(Junk?) Wessely et al paper talking about revisions of ICD-10, DSM-IV, etc

[Dolphin]

[Sorry, this doesn't have much info. Apologies if this has been highlighted already somewhere or is not that relevant - I can't see the full paper so can't check what is being talked about, nor am I up-to-date enough to make a good guess. But I'm guessing what is said in the paper could be relevant to ME/CFS and/or others with what are sometimes called "medically unexplained illnesses".]

What's so special about conversion disorder? A problem and a proposal for diagnostic classification.

RA Kanaan, A Carson, SC Wessely, TR Nicholson, S Aybek, and AS David

The British Journal of Psychiatry, June 1, 2010; 196(6): 427-8.

Abstract

Conversion disorder presents a problem for the revisions of DSM-IV and ICD-10, for reasons that are informative about the difficulties of psychiatric classification more generally. Giving up criteria based on psychological aetiology may be a painful sacrifice but it is still the right thing to do.

 

[xanadu]

Dolphin, It's about conversion disorder (hysteria), which it distinguishes from somatoform disorders in the first para:

Proposals for the classification of somatoform disorders seem to be approaching consensus, but no one knows what to do with conversion disorder.13 The somatoform disorders in general would be modelled as physical symptoms modified by psychosocial factors, restoring physiology to the diagnoses centre and dispersing some of their stigma: these are the same physiological processes that afflict us all, the proposals would say, made more problematic by psychosocial factors. Unfortunately, although that might make sense of a range of somatic syndromes from irritable bowel syndrome to fibromyalgia, it does not make sense of conversion disorder.2 It is a problem for DSMV and ICD11, for reasons that are informative about the practical and political difficulties of psychiatric classification more generally.

Unfortunately, I'm not allowed to post it to the library as I have fewer than 100 posts.

 

[Dx Revision Watch]

It's now in the Library.

 

[Dolphin]

Thanks for the full paper.

They want to change the definition from the current situation:

Currently, the criteria for conversion in both DSMIV and
ICD10 reflect this in two ways: first, they require a psychosocial
association, and second, the disorder cannot be merely feigned.5,6

to:

Our proposal is this: the diagnostic criteria for conversion should
simply be the following:
(a) the patient presents with symptoms suggestive of a motor or
sensory neurological deficit of significant severity;
(b) neuropathological explanations have been excluded, with a
qualifier acknowledging the degree of confidence in that
exclusion.

This could lead to more people getting the diagnosis, it seems to me.

They also point out:

"it would mean neurologists could diagnose the disorder, just as
gastroenterologists can diagnose irritable bowel syndrome."

 

[Esther12]

Our proposal is this: the diagnostic criteria for conversion should
simply be the following:
(a) the patient presents with symptoms suggestive of a motor or
sensory neurological deficit of significant severity;
(b) neuropathological explanations have been excluded, with a
qualifier acknowledging the degree of confidence in that
exclusion.

Imagine if they diagnosed CFS as a viral illness in this way:

a) Patient presents with symptoms historically seen as sugestive of a functional disorder yet
b) no further evidence of psychological illness is found, with a qualifier acknowledging the degree of
confidence in that exclusion.

In such cases antiretrovirals should be administered.

Bookmarked in the hope I'll find the time to read the whole thing in the future. Thanks.

 

[Dolphin]

One can reply if one wants

One can reply on the journal website if one wants:
http://bjp.rcpsych.org/cgi/eletter-submit/196/6/427

Probably best to make it look like a letter by putting a reference. An easy one is the article[1] itself! Of course, websites can be put as a reference[2] also.

References:

[1] Kanaan RA, Carson A, Wessely SC, Nicholson TR, Aybek S, David AS. What's so special about conversion disorder? A problem and a proposal for diagnostic classification. Br J Psychiatry. 2010 Jun;196(6):427-8.

[2] www.x.com