts, below, are littered with typos which are the Work Group's and not mine.]

*At June 9, no PDF documents have been issued.


Instead of the categories as they had stood since May 2011:

Somatic Symptom Disorders

J 00 Complex Somatic Symptom Disorder
J 01 Simple Somatic Symptom Disorder
J 02 Illness Anxiety Disorder
J 03 Functional Neurological Disorder (Conversion Disorder)
J 04 Psychological Factors Affecting Medical Condition
J 05 Other Specified Somatic Symptom Disorder
J 06 Unspecified Somatic Symptom Disorder Pseudocyesis

the proposed categories now read (and note, are now renumbered):

Somatic Symptom Disorders

J 00 Somatic Symptom Disorder
J 01 Illness Anxiety Disorder
J 02 Conversion Disorder (Functional Neurological Symptom Disorder)
J 03 Psychological Factors Affecting Medical Condition
J 04 Factitious Disorder
J 05 Somatic Symptom Disorder Not Elsewhere Classified


Continued in Part Two

 

[Dx Revision Watch]

I'd be pleased if no comments are added until I have completed uploading this post.

[Content edited on 9 June, 2012]

Part Two

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=368

[Ed: Proposal, Rationale and Severity texts have been revised since the May 2011 iteration.]

J 00 Somatic Symptom Disorder

Updated April-27-2012

Proposed Revision

Somatic Symptom Disorder

Please refer to DSM-5 Development website for criteria.

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=368#

Rationale

Please refer to DSM-5 Development website for Rationale.

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=368#

Severity

Please refer to DSM-5 Development website for Severity Specifiers.

Severity Specifiers (mild, moderate, severe)*

[Ed: Cf with ICD-11 Alpha drafting platform proposals for three (as yet undefined) degrees of Mild, Moderate and Severe "Bodily Distress Disorder." See Post #145: Bodily Distress Disorders to replace Somatoform Disorders for ICD-11? February 20, 2012 at: http://wp.me/pKrrB-1Vx ]


Continued in Part Three

 

[Dx Revision Watch]

[Content edited on 9 June, 2012]

Part Three

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=10

[Ed: Proposal, Rationale and Severity texts have been revised since the May 2011 iteration.]

J 01 Illness Anxiety Disorder

Updated April-27-2012

Proposed Revision

Illness Anxiety Disorder

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=10#

Please refer to DSM-5 Development website for criteria.


Rationale

Please refer to DSM-5 Development website for Rationale.


http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=10#

Severity

Please refer to DSM-5 Development website for Severity.

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


http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=8

J 02 Conversion Disorder (Functional Neurological Symptom Disorder)

[Ed: Previous proposal was for renaming "Conversion Disorder" to "Functional Neurological Disorder (Conversion Disorder)" and to possibly relocate under "Dissociative Disorders" in line with ICD-10. Proposal, Rationale and Severity texts have been revised since the May 2011 iteration.]

Updated April-27-2012

Proposed Revision

Conversion Disorder (Functional Neurological Symptom Disorder)

Please refer to DSM-5 Development website for criteria.

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=8#

Rationale

Please refer to DSM-5 Development website for rationale.


http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=8#

Severity

Please refer to DSM-5 Development website for Severity Specifers.


Continued in Part Four

 

[Dx Revision Watch]

Part Four This concludes this four part posting

[Edited on 9 June, 2012]

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=387

J 03 Psychological Factors Affecting Medical Condition

Updated April-27-2012

Proposed Revision

Psychological Factors Affecting Medical Condition

Please refer to DSM-5 Development website for criteria.


[Ed: Rationale and Severity texts have been revised since May 2011 iteration.]

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=387#

Rationale

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=387#

Please refer to DSM-5 Development website for Rationale and Severity Measures


http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=386

J 04 Factitious Disorder

[Ed: Proposal, Rationale and Severity texts have been revised since the May 2011 iteration.]

Updated March-22-2012

Proposed Revision

Proposed Subtypes:

Factitious Disorder Imposed on Self


Factitious Disorder Imposed on Another (previously, Factitious Disorder By Proxy)

Please refer to DSM-5 Development website for criteria.

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=386#


Rationale

Please refer to DSM-5 Development website for Rationale and Severity.


http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=541

J 05 Somatic Symptom Disorder Not Elsewhere Classified


Please refer to DSM-5 Development website for Criteria, Rationale and Severity.


I will continue to monitor the DSM-5 Development site for any further changes and for the announcement of the third and final stakeholder review and will update the thread as more information becomes available or if the "Disorder Description" and "Rationale/Validity" PDF documents are republished before the third review, since these expand on the proposals as posted.

The APA holds its annual conference between May 5-9, during which the 13 Work Group chairs will be presenting on proposals. I doubt that the APA intends to launch the third and final review until after the conference, so we could be looking at the last two weeks of May for the launch of the third review, but I don't have confirmation.

This concludes this four part posting

 

[nanonug]

DSM-5 proposals

My gut reaction is: who cares?

Anything that comes out of the APA is not based on anything that can be measured. It is just a bunch of people voting based on their opinions. This is not science! They might as well invite the astrologers to their meetings, as far as I am concerned.

 

[merylg]

I wonder if all these patients will be offered genetic & other testing for Mitochondrial Diseases, before they are slapped with one of these silly labels???

"Could it be Mitochondrial Disease?"......."any organ, any symptom, any age"

http://www.amdf.org.au/mito-info.htm

 

[Dx Revision Watch]

So at least four members of PR don't care about the forthcoming DSM-5 (publication date May 2013).


Submissions from US and international patient advocacy organizations and individuals who do care about DSM-5 proposals can still be accessed at:

Submissions to the first DSM-5 public review (February 10 April 20, 2010)

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

Submissions to the second DSM-5 public review, May 4 - June 15, 2011 (extended to July 15)

http://dxrevisionwatch.wordpress.com/dsm-5-proposals/dsm-5-submissions-2011/

Page 1: International patient organizations

Coalition4ME/CFS (US); 25% ME Group with Greg Crowhurst (UK); CFIDS (US); Rocky Mountain CFS/ME and FM Association (US); National ME/FM Action Network (Canada); The Danish ME Association; ESME (Int); EMEA (Int); The ME Association (UK); Action for M.E. (UK); IACFS/ME (US); ME Free For All.org (UK); The Young ME Sufferers Trust (UK)

Page 2: Medical, allied health and other professional stakeholders

Dr Alan Gurwitt, M.D., President, Massachusetts CFIDS/ME & FM Association; Bill Goodin, M.D. (US); Richard A. Van Konynenburg, Ph.D. (US); Therese Duncan J.D., CADCII, ICADC (US); Angela Kennedy, sociology lecturer (UK); Dr John L Whiting MD, (Australia)

Page 3: Patients and advocates

Andrew (US); UK patient 3; US patient 1; Caroline Davis (UK); B Tilley (UK); Suzy Chapman (UK) (2); Glen Rich (Canada); Maarten Maartensz (NL); Jay Spero (US); UK patient 2; 26yearsME/CFS; UK patient 1; Gabrielle Lewis (UK); Chris Douglas (UK); Kati (Canada); Kevin Short (UK); Susanna Agardy (Australia); Mary Barker (US); Peter Kemp (UK); Mary M. Schweitzer (US)

Page 4: Professional bodies

British Psychological Society (BPS)

 

[Esther12]

Thanks Suzy.

It's a lot of info to take in.

B. Excessive thoughts, feelings, and behaviors related to these somatic symptoms or associated health concerns: At least one of the following must be present.

(1) Disproportionae and persistent thoughts about the seriousness of ones symptoms.

(2) Persistently high level of anxiety about health or symptoms

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

I wonder how this is to be assessed?

Psychological Factors Affecting Medical Condition

This seems to give a lot of power over the ill to medical practitioners... particularly when advice from doctor is often so poor.

I feel like my brain's swimming a bit from having read all that. There's a lot to take in, but also a lot f important details missing.

 

[merylg]

I get the impression that if one presents at the Emergency Room (Accident & Emergency)...for whatever reason...and it is NOT an emergency...one will be classified with a mental illness!!!

If one DOES NOT present at Emergency Room when one has chest pain or other symptom's of a heart attack, one will also be classified as mentally ill!!!

Did I read right???

 

[nanonug]

So at least four members of PR don't care about the forthcoming DSM-5 (publication date May 2013).

Is it too late to add a poll to the thread?

 

[taniaaust1]

Conversion Disorder (Functional Neurological Symptom Disorder)

A. One or more symptoms or deficits are present that affect voluntary motor or sensory function, with or without apparent impairment of consciousness.

B. Clinical findings provide evidence of internal inconsistency or incompatibility with recognized neurological or medical disease.

C. The symptom or deficit is not better explained by another recognized medical or DSM disorder.

D. The symptom or deficit is associated with clinically significant distress or imapairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

http://www.dsm5.org/ProposedRevision...on.aspx?rid=8#

Rationale

Name Change: The additional parenthetical functional neurological symptom disorder has been introduced as it is more frequently used by neurologists who see the majority of these patients. It is also a term that is more acceptable to patients.

Im so glad to hear that that patient group will be given a better name along side of Conversion disorder (Id rather see that conversion disorder removed), for their so called illness. I bet most who are given this diagnoses dont even have a psych illness but just have rare medical issues so fit B and C or bad doctors who arent good at diagnosing many things or dont know enough about things such as ME (when I told my doctor I was once admitted to hospital due to tremors and spasms and other neuro issues.. he said .. umm well that cant be ME/CFS).

Most of us have symptoms that most GPs arent even aware go along with having ME/CFS.. and could cop such a diagnoses due to naive doctors. I'd love to see that diagnoses gone as all it is is an outlet for a lazy doctor who cant work out what someone has, to throw someone into.

 

[taniaaust1]

I wonder if all these patients will be offered genetic & other testing for Mitochondrial Diseases, before they are slapped with one of these silly labels???

"Could it be Mitochondrial Disease?"......."any organ, any symptom, any age"

http://www.amdf.org.au/mito-info.htm

That's the thing.. we all know that these patients will not be provided with all the tests they should of had and once slapped with one of those labels.. there usually goes the persons chance of getting any more tests.

What is quite scary is that they are proposing to put the factitous disorders, in with the group which have symptoms of medically unknown causes eg the functional neurological symptom disorder group (and those often probably do have real undiagnosed medical disorders).

They want to put the 2 factiitous groups in with the others, they say to help research? ummmm that sounds very strange to me.

The medical profession should just admit it dont have all the answers.. and not be giving psych diagnoses just cause it dont have all the answers to the symptoms many have. Convesion disorder should be thrown out from the psych field cause it puts too many into a dangerous position of getting no real medical help for whatever is being experienced at all.

To those who say they dont care about this...

Anyone here could start getting new ME symptoms and end up at a hospital seeing a doctor who isnt aware of ME and hence wack a new diagnoses on top of having their previous ME/CFS one. (I suspect that is what a hospital may of done to me and hence why ive been kicked out of hospital (wheelchaired out) a couple of times when I couldnt even walk out. I suspect this is why I kept being sent home without home help.

(im going to get my hospital records one day and find out).

 

[Valentijn]

Im so glad to hear that that patient group will be given a better name along side of Conversion disorder (Id rather see that conversion disorder removed), for their so called illness.

But that's the problem - "functional disorder" is now just the new way to say "crazy" without upsetting the crazy person.

They can see nothing wrong physically, despite physical symptoms, so it's not categorized as physiological. The best thing that can be said about the new label is that it used to be more ambivalent - undiscovered physical causes were a possibility.

But by equating it with conversion disorder, they've moved it firmly into the psychological camp.

 

[PhoenixDown]

Upto the same old games as usual. Anyone with half a brain can see what's wrong with this picture.

 

[Enid]

With half a brain I fought off the psyche produced - now whole (thanks to no-one except the true experts) will continue to expose the ignorance of what is somewhat hopefully termed a profession of psychiatry and all too sticky fingers in ME with pure guesswork. Try gardening but spare the plants - that way you just may do less damage.

 

[Dx Revision Watch]

[Content edited on 9 June 2012]

02 May 2012

THIRD and FINAL stakeholder review published

Somatic Symptom Disorders: http://www.dsm5.org/ProposedRevision/Pages/SomaticSymptomDisorders.aspx

Please refer to DSM-5 Development site for proposals and criteria for third draft.

J 00 Somatic Symptom Disorder
J 01 Illness Anxiety Disorder
J 02 Conversion Disorder (Functional Neurological Symptom Disorder)
J 03 Psychological Factors Affecting Medical Condition
J 04 Factitious Disorder
J 05 Somatic Symptom Disorder Not Elsewhere Classified

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

http://www.dsm5.org/Pages/Default.aspx

Final Updates to DSM5.org

Please refer to DSM-5 Development site for information.


http://www.dsm5.org/ProposedRevision/Pages/Default.aspx

Proposed Draft Revisions to DSM Disorders and Criteria

 

[Calathea]

On reading the first section, my main response was that I actually know someone who has two of those disorders, not that she's been diagnosed as far as I know. Illness Anxiety Disorder (partly by proxy) and in the past, Factitious Disorder by Proxy. So it doesn't seem odd to me to list them, nor to link them. However, there is a very strong reliance on getting the physical diagnosis correct at the first try, and an underlying assumption that all physical disorders are now known and can be diagnosed correctly and easily. That part is highly damaging. Not just to us folks with ME - a friend of mine had a traumatic brain injury about eighteen years ago, and it was nearly a year before the doctors would actually believe that she really had total amnesia and various neurological symptoms.

With the list of mental illnesses in the latest post, a couple more stood out. Firstly, I'm not sure that gender dysphoria is psychiatric rather than hormonal. The people I have known who have had gender dysphoria have benefited from psychotherapy, but a lot of that was due to the horrendous discrimination they face and the fact that it's a very hard condition to live with. I've a feeling I've heard of people who really just needed the hormone treatment and surgery, and found it invasive to be constantly thrown at psychologists. You could compare it to any tough physical illness such as cancer, which is likely to be highly distressing and even traumatic, but remains a physical illness at root. Secondly, since when is a sleep-wake sleep disorder a mental illness? I didn't need psychiatric treatment for having Non-24 Sleep-Wake Disorder, I needed treatment to alter my circadian rhythms, in particular the timing of melatonin and serotonin, and I accomplished this using light therapy and darkness therapy. The vast majority of people with N24 have it because they're blind and don't get proper light signals, for heaven's sake!

 

[Enid]

What on earth is a mental illness if it is not dysfunction of brain chemistry etc. I mean last stages of syphilis is just that - who needs psyches to ponder as understanding of viral infections/treatments and all things affecting the brain grow.

 

[jimells]

My gut reaction is: who cares?

They might as well invite the astrologers to their meetings, as far as I am concerned.

I can't thank you enough for your comment! I'm still laughing!

Actually this is unfair to the astrologers. At least they get out of the ivory towers and look to the heavens for inspiration.

The 'diagnosis' I liked the best was the one that said if a person seeks medical care they qualify for the Dx, and if they *avoid* medical care, they *still* qualify.

I think there's a word for this kind of rubbish... psychobabble, perhaps?

 

[Esther12]

It doesn't matter if their arguments are poor - their views can and will be imposed upon patients, particularly those patients lacking in independent support. I don't know how these matters will pan out, but it could cause people real problems I'm afraid.