The American Psychiatric Association (APA) has gone crazy -- like a fox.
Jan 21, 2011 9:55 PM
Good article, that says things that need to be said, long and loud.
Both the APA, and the broader psychiatric profession, are currently indulging in a seriously unjustified power grab, and they and their claims are in desperate need of much closer and tougher (and ongoing) external scrutiny then they have been subject to date.
Generally speaking, I would have to agree that the profession is becoming much too closely aligned with and mutually reliant on both state and corporate interests, as opposed to the interests of the patient and the science on which they base their claims to authority.
One small point: I would not invoke British psychiatry as any counterbalance to the excesses of their American colleagues. The Brits have their own serious problems. Not least of which is that they are mired deep in the methodological and ethical swamp of somatoform disorders (aka conversion or psychosomatic disorders, and their related 'treatments'), and a lot of patients are paying a very heavy price indeed for this obsession by certain influential members of the British psych establishment.
By: Suzy Chapman
Jan 22, 2011 7:28 AM
Erasing the interface between psychiatry and medicine
The previous commenter cautions against invoking members of the "British psych establishment". Two very influential members of the British psychiatry and psychosomatics establishment, Professors Michael Sharpe and Francis Creed, have seats on the DSM-5 "Somatic Symptom Disorders" Work Group.
While many column inches by rightly perturbed journalists and a stream of often acerbic critiques from former DSM Task Force chairs, Allen Frances and Robert Spitzer, have focussed on the implications for introducing new additions into the DSM and broadening the definitions of existing diagnostic criteria, the DSM-5 "Somatic Symptom Disorders" Work Group (Chair, Joel E Dimsdale) has been quietly redefining DSM's Somatoform Disorders categories with proposals that if approved would legitimise the application of an additional diagnosis of Somatic Symptom Disorder to all medical diseases and disorders.
Radical proposals for renaming the Somatoform Disorders" category Somatic Symptom Disorders and combining a number of existing categories under a new umbrella, "Complex Somatic Symptom Disorder (CSSD)" and a more recently suggested "Simple Somatic Symptom Disorder (SSSD)", have the potential for bringing millions more patients under a mental health banner and expanding markets for psychiatric services, antidepressants, antipsychotics and behavioural therapies such as Cognitive Behavioural Therapy (CBT) for all patients with somatic symptoms, irrespective of cause.
Professor Creed is co-editor of The Journal of Psychosomatic Research. In a June '09 Editorial, titled "The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV - a preliminary report", which expanded on a brief DSM-5 Work Group progress report published on the DSM-5 Development website that April, Joel E Dimsdale and fellow DSM-5 Work Group member, Francis Creed, reported that by doing away with the "controversial concept of medically unexplained symptoms", their proposed classification might diminish the "dichotomy, inherent in the 'Somatoform' section of DSM IV, between disorders based on medically unexplained symptoms and patients with organic disease."
If the most recent "Somatic Symptom Disorders" Work Group proposals gain DSM Task Force approval, all medical conditions, whether "established general medical conditions or disorders" like diabetes or conditions presenting with somatic symptoms of unclear etiology will have the potential for a bolt-on diagnosis of "somatic symptom disorder".
Under the guise of "eliminating stigma" and eradicating "terminology [that] enforces a dualism between psychiatric and medical conditions" the American Psychiatric Association (APA) appears hell bent on colonising the entire medical field by licensing the application of a mental health diagnosis to all medical diseases and disorders.
Journal of Psychosomatic Research: Two articles In Press
Two of the three co-editors of the Journal of Psychosomatic Research are Francis Creed and James Levenson. Like Creed, Levenson is a member of the DSM-5 "Somatic Symptom Disorders" Work Group (SSD WG).
Michael Sharpe is listed as an Associate Editor of J Psychosoma Res and is also a member of the DSM-5 SSD WG.
Arthur Barsky is listed as an Adviser to the journal and is also a member of the DSM-5 SSD WG.
All four were members of Dr Richard Sykes' CISSD Project, as was Javier Escobar, who is now a member of the DSM-5 Task Force and is said to work closely with the DSM-5 SSD Work Group.
Simon Wessely is also listed as an Adviser to J Psychosoma Res.
J Psychosoma Res has been used as a discussion platform for the DSM-5 SSD WG, with editorials and articles by SSD WG Chair, Joel E Dimsdale, et al, being published in the journal around the DSM-5 SDD revision process and the papers and articles the process has been generating over the last few years.
The journal is the official organ of the EACLPP (European Association for Consultation-Liaison Psychiatry and Psychosomatics) which holds annual conferences. Creed and colleagues, Henningsen, Per Fink et al, have been engaged in an EACLPP working group project, over the past couple of years, towards the development of a White Paper on MUS:
Somatoform disorders: 30 years of debate about criteria! What about children and adolescents? • REVIEW ARTICLE
In Press Corrected Proof , Available online 08 November 2010
Ilva Elena Schulte, Franz Petermann
Journal of Psychosomatic Research DOI: 10.1016/j.jpsychores.2010.08.005
Abstract | Full Text | Full-Text PDF (170 KB)
Journal of Psychosomatic Research xx (2010) xxx–xxx
Somatoform disorders: 30 years of debate about criteria! What about children and adolescents?
Ilva Elena Schulte, Franz Petermann
Center of Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
Received 26 November 2009; received in revised form 12 August 2010; accepted 18 August 2010
The aim of this study was to evaluate the suitability of the complex somatic symptom disorder, proposed by the DSM-V Somatic Symptom Disorders Workgroup, in classifying children and adolescents who suffer severely from medically unexplained symptoms. Methods: The existing knowledge about somatoform disorders (SDs) in children and adolescents was delineated by means of a comprehensive search in the psychological, psychiatric, and pediatric literature. It was analyzed to assess whether children and adolescents suffer from SDs according to DSM-IV-TR (prevalence, developmental course, comorbidity, risk factors, and impact on daily functioning).
Subsequently, each criterion of the complex somatic symptom disorder was outlined and discussed with respect to its suitability in classifying children and adolescents. The suitability of the DSM-IV-TR criteria of SDs and that of the criteria of the complex somatic symptom disorder were compared.
Current data of sufficient quality are limited but indicate that the DSM-IV-TR criteria are inappropriate for classifying most children and adolescents suffering from somatoform symptoms. The criteria for complex somatic symptom disorder are more appropriate.
Nevertheless, it is recommended to include two additional parameters: “parental excessive concern and preoccupation with the child's symptoms” and “high parental health anxieties.”
The criteria for complex somatic symptom disorder are more appropriate for children and adolescents than the current DSM-IV-TR criteria; they should be better adapted to the special situation of children and adolescents.
Differing perspectives on diagnostic proposals for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition • EDITORIAL
In Press Corrected Proof , Available online 18 January 2011
Joel E. Dimsdale, James Levenson, Michael Sharpe
Journal of Psychosomatic Research
Full Text | Full-Text PDF (66 KB)
The paper to which they are responding is this one:
Psychiatric classification in the setting of medical disease: Comparing the clinical value of different proposals • EDITORIAL
In Press Corrected Proof , Available online 16 December 2010
Laura Sirri, Giovanni A. Fava, Thomas N. Wise
Journal of Psychosomatic Research DOI: 10.1016/j.jpsychores.2010.10.008
Full Text | Full-Text PDF (96 KB)
As others have said, anyone who has a medical condition which gives them a high level of anxiety for a month has this new 'disorder'. This is already covered by 'adjustment disorder' so it seems to me, given the people writing the definitions, that it's an attempt to label us with a disorder ("somatic symptom disorder") that they can say was previously known as "somatization" thus further weighing us down with associations to "somatization" in order to discredit us.
It looks like APA is not officially accepting comments, but does anyone have a list of email addresses to which we can send letters before the comment period in the late spring? Committee members (although the emails will go in the trash), higher ups in APA, psychology websites, etc.? Anyone want to set up a petition?