CISSD Project: Commentaries from Stephen Ralph; Connie Nelson

A reminder of the make up of the Conceptual Issues in Somatoform and Similar Disorders Work-Group (CISSD Project):

International Chair: Professor Kurt Kroenke, Indiana University School of Medicine and Regenstrief Institute, Indianapolis;
UK Chair: Professor Michael Sharpe*, Department of Psychiatry, University of Edinburgh;
Principal Collaborator: Professor Rachel Jenkins, WHO Collaborating Centre;
Project Co-ordinator: Dr Richard Sykes, WHO Collaborating Centre.
Project Advisor: John Bradfield  [Source: WHO  ICD Update and Revision Platform ]

The Conceptual Issues in Somatoform and Similar Disorders Work Group included, in addition to the above: Natalie Banner, Arthur Barsky*, John Bradfield, Richard Brown, Frankie Campling, Francis Creed*, Veronique de Gucht, Charles Engel, Javier Escobar**, Per Fink, Peter Henningsen, Wolfgang Hiller, Kari Ann Leiknes, James Levenson*, Bernd Löwe, Richard Mayou, Winfried Rief, Kathryn Rost, Robert C. Smith, Mark Sullivan, Michael Trimble. [Source: ]

*All four are APA DSM-V Revision Process Somatic Distress Disorders Work Group members
**APA DSM-V Task Force member


Commentary from Stephen Ralph, including a commentary from Margaret Williams, first published in June 2004, followed by commentary from Connie Nelson.  (Although this makes for a lengthy posting, I am combining all three in one post for ease of reference.)

From Stephen Ralph, ME Action UK

28 February 2008

The “harmonisation” of “CFS/ME” in DSM V and ICD-11 and why this must fail  

How many times have we seen a psychiatrist or a psychiatric study describe “CFS/ME” as a “poorly understood illness“?

When torn up, these studies would provide enough confetti to supply the planet for a generation.

Is it the case that any poorly understood illness must now be classified as a psychiatric disorder?

If we were to believe these studies then the answer would be “Yes” because somewhere along the line there has been a decision to accept that new as yet untreatable complex biomedical diseases simply do not evolve and cannot in future arrive.

If Wessely, Sharpe, White, Sykes and even Sir Peter Spencer want “CFS/ME” in the mental health DSM V and in the forthcoming ICD-11 under the same mental health classifications then they must ensure that they have solid irrefutable proof that putting “CFS/ME” under mental health codes is without any doubt the acceptable thing to do not just for themselves but for the whole of medicine of which they are just a small often criticised faction.

The fact is that Wessely and his somatoform colleagues do not (even now after many years of incestuously “peer reviewed” studies) have this irrefutable proof especially when there are so many scientists carrying out significant physiological studies globally – who find indicative evidence – diametrically opposed to the claims of functional psychiatrists.

If the whole nosological picture was observed objectively and without conflicting interests then the whole field is still very much wide open.

So I have a feeling that when the final proofing meeting is held in Geneva, the World Health Organisation will in the end not bow to the somatoform lobbyists because of their total lack of robust conclusive scientific proof.

If it isn’t proven beyond doubt that “poorly understood illnesses” are in fact mental illnesses then the WHO should simply be bound to say “No” to the proposals to reclassify “CFS/ME” as physically manifested mental health disorders.

Otherwise, if they did then we would be left in a situation whereby ANY emerging and evolving pathology that could take 20 years to identify, will be treated in the future by default as a mental illness.

Patients who could end up with a new and as yet non-existent 21st Century equivalent of HIV/AIDS or Multiple Sclerosis would find themselves being given a knee jerk functional somatoform diagnosis of mental illness many years before being correctly diagnosed by hard biomedical research.

Patients will not find any use for CBT and GET because such interventions do nothing for the complex “invisible” underlying pathology that hard science has yet to pin down just as is the case with Myalgic Encephalomyelitis and other diseases such as Behet’s disease and Lyme Disease…

These people are now and will be victims of a medical misdiagnosis. How do they get their years of factitious medical history deleted?

How do they get there many years of lost life back? And when these people have lived with the label of mental illness and have lost all their friends, their husbands or wives and their children; how do they go about getting them back?

And if people are officially shunted into a functional mental health diagnosis then biomedical medical research to break them free will become almost impossible to fund because State funding will dry up. There will be an assumption that biomedical research is not needed because patients are all just mentally ill and all they will need is CBT, GET and antidepressants.

The end result will be hundreds of thousands of lifetimes of suffering for patients on lucrative gravy trains of CBT and GET and lucrative careers for the Somatoform Industry that is trying so hard to take off with Action for ME at its very heart.

In the Royal Courts of Justice on the 11th and 12th of February, Mr Bear the barrister for NICE claimed that there is no evidence that the Insurance Industry has any interest in “CFS/ME” yet there is an abundance of evidence.

And to give a small demonstration, Action for ME – not long after the Judicial Review was over – announced a conference in April…

CFS/ME Clinical & Research Network & Collaborative (CCRNC) 2009 Conference

AYME and Action for ME in collaboration with the CCRNC

Milton Keynes 23rd-24th April 2009

This is the second national conference for specialist services and health professionals working with people with Chronic Fatigue Syndrome/ME.

Thursday: Keynote Speaker Professor Mansel Aylward, Director of UNUM Centre for Psychosocial and Disability Research

(CPDR), University of Cardiff

Pathways to work (exact title tbc)

The conference dinner will be held on the Thursday night in Jurys Hotel.

Further details from this website: Chronic Fatigue Syndrome / ME Service at St Bartholomew’s Hospital.  


As you can see, the insurance company UNUM Provident is yet again at the heart of the agenda – the vehicle being driven by Action for ME linked nicely into the Pathways to Work scheme promoted by our UK Government.

Of course the Insurance Industry are laughing all the way to their offshore banks because there will be a greatly enhanced ability for any insurer to decline policy claims when a victim or a customer gets labelled as suffering from a functional mental illness that a bit of CBT will sort out – enough for them to return to work for a few months before those victims end up losing their jobs.

This is why this whole CISSD project  [Ed: see previous post] whose funding over 3 years has been administered (and because of this – fully supported) by Action for ME – a project to petition the WHO to “harmonise” a somatoform mental health classification of *CFS/ME* in the DSM V and in the ICD-11 MUST fail.

We all have the ability to lobby the World Health Organisation ourselves and this is exactly what we need to do.

And whilst I am here, can somebody ask why Richard Sykes, formerly of Westcare/Action for ME and now the force behind the Action for ME backed CISSD (mental health reclassification) Project has stated as a reason for change that Chronic Fatigue Syndrome has not yet been classified in the World Health Organisation ICD-10.

As Mr Sykes should know very well, Chronic Fatigue Syndrome has always been classified in the International ICD-10 – under G93.3 along with Benign Myalgic Encephalomyelitis and Post Viral Fatigue Syndrome.  

There are literally hundreds and thousands of concerned people out here who want answers.

Meanwhile Action for ME remains tellingly and culpably silent.

Thank you.

Stephen Ralph. DCR(D) Retired.  


From Stephen Ralph, ME Action UK

28 February 2008

The 2nd attempt to reclassify CFS/ME

Back in 2001 an “independent” WHO Collaborating Centre in London tried and failed to unofficially change the classification of CFS and ME to F48.0

That attempt failed when Connie Nelson with others lobbied various individuals and the World Health Organisation.

In short, the WHO in Geneva confirmed the correct classifications of CFS, ME and PVFS and quite rightly stated that all three were coded under the neurological diseases code of G93.3.

It was also officially stated by the head of the WHO in Geneva that these conditions could not be dual classified.

This first attempt by an unofficial group of “interested” individuals using World Health Organisation logos and banners on an unofficial website were thwarted.

Those concerned were forced to modify that website and eventually take it offline to be replaced by another website that included neurological disorders.

Here is the original letter from Connie to the Chief Medical Officer from 2001:

Letter from Connie Nelson to the Chief Medical Officer Professor Sir Liam Donaldson:

“Towards the end of August 2001 I inadvertently stumbled across a website hosting a “GUIDE to Mental Health in Primary Care” developed by the WHO Collaborating Centre for Research and Training for Mental Health, Institute of Psychiatry, Kings College, London.”……….

……….”Realising neither ME nor CFS are classified as mental health disorders, with ME being classified in the ICD-10 under G93.3 (neurological) and Chronic Fatigue Syndrome being index linked to the same, myself and others contacted the Collaborating Centre and the WHO Headquarters in Geneva to voice our concerns.”

View here:  26th October 2001

When challenged, Jo Paton of the original WHO Collaborating Centre wrote to Connie Nelson and the letter Connie received can be read here…

My view is that after this initial failure, those concerned decided to work on a bigger plan – a more organised plan to not only change the codings in ICD-11 but also to get CFS, ME and PVFS coded as mental illnesses in the DSM V.

This time they had the help of Action for ME – a silent partner but the vehicle through which all the money flowed.

Thus the “CISSD Somatisation Project” was formed.

Led by Richard Sykes who used to work for AfME/Westcare, the plan has been exactly the same.

Get together a WHO Collaborating Group but this time make the group bigger – more letters after names – more force and assumed credibility but this time keep it all underground with no website.

Without a website or any advertising by Action for ME who controlled the cash flow, everything has been kept difficult to find.

In a paper from December of 2007 the following can be seen:

Somatoform disorders and recent diagnostic controversies, Kroenke K, Psychiatr Clin North Am, 01-DEC-2007; 30(4): 593-619

“Although the CISSD is an ad hoc group that includes many international experts on somatoform disorders, it was neither appointed nor sanctioned by the APA or WHO, the organizations authorized to approve revisions of DSM and ICD, respectively…”

This time around, whilst AfME has organised the funding, it made no mention of its involvement, aside from having to mention such in its accounts – forced to reveal this project through accounting law.

This time around a far larger group of interested individuals have been working hard to get this reclassification sorted out more forcefully.

Yet again this WHO Collaborating Group do not appear to be sanctioned by the World Health Organisation themselves but are in fact an “independent” lobby group doing the very same thing i.e. attempting to get the classifications of CFS, ME and PVFS changed so that they can be listed as mental health disorders in both the DSM V and ICD-11.

I am sure I read somewhere that when asked about the codings of ME, CFS and PVFS, Wessely School psychiatrists used to dismiss the importance of classification because classifications only really mattered for statistical purposes.

It would seem that this is a very long way from the truth.

The codings matter a great deal to those who have been running this 2nd underground campaign backed by Action for ME.

This article below by Margaret Williams explains that going back to 2003 after the bungling of the first campaign, the second campaign that we are finding out about now was very much being put together.

For me – I find It quite chilling that Action for ME are effectively condoning and backing an underground effort to have all their members and the rest of the ME community labelled as being functionally mentally ill.

The fact that in their accounts AfME explain that “if accepted by the World Health Organisation, would be of direct benefit to people with ME”; Action for ME has no explanation and none of their members have ever been given a detailed explanation of exactly how their members or everyone else in the UK affected would benefit from being given a functional mental illness label.

Stephen Ralph. DCR(D) Retired.


Margaret Williams

First published 5 June 2004

On 3rd June 2004 Christine Hunter from Australia, whose daughter Alison died of severe ME aged just 19, was moved to ask where is the response of the worldwide ME community to the CDC International CFS Study Group’s proposed refinement of the 1994 CFS criteria (published on 31st December 2003).

The CDC Study Group relies heavily on the work of those who support the views of UK psychiatrist Simon Wessely and Wessely is listed as a member of the International Study Group that produced the 1994 CDC criteria. The UK representative is currently listed as Anthony Cleare, who is one of the psychiatric lobby that withdrew in pique and publicity from the UK Chief Medical Officer’s Working Group before publication of the Report, apparently because they did not succeed in their obsession to get “CFS/ME” unequivocally defined in that Report as a psychiatric disorder. Cleare has often co-authored papers on “CFS” with Wessely (a self-proclaimed expert on “CFS/ME” and a Government adviser internationally known for his well-published personal belief that ME does not exist other than as an “aberrant belief” and that “CFS/ME” is a behavioural disorder that is amenable to his own brand of psychotherapy).

Chris Hunter drew renewed attention to the fact that the CDC International Study Group recommends reliance upon the SPHERE mental health instrument for determining the new research case definition of “CFS” and pointed out that the SPHERE mental health instrument specifically encapsulates dimensions of neurasthenia and Somatisation.

One would have anticipated a world-wide response that required a credible explanation as to why such an instrument has any place in deliberations about the WHO ICD-classified neurological disorder ME, but none seems to have materialised, and the major ME charities have been notably silent on this important issue.

Certainly, those clinicians and researchers who support the organic nature of ME are not likely to put their head above the parapet because if they do, it is likely that they would be instantly targeted and vilified by the Mental Health Movement and its powerful global sponsors.

It seems that the Mental Health Movement is not to be deflected by the evidence of mere medical science from its crusade of establishing psychiatry as underpinning not only service provision for those with ME but also the whole of medicine (and of its sibling, the health insurance industry).

Given its supporters’ stated reliance on “evidence-based medicine”, it is curious that the Movement shows such disregard and contempt for the evidence that ME is not a psychiatric disorder, for example, the evidence that is listed on the website of MERGE ( ) as recently posted in the e-BMJ by Doug Fraser. Such evidence includes documented biochemical, metabolic, vascular, neurological and muscle abnormalities in ME/CFS patients, but this evidence seems not to be to the liking of certain psychiatrists.

Despite the fact that the Health Minister, Lord Warner, confirmed in a letter dated 11th February 2004 to the Countess of Mar that the UK Department of Health and the WHO Collaborating Centre at the Institute of Psychiatry have now agreed on the classification of ME/CFS and that such classification is undoubtedly neurological, in a letter dated 28th May 2004 from the Department of Health signed by Robert Harkins (ref: TO1056746) is to be found the following: “In May 2003 we announced that £8.5 million would be made available for people with Chronic Fatigue Syndrome / Myalgic Encephalomyelitis. This is an important step in the development of NHS services and means that we can start making improvements in the care and treatment of people with CFS/ME. This investment will enable the NHS to set up centres of expertise to develop clinical care and clinical research (and) expand education and training programmes for health care professionals. The centres will be headed up exclusively by psychiatrists”.

From this letter, it seems that the DoH is full of self-congratulation over its generous commitment to those with “CFS/ME” and sees no incongruity that all the centres are to be “headed up exclusively by psychiatrists”.

Why should this be? There is no published evidence as opposed to opinion that ME (as distinct from chronic fatigue) is a psychiatric disorder.

Why do the influential adherents to the Mental Health Movement so persistently disregard the now-abundant evidence of physiological abnormalities that are seen in ME? Is it because they choose not to look? How can any qualified physician ignore common problems found in ME and rationally conclude that such problems are psychogenic in origin, with never  a mention of the inordinate losses sustained by those who are afflicted with such problems?

Such problems include hair loss, double vision, quantifiable liver dysfunction, pancreatic dysfunction, vertigo, shortness of breath, inability to stand unsupported, severe myalgia, disrupted temperature regulation with marked intolerance to heat and cold and alternate sweating and shivering, nocturia, swollen glands, recurrent mouth ulcers, recurrent nausea, lack of bowel control, observable muscle spasm including “jelly knees” not brought about by deconditioning, oophoritis, prostatitis, intractable headache, demonstrable cardiac problems, vasculitis, definable hypersensitivities (especially to medicinal drugs and anaesthetics), alcohol intolerance, and a degree of incapacitating exhaustion about which in a statement posted on Co-cure on 3rd June 2004 Charles Lapp, Professor of Community and Family Medicine at Duke University, North Carolina (and a world expert on the disorder) says “there is no word in the English lexicon that describes the lack of stamina, the paucity of energy (and) the absolute malaise that accompanies this illness”.

Is it the case that these psychiatrists do not have patients’ best interests at heart, but only their own status and influence and that of their paymasters, with all the accolades and rewards that accompany such status? Or is it the case that the liability issue must never, ever, be officially recognised, as in the case of the Chinook helicopter crash on the Mull of Kintyre ten years ago and as in the case of Gulf War Syndrome?

Whatever the reason, attempts by these psychiatrists to eradicate ME continue to abound.

In an Editorial on somatoform disorders in the current British Journal of Psychiatry (2004:184:465-467), psychiatrists Michael Sharpe of Edinburgh and Richard Mayou of Oxford (where Sharpe used to work) present what they clearly perceive to be an appealing alternative classification and terminology for disorders including what they refer to as chronic fatigue syndrome (but which bears little resemblance to Ramsay-described ME). Sharpe and Mayou do not like the present somatoform disorder classification: they think the main limitation is that the psychogenic implication of the diagnosis is “unacceptable to many patients, making it a poor basis for collaborative management” and that such a diagnosis “may lead to the underdiagnosis of depression and anxiety”. They also point out something that many ME patients know for themselves only too well, namely that a label of somatoform disorder is “often taken simply to indicate a need to minimise access to medical care”.

The authors state that somatoform disorders could readily be re-housed within the existing classification system and that such disorders are better considered as a combination of a personality disorder and an anxiety / depressive syndrome.

However, Sharpe and Mayou want a new classification that could accommodate “behaviour” disturbances and they state that “mere tinkering” with classification and terminology of disorders such as CFS is unlikely to be adequate, urging the need for “more radical revision”. They then reveal their hand by stating “The ambitious programme to prepare for the forthcoming DSM-V and ICD-11 offers an opportunity to reconsider the somatoform disorders”.

This seems to accord with a recent letter from the UK Chief Medical Officer written in response to a request for confirmation that in the light of Lord Warner’s letter of 11th February 2004, the UK Department of Health will not seek to change the ICD classification of ME/CFS from neurological to psychiatric: in his reply, the CMO made it plain that involvement with changes in ICD classification is not within his remit as the UK WHO representative but is the responsibility of the WHO Collaborating Centre at the Institute of Psychiatry.

It is at the IOP that Professor Wessely exerts such influence amongst his like-minded psychiatrist colleagues; it is the Dean of the IOP who co-edited a psychiatric textbook with Wessely’s wife, and the Dean’s opinion about Wessely is on record in a letter he sent to the Countess of Mar on 27th August 2003 in which he stated “Professor Wessely must be judged one of the outstanding medical researchers in the UK, and indeed internationally. (He) has been awarded a Research Medal by the Royal College of Physicians (specially for work on CFS) and he has served on many prestigious scientific committees further attesting to the high regard in which he is held by the scientific community. The Institute of Psychiatry thus has every reason to have confidence in the quality and integrity of Professor Wessely’s “research”.

The letter from the CMO confirmed the worst fears of the UK ME community, namely that the issue of reclassification of ME lies in the hands of Wessely and his psychiatrist friends: concern about this is growing, as there is plentiful evidence of the psychiatrists’ determination to succeed in what they have worked so tirelessly for the last 17 years to achieve, namely the re-categorisation of “medically unexplained” disorders (including “CFS/ME”) as “functional” disorders.

From Sharpe’s Editorial, changes that would harm those with ME seem inevitable. True to the Mental Health Movement mantra, Sharpe and Mayou state “In the ‘post-somatoform’ world we envisage that there will be a renewed interest by all parts of medicine in an integrated approach to patients’ symptoms. Such a development will require that psychological assessment and intervention are fully integrated into medical care”.

Do the authors envisage that it is logistically possible for every single patient presenting with complex and chronic illness for which medicine does not yet understand the cause to be subjected to “psychological assessment and intervention” as a necessary component of medical care? Will such psychological assessments be mandatory for those with multiple sclerosis and other neurological disorders for which the cause, if not the effects, remains unknown, or is there to be special pleading only for ME/CFS?

Many informed people would doubtless concur with Alan Gurwitt MD, who put the matter concisely in a Co-cure post on 27th May 2004: “It is not well-trained psychoanalysts who are making wild generalisations about ‘somatisation’ (and) ‘functional’ symptoms etc. Psychoanalysts depend on a carefully gained understanding of each individual rather than cursory evaluations that are often inaccurate and misleading yet pass for ‘science’ “.

What passes for “science” is of great relevance to those with ME, for example, on what rational basis can the Medical  Research Council persist in ignoring the evidence of organic pathoaetiology in the world literature on ME/CFS that has been provided for its use?

It would seem to defy reason for the MRC to maintain, as it does, that the publicly-funded PACE trials for “CFS” patients (described as such in the Trial Identifier, though not now on the MRC website, which refers to them as “CFS/ME” patients) will indeed use the broad-ranging Oxford entry criteria that were compiled by Sharpe and Wessely et al in 1990 and published in 1991.

It must be asked why the Oxford criteria were passed by the MRC reviewers in relation to studies of people with ME, because it is the case that the Oxford criteria specifically include those with psychiatric disorders and specifically exclude those with neurological disorders; the Oxford criteria never attained international consensus and have been superceded.

In apparent response to public disquiet about the use of the Oxford entry criteria, it was confirmed by the MRC that there will now be additional “secondary analysis” of the data, as such secondary analysis might identify the more severely affected, but there was no mention of any “secondary analysis” in the Trial Identifier.

It is a straightforward fact that if those with classified neurological disorder are to be excluded from the outset by virtue of the Oxford entry criteria, no amount of “secondary analysis” will reveal those with classified neurological disorder, and it is seen as offensive for the MRC to patronise desperately sick ME patients by such condescending and meaningless platitudes.

When concerns about the MRC trial entry criteria were made public, there were repeated assurances from both the MRC and the Department of Health that those with ME would not be excluded from the PACE trials. However, if this is so, then on what basis are those with ME to be included in the MRC trials, given that the Oxford criteria stipulate that patients with neurological or organic brain disease must be excluded?

Is it in fact the case that those with ME are to be included on the basis that “CFS/ME” is deemed by the MRC (and by the psychiatrists running the trial) to be a psychiatric disorder and therefore to come under the aegis of the Oxford entry criteria? It is a matter of published record that Wessely believes “neurasthenia would readily suffice for ME” and in the same item he pointed out that “the term neurasthenia remains in the Mental and Behavioural Disorders chapter under Other Neurotic Disorders”. (Chronic fatigue, ME, and ICD-10 Anthony David, Simon Wessely. Lancet 1993:342:1247-1248).

It seems that these powerful psychiatrists whom the MRC holds in such esteem are still calling all the shots, apparently for no more scientifically robust a reason than that the very psychiatrists who are to carry out the trials have chosen to use their own criteria for “CFS” in the sure knowledge that those eligible to be enrolled do not suffer from Ramsay-described ME but from chronic fatigue, and may therefore stand some chance of gaining at least some benefit from the psychiatrists’ favoured behaviour-modifying intervention.

This being so, the results of the trials may be anticipated to confirm that people with “CFS/ME” do improve with Wessely’s brand of cognitive behavioural therapy, even though people with Ramsay-described ME would in reality be excluded by virtue of the trial entry criteria. Although unthinkable, could this be calculated deceit for financial gain?

The deliberately heterogeneous population that is to be studied in the MRC PACE trials on “CFS” is a matter of mounting concern. It is hardly what most  people would regard as good science to include in the same study those who from the outset are known to suffer from a different disorder that is separately classified in the ICD, yet those with fibromyalgia (classified in the ICD-10 at M79 under Soft Tissue Disorders) are to be included in the MRC trials on “CFS”, together with those who suffer from medically unexplained fatigue (classified in the ICD-10 at F48.0 under Mental and Behavioural Disorders) as identified by the Oxford criteria.

It is the case that at a meeting of the All Party Parliamentary Group on Fibromyalgia held on 12th May 2004 at the House of Commons, the Parliamentary Under Secretary of State at the Department of Health (Dr Stephen Ladyman MP) announced that GPs would be offered financial incentives and encouraged to identify patients with fibromyalgia and to refer them to the new “CFS/ME” centres, where these fibromyalgia patients would be included in the CFS study.

Despite such intentional heterogeneity, it seems that the results of the MRC PACE trials on “CFS” are likely to be claimed to relate to those with specific Ramsay-described ME (classified in the ICD-10 at G93.3 under Disorders of the Nervous System).

It remains to be explained how the lumping together of such a deliberately heterogeneous study population can yield accurate and meaningful scientific results that relate to those with ME when, by the Oxford case definition entry criteria, those with ME will have been excluded from the study.

To many knowledgeable and informed people, including medical scientists, this smacks of state control and of sinister science designed for purely political ends.

To whom can ME patients now turn? Despite initial interest, enthusiasm and commitment, even the Chairman of the House of Commons Select Health Committee, David Hinchliffe MP, has declined to take the ME situation on board, now claiming that it is a matter of divergent medical opinion and is therefore not something with which the Select Health Committee could become involved. When she heard this, the well-informed ex-wife of a prominent Member of Parliament said that such an about-turn was “interesting”, and wondered if those involved had been leant on “by people in high places”.

Why will the usually rapier-sharp investigative media not pay proper and sustained heed to ME patients’ quite desperate plight? Is that not their job? Or is it the case that, as in anything to do with ME, they, too, are being effectively controlled by sinister science and by Government? Some people think so.

Margaret Williams, 5 June 2004

From Connie Nelson

28 February 2008

Revision of CFS – ICD and DSM

As we’re all aware, many psychs and their compadres are desperate to have CFS officially accepted as a mental disorder eg mental / behavioural disorder and included in the DSM but in order to achieve this it also has to be included in the ICD as a mental disorder.

See extracts from 2 different documents below:

C. ICD-DSM Harmonization Group Introduced by Dr. Shekhar Saxena

Summary Report of the 3rd Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders 1 World Health Organization Department of Mental Health and Substance Abuse Geneva, Switzerland

Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders 11 – 12 March, 2008, Geneva SWITZERLAND

The task of this group is to facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD- 11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria.

Dr. Saxena emphasized the genuine desire of both organizations to achieve harmonization of the two systems. He described a variety of specific issues related to differences between the DSM and the ICD-10 that are important areas of discussion by the Harmonization Group.

The AG endorsed the following statement intended to guide the WHO representatives in their activities as part of the ICD-DSM Harmonization Group:

“WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM. Adaptations of the ICD should be directly translatable into the core version.” 

“The timeline for the revision process is as follows: the Alpha draft version of ICD-11 should be completed in 2010,  followed by 1 year for commentary and consultation. The Beta draft version should be completed in 2011, followed by field trials, analysis of field trial data, and revision during the subsequent 2 years. The final version for public viewing should be completed in 2013, with approval by the World Health Assembly in 2014.”

…and then:  [Ed: Review paper published by the CISSD Project leads, July 2007] 

3. Should the conditions currently diagnosed as Somatoform Disorders remain psychiatric disorders on Axis I in DSM-V?

5. How should functional somatic syndromes be classified?

These so-called functional somatic syndromes include conditions such as irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, interstitial cystitis, and others.

These syndromes are overlapping and frequently coexist. [35]  Also, there are individual symptoms, such as tension headache, low back pain, non-ulcer dyspepsia, and atypical chest pain, to name a few, for which the etiology is unknown. These functional syndromes and somatic symptom-defined conditions, if regarded as medical, would properly be placed on Axis III as general- medical conditions.

However, this practice can be seen as inconsistent if a patient with the same symptoms seen by a psychiatrist is diagnosed with a somatoform disorder on Axis I. Expert opinion differs about whether functional somatic syndromes and somatoform symptoms should be combined in a new classification system [12] or whether, in the absence of clear linkage to psychological factors, the default should be to code somatic symptoms and syndromes on Axis III. [22,23]

Connie Nelson