The Elephant in the Room Series Four: DSM-V: What do we know so far?

 Elephant70

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Keywords

APA    DSM    DSM-IV    DSM-V    DSM-5   WHO    ICD    ICD-10    ICD-11    American Psychiatric Association    Diagnostic and Statistical Manual of Mental Disorders    World Health Organization    Classifications    DSM Revision Process    DSM-V Task Force    DSM-V Somatic Distress Disorders Work Group    Somatic Symptom Disorders Work Group    DSM-ICD Harmonization Coordination Group    International Advisory Group    Revision of ICD Mental and Behavioural Disorders    Global Scientific Partnership Coordination Group    ICD Update and Revision Platform    WHO Collaborating Centre    CISSD Project    MUPSS Project    Somatoform    Somatisation    Somatization    Functional Somatic Syndromes    FSS    MUS    Myalgic encephalomyelitis    ME    Chronic fatigue syndrome    CFS    Fibromyalgia    FM    IBS    CS    CI    GWS

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The Elephant in the Room Series Four: DSM-V: What do we know so far?

A copy of this material has been sent to:

Sir Peter Spencer, Heather Walker, Tristana Rodriguez (Action for M.E.); Dr Charles Shepherd, Neil Riley, Tony Britton (ME Association); Jane Colby (The Young ME Sufferers Trust); Mary Jane Willows (AYME); ME Research UK; Simon Lawrence (25% M.E. Group); Trustees Invest in ME; BRAME; RiME; The Countess of Mar; Dr Ellen Goudsmit; Professor Malcolm Hooper. Five documents have been also been provided, including WHO ICD Revision: Content Model Style Guide; WHO ICD Revision: Content Model Blank; WHO ICD Revision: Morbidity Reference Group Discussion paper: ICD-11 rules, conventions and structure available from:

https://sites.google.com/site/icd11revision/home/documents

Part One

DSM-V draft proposals

In the UK, the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), does not have as much relevance for us as the WHO’s ICD. But the revision of DSM-IV will shape international research and literature in the fields of liaison psychiatry and psychosomatics for many years to come.

Until the APA publishes its alpha draft, we won’t know what the most recent proposals are. But if our corner needs fighting, then according to UK health psychologist, Dr Ellen Goudsmit C.Psychol. FBPsS, we can rely on US psychologists, Jason and Friedberg, to fight our corner for us. Who else might we rely on?

In his commentary Alert to the Research Community—Be Prepared to Weigh in on DSM-V, Psychiatric Times, 3 December, Allen Francis MD, who had chaired the DSM-IV revision Task Force, wrote:

The research community has a central role and a great responsibility in taking advantage of this precious opportunity to carefully review and identify the problems in the DSM-V drafts and to suggest solutions…

Will our own professional advocates – our researchers, clinicians and patient organisations be reviewing and commenting on these draft proposals when they are published, early next year?

According to a PowerPoint presentation delivered Dr B Üstün at the WHO’s September ICD-11 iCAMP meeting:

“ICD will be about 15 thousand Diseases, disorders…”

and will involve

“Between 5000 – 50,000 contributors”

We are just one patient constituency amongst thousands of diseases, disorders and syndromes. But because of the means through which ICD is being revised this time round, there will be opportunity for input from a far wider range of sources into the ICD-11 development process. Again, our interests will need to be effectively represented and it should not be left entirely to the patient community. Our researchers and clinicians will need to be encouraged to input into the ICD revision process, too.

The “H” word

The APA participates with the WHO in the International Advisory Group (AG) for the Revision of ICD-10 Mental and Behavioural Disorders and a DSM-ICD Harmonization Coordination Group.

The DSM-V Task Force and ICD-11 Revision Steering Group have committed as far as possible “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” with the objective that “the 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.”

The forthcoming shift, scheduled for October 2013, to a US modification of ICD-10 (ICD-10 CM*) and the disparity between the proposed ICD-10 CM classifications and the current ICD-10 codings for Postviral fatigue syndrome, (Benign) myalgic encephalomyelitis and chronic fatigue syndrome may account for an apparent lack of interest in the US in the development of ICD-11. But the proposed structure of ICD-11 may have implications for the US patient population, even though the US might not anticipate moving on to ICD-11 for many years.

From the APA’s 10 December press release:

APA will continue to work with the WHO to harmonize the DSM-5 with the mental and behavioral 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.

It was reported, in August (DSM-V Field Trials Set to Begin Elsevier Global Medical News), that the APA planned to launch some field trials for DSM-V in October, with all field trials scheduled for completion by the end of 2010, for a previously anticipated publication date of May 2012.

According to Christopher Lane, author of Shyness: How Normal Behavior Became a Sickness, most of the field trials have yet to begin because the Work Groups can’t agree on their criteria (Psychology Today).

*For current proposals for US modification ICD-10 CM see: 
http://en.wikipedia.org/wiki/History_of_chronic_fatigue_syndrome#ICD-10-CM   

**Postviral fatigue syndrome and (Benign) myalgic encephalomyelitis are classified in Chapter VI of ICD-10: Volume 2: The Tabular List at G93.3; Chronic fatigue syndrome is indexed at G93.3 in ICD-10: Volume 3: The Alphabetical Index.

See:  http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933 
See:  http://www.scribd.com/doc/7350978/ICD10-2006-Alphabetical-Index-Volume-3  (Page 528, top right hand column)

 

Somatic Distress Disorders

The DSM-V Work Group that has relevance for us is the Work Group for “Somatic Distress Disorders” (aka “Somatic Symptom Disorders”).

This group has responsibility for the revision of the DSM classifications currently listed under “Somatoform Disorders”. The equivalent section in ICD-10 is “Somatoform Disorders” classified in Chapter V: Mental and Behavioural Disorders between codes F45 – F48.0.

Go here: https://meagenda.wordpress.com/dsm-v-directory/

scroll down to the heading “Related documents” and open Document [6] DSM-IV ICD-10 Classifications

This document sets out how the two classification systems currently correspond for “Somatoform Disorders”. You will also find links in Document [6] for ICD Chapter V classifications for “Somatoform Disorders” codings at F45 – F48.0, and for G93.3 (ICD Chapter VI, the Neurological chapter).

The members of the Somatic Distress Disorders Work Group (SDD WG) are published on the APA’s website here:

http://www.psych.org/MainMenu/Research/DSMIV/DSMV/WorkGroups/SomaticDistress.aspx

This document also includes biosketches and disclosure information for each Work Group member. The group is chaired by Professor Joel E. Dimsdale, MD. The nine members of the DSM-V Somatic Distress Disorders Work Group are:

Arthur J. Barsky, MD*; Francis Creed, MD*; Nancy Frasure-Smith, PhD; Michael R. Irwin, MD; Francis J. Keefe, PhD; Sing Lee, MD; James L. Levenson, MD*; Michael Sharpe, MD*; Lawson R. Wulsin, MD.

DSM-V Task Force member, Javier Escobar, MD, serves as Task Force liaison to the DSM-V Somatic Distress Disorders Work Group and works closely with this group.

Four out of the ten members of the DSM-V Somatic Distress Disorders Work Group (asterisked) were also members of the CISSD Project workgroup; Prof Michael Sharpe served as the CISSD Project’s UK Chair. The CISSD Project’s International Chair was Prof Kurt Kroenke, MD.

We have no information on how closely the ICD Topic Advisory Group for the revision of Mental and Behavioural Disorders (TAG MH) is collaborating with the DSM-V SDD Work Group over the revisions of their respective “Somatoform Disorders” sections. Until the iCAT platform is launched, it is not apparent what changes TAG MH might be proposing for the structure and content of its corresponding Chapter V: F45 – F48.0 codes or to what extent ICD Revision intends that any changes to its own “Somatoform Disorders” will mirror Task Force proposals for DSM-V.

If the DSM-V Task Force were to approve radical changes to its “Somatoform Disorders” category, will ICD Revision still aim for “harmonization”?

Earlier this year, I called publicly on the ME Association to publish an analysis and commentary on the aims, objectives and recommendations of the CISSD Project in the context of the ICD and DSM revision processes and to inform its members, generally, around the forthcoming revisions of these two classification systems, which have been in progress since 2007 and 1999.

To date, apart from trumping Action for M.E. by publishing a summary report on the CISSD Project, provided by Dr Richard Sykes (in response to which the ME Association has expressed no comment or opinion whatsoever), this organisation has done nothing to inform its membership and the wider ME community around the forthcoming ICD revision, or that of DSM.

Nor has the ME Association clarified whether it intends to participate in draft consultations or in the submission of proposals to ICD, and if so, whether its membership will be given an opportunity to inform its position.

I have provided the ME Association board members with key information and documents: not a flicker of interest.

Stephen Ralph, who maintains the ME Action UK website, reports that when he approached Dr Charles Shepherd, recently, to ask what the ME Association was doing in relation to DSM and ICD, Dr Shepherd’s response had been that this was not an issue he had time for or was interested in.

An extraordinary response from an Honorary Medical Adviser given:

  The influential membership of the CISSD Project workgroup and the positions that some of its members now hold on the DSM Task Force and Somatic Distress Disorders Work Group.

•  The potential for review and revision of the current ICD-10 classifications and codings for Postviral fatigue syndrome, (Benign) myalgic encephalomyelitis (both currently classified in Chapter VI at G93.3) and chronic fatigue syndrome (currently indexed in Volume 3 at G93.3, only);

•  The means through which ICD-11 will be developed (the iCAT electronic multi-authoring platform) enabling a wide range of input from many sources;

•  The potential for, and implications of a radical revision of the DSM-IV category currently known as “Somatoform Disorders”;

•  The commitment of ICD and DSM to “harmonization” and congruency between the two systems;

•  The potential for considerably more content to be included in ICD-11 than in previous versions of ICD*.

*See: Key documents, particularly: Content Model Style Guide on the ICD-11 Revision site at: https://sites.google.com/site/icd11revision/home/documents 

The ME Association has adopted and promotes the use of the term “myalgic encephalopathy”. Is this at the root of Dr Shepherd’s disinclination to become drawn into debate around the forthcoming ICD revision, since “myalgic encephalopathy” has no classification or coding within ICD-10, at all?

Given the views expressed by Jane Colby, Executive Director of The Young ME Sufferers Trust, it would be useful if Ms Colby would also set out her organisation’s position in relation to PVFS, ME, CFS in the context of ICD-11.

Part Two

The 10 December APA press release noted that draft changes to the DSM will be posted on the DSM-V website in January 2010 and that comments will be accepted for two months and reviewed by the relevant DSM-V Work Groups in each diagnostic category.

That’s not very long for consultation for a patient community like ours.

A number of patient communities and interest groups have already been engaging for some time with DSM-V Work Groups. For one category (schizophrenia), quite detailed proposals have been made available for discussion and posted online. But for the DSM-V Work Group that has relevance for us – the “Somatic Distress Disorders” aka the “Somatic Symptom Disorders” Work Group, very little has emerged to date, and what has been published is lacking in detail.

What do we know so far?

Since the DSM-V Work Groups were announced in May 2008, each group has published just two progress reports.

The November 2008 report of the Somatic Distress Disorders Work Group can be read here:

http://tinyurl.com/DSMSDDWGNov08

The April ’09 progress report of the Work Group can be read here:

http://tinyurl.com/DSMSDDWGApril09

Since April, no further updates have been issued by any of the DSM-V Work Groups. So until a draft for DSM revision proposals is released we are forced to glean what we can from journals.

In April ’09, the Somatic Distress Disorders Work Group reported that they were exploring the potential for eliminating criteria such as “medically unexplained symptoms”:

…More controversial is a proposal the group has been examining, which would combine somatization disorder, hypochondriasis, pain disorder and undifferentiated somatoform disorder into one overarching disorder (tentatively entitled, “complex somatic symptom disorder”). The hallmark of this disorder would be somatic symptoms associated with significant distress and disability. In some cases the patient’s response is disproportionate and maladaptive. Our group is exploring the potential for eliminating criteria such as “medically unexplained symptoms” as a marker of this disorder because such considerations are commonly unreliable, divisive between doctor and patient and lead to mind-body dualism…

This was followed, in June, by an Editorial co-authored by DSM-V Work Group Chair, Joel Dimsdale, and fellow Work Group member, Francis Creed, which expanded on the themes in the April ’09 update. This Editorial was published as free access, so at least those without access to journal papers were able to read it – assuming they were aware of it.

The Editorial: “The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report” was published on behalf of the Somatic Symptom Disorders Work Group in the June ’09 issue of the Journal of Psychosomatic Research, for which Francis Creed is a co-editor. Several Letters to the editor in response to this Editorial have been published in the January ’10 edition of this journal, but these are not free access.

Free full text and PDF versions of the June ’09 Editorial here:

http://www.jpsychores.com/article/S0022-3999(09)00088-9/fulltext

The relevant section is “Psychological factor affecting a general medical condition” – towards the end of the document.

Under this section, Dimsdale and Creed wrote that some authors have recommended wider use of this existing DSM-IV category as “a diagnosis that encompasses the interface between psychiatric and general medical disorders”, citing the 2005 paper by Mayou R, Kirmayer LJ, Simon G, Kroenke K, Sharpe M: Somatoform disorders: time for a new approach in DSM-V. Am J Psychiat. 2005;162:847–855.

Free full text: http://ajp.psychiatryonline.org/cgi/content/full/162/5/847 

The Editorial reports that the [Psychological factors affecting a general medical condition] diagnosis “has been underused because of the dichotomy, inherent in the ‘Somatoform’ section of DSM-IV, between disorders based on medically unexplained symptoms and patients with organic disease”, and that by doing away with the “controversial concept of medically unexplained”, the proposed classification might diminish the problem.

The conceptual framework the Work Group were proposing, at that point:

…will 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.

The Editorial goes on to list a variety of different subtypes included within the diagnosis of “Psychological factors affecting a general medical condition” including a specific psychiatric disorder which affects a general medical condition; psychological distress in the wake of a general medical condition and personality traits or poor coping that contribute to worsening of a medical condition.

It suggests that these might be considered in the rubric “adjustment disorders” but that the location of this type of adjustment disorder had yet to be settled within the draft of DSM-V and that the text and placement for these different variants of the interface between psychiatric and general medical disorders was still under review.

(The current use of the diagnosis “Psychological Factors Affecting Medical Condition” in DSM-IV is set out here: http://www.behavenet.com/capsules/disorders/psyfactorsmedcon.htm )

The recently published Editorial: Is there a better term than “Medically unexplained symptoms”? Creed F, Guthrie E, Fink P, Henningsen P, Rief W, Sharpe M and White P (Journal of Psychosomatic Research: Volume 68, Issue 1, Pages 5-8 January 2010) discusses the deliberations of the EACLPP study group* on which I have previously reported. The Editorial also includes references to the DSM and ICD revision processes.

* https://meagenda.wordpress.com/2009/05/18/the-elephant-in-the-room-series-two-more-on-mups/
* http://www.eaclpp.org/documents/Patientswithmedicallyunexplainedsymptomsandsomatisation.doc

References to DSM and ICD revision in:

Is there a better term than “Medically unexplained symptoms”? Creed F, Guthrie E, Fink P, Henningsen P, Rief W, Sharpe M and White P. J Psychoso Res: Volume 68, Issue 1, Pages 5-8.

[Extract]

Introduction

The European Association of Consultation Liaison Psychiatry and Psychosomatics (EACLPP) is preparing a document aimed at improving the quality of care received by patients who have “medically unexplained symptoms” or “somatisation” [1]. Part of this document identifies barriers to improved care and it has become apparent that the term “medically unexplained symptoms” is itself a barrier to improved care…

…The authors of this paper met in Manchester in May 2009 to review thoroughly this problem of terminology and make recommendations for a better term….The deliberations of the group form the basis of this paper…

[…]

Our priority was to identify a term or terms that would facilitate management – that is it would encourage joint medical psychiatric/psychological assessment and treatment and be acceptable to physicians, patients, psychiatrists and psychologists.

Criteria to judge the value of alternative terms for “medically unexplained symptoms”

Ten criteria were developed in order to judge the value of potential terms which might be used to describe the group of symptoms currently referred to as medically unexplained symptoms. Obviously, this list of criteria does not claim to be exhaustive, but we believe that it captures the most important aspects. The criteria are that the term:

1. is acceptable to patients
2. is acceptable and usable by doctors and other health care professionals, making it likely that they will use it in daily practice.
3. does not reinforce unhelpful dualistic thinking.
4. can be used readily in patients who also have pathologically established disease
5. can be adequate as a stand alone diagnosis
6. has a clear core theoretical concept
7. will facilitate the possibility of multi-disciplinary (medical and psychological) treatment
8. has similar meaning in different cultures
9. is neutral with regard to aetiology and pathology
10. has a satisfactory acronym.

Terms suggested as alternatives for “medically unexplained symptoms”

The group reviewed terms which are used currently or have been proposed for the future. An extensive list was abbreviated to the following 8 terms or categories: The terms we reviewed were:

1. Medically unexplained symptoms or medically unexplained physical symptoms
2. Functional disorder or functional somatic syndromes
3. Bodily distress syndrome/disorder or bodily stress syndrome/disorder
4. Somatic symptom disorder
5. Psychophysical / psychophysiological disorder
6. Psychosomatic disorder
7. Symptom defined illness or syndrome
8. Somatoform disorder

[…]

Implications for DSM-V and ICD-11

There is overlap between the discussion reported here and the discussion currently under way towards the creation of DSM-V. Two of the authors (FC, MS) are also members of the working group on Somatic Distress Disorders of the American Psychiatric Association (APA), which is proposing a new classification to replace the DSM-IV “somatoform” and related disorders. In this working group, similar concerns about the use of the term and concept of “medically unexplained symptoms” have been raised [12]. The current suggestion by the DSM-V work group to use the term “Complex somatic symptom disorder” must be seen as step in a process and not as a final proposal. Unfortunately this term does not appear to meet many of the criteria listed above.

[…]

One major problem for reforming the classification relates to the fact that the DSM system includes only “mental” disorders whereas what we have described above is the necessity of not trying to force these disorders into either a “mental” or “physical” classification. The ICD-10 system has a similar problem as it has mental disorders separated from the rest of medical disorders.

The solution of “interface disorders”, suggested by DSM IV, is a compromise but it is unsatisfactory as it is based on the dualistic separation of organic and psychological disorders and prevents the integration of the disorders with which we are concerned here. This lack of integration affects the ICD classification also. For example functional somatic syndromes (e.g. irritable bowel syndrome) would be classified within the “physical” classification of ICD or Axis III in DSM (gastrointestinal disorders) and omitted from the mental and behavioural chapter entirely [13].

[End Extract]

Peter Denton White, Professor of Psychological Medicine, Barts and the London Medical School, has had quite a lot to say, recently, about ICD-10. In December 2008, Prof White gave a workshop presentation titled “Chronic fatigue syndrome: neurological, psychological or both?” at a Neurology and Psychiatry SpRs Teaching Weekend held in Oxford and sponsored by UCB Pharma and Biogen Idec UK. In the workshop handbook, Prof White talks about the taxonomy of CFS as being “a mess”.

Prof White writes:

My personal view is that it is high time that all mental health disorders and neurological diseases affecting the brain were classified within the same chapter, simply called diseases/disorders of the brain and nervous system.

(Workshop Handbook: Prof Peter White: Pages 46 – 50 http://bnpa.org.uk/doc/HANDBOOK.pdf  )

During his Royal Society of Medicine “CFS” Conference presentation, in April 2008, Prof White had told the conference:

…So ICD-10 is not helpful and I would not suggest, as clinicians, you use ICD-10 criteria. They really need sorting out; and they will be in due course, God willing.

See: Document [5] Extract, transcript, RSM CFS Conference presentation: Prof Peter White discouraging Conference from using ICD:  https://meagenda.wordpress.com/dsm-v-directory/  

In the paper: “Risk markers for both chronic fatigue and irritable bowel syndromes: a prospective case-control study of primary care” Psychological Medicine, Nov 2009, co-authored by Prof White, the authors propose a change to current ICD-10 codings ( http://www.ncbi.nlm.nih.gov/pubmed/19366500 ).

In the section “Implications for Further Research” the authors state that because the paper finds, “These data also suggest that fatigue syndromes are heterogeneous (Vollmer-Conna et al. 2006), and that CFS/ME and PVFS should be considered as separate conditions, with CFS/ME having more in common with IBS than PVFS does (Aggarwal et al. 2006). This requires revision of the ICD-10 taxonomy, which classifies PVFS with ME (WHO, 1992).”

According to DSM-V Task Force member, Javier Escobar, who works closely with the Somatic Distress Disorders Work Group, the so-called “Functional Somatic Syndromes (FSS)”, or “Medically Unexplained Symptoms (MUS)” include a long list of medical conditions:

Irritable bowel syndrome, Chronic fatigue syndrome, Fibromyalgia, Multiple chemical sensitivity, Nonspecific chest pain, Premenstrual disorder, Non-ulcer dyspepsia, Repetitive strain injury, Tension headache, Temporomandibular joint disorder, Atypical facial pain, Hyperventilation syndrome, Globus syndrome, Sick building syndrome, Chronic pelvic pain, Chronic whiplash syndrome, Chronic Lyme disease, Silicone breast implant effects, Candidiasis hypersensivity, Food allergy, Gulf War syndrome, Mitral valve prolapse, Hypoglycemia, Chronic low back pain, Dizziness, Interstitial cystitis, Tinnitus, Pseudoseizures, Insomnia, Systemic yeast infection, Total allergy syndrome [1]

[1] PSYCHIATRY AND MEDICAL ILLNESS Special Report
Unexplained Physical Symptoms What’s a Psychiatrist to Do? Humberto Marin, MD and Javier I. Escobar, MD,  Psychiatric Times. Vol. 25 No. 9, 01 August 2008
http://www.psychiatrictimes.com/display/article/10168/1171223

——————

Over the past four or five years, dozens of journal reviews, papers and editorials have been published to inform the DSM revision process (with a very few papers specifically ICD-centric). Research planning conferences, symposia and monographs have further generated dialogue within the field around the taxonomy of the so-called “somatoform disorders” – it’s been quite an industry for liaison psychiatry and psychosomatics.

The CISSD Project, initiated in 2002 by Dr Richard Sykes, PhD, and administered by Action for M.E., between 2003 and 2007, is one project that has fed into both the DSM and the ICD revisions. Dr Sykes describes his project’s objective “to stimulate a multidisciplinary dialogue about the taxonomy of somatoform disorders and the medical diagnoses of functional somatic syndromes (e.g., irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia)” and that the three CISSD Project workshops “brought together American and European experts to further consider the key questions and potential changes to be addressed in any revision of the Somatoform Disorders category, with the explicit aim of informing the development of DSM–V.”

The members of the CISSD Project workgroup were drawn almost exclusively from the fields of liaison psychiatry and psychosomatics. There were no patient organisation representatives on board and the only patient rep had co-authored a book on CFS with Prof Michael Sharpe, the project’s UK Chair.  Little wonder that Action for M.E. sought to keep a lid on this project for so long.

Understand that this unofficial project, initiated by Dr Richard Sykes and administered by Action for M.E. as part of the “merger” deal between Action for M.E. and Westcare UK, in mid 2002, does not have the authority of either the WHO or the APA, but that a number of influential CISSD Project workgroup members now serve on DSM-V Task Force and DSM-V Work Group committees – including Sharpe, Creed, Barsky, Levenson, Escobar and Dimsdale.

The first two tranches of funding paid to Dr Sykes for his co-ordination of the CISSD Project (£24,000 and £18,750) had been recorded in Action for M.E.’s year end accounts for 2006, and 2007, as a grant administered for the WHO Somatisation Project This grant is provided to help lobby the World Health Organisation for the recognition of M.E. and its re-categorisation as a physical illness.”

But the review paper resulting out of the CISSD Project, published by project leads Kroenke K, Sharpe M, Sykes R: Revising the Classification of Somatoform Disorders: Key Questions and Preliminary Recommendations. Psychosomatics 2007 Jul-Aug;48(4):277-285, was DSM-centric.

(Full free text: http://psy.psychiatryonline.org/cgi/content/full/48/4/277  )

A single reference to ICD appears in Table 2: Recommendations for Revising Somatoform Disorders in DSM-V at point VII. under “Other Recommendations: 3. The APA and WHO should work together to make DSM-V and ICD-11 compatible with respect to the categories, disorders, and criteria for mental disorders…”

Chronic fatigue syndrome is mentioned twice: in the introduction, and under Key Questions 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…”

There is no reference in the review to Postviral fatigue syndrome or to (Benign) myalgic encephalomyelitis; the paper does not set out what its authors understand by the term “chronic fatigue syndrome” or their understanding of its relationship to Postviral fatigue syndrome or to (Benign) myalgic encephalomyelitis nor does it set out existing ICD-10 classifications and codings for any of these terms.

The paper fails to acknowledge that in ICD-10, Chronic fatigue syndrome is indexed in Volume 3 at G93.3. In fact, Dr Sykes had undertaken his project under the misapprehension that Chronic fatigue syndrome was not included anywhere in ICD-10 – a point he has since conceded.

The review paper has informed both the DSM and ICD revision processes and its recommendations have been submitted to the ICD Update and Revision Platform by Dr Sykes, in 2008, on behalf of the CISSD Project workgroup.

Note that the journal review paper, published in Psychosomatics 2007 Jul-Aug, by CISSD Project leads, Kroenke K, Sharpe M and Sykes R, is an entirely different document to the “CISSD Project and CFS/ME Report on the CISSD Project for Action for ME” which was an internal document handed to the project administrators, Action for M.E., in December 2007, by project co-ordinator, Dr Sykes, and not intended for publication. A copy of Dr Sykes’ Report for Action for M.E. and an accompanying “Co-ordinator’s Report” are now in the public domain.

( http://www.afme.org.uk/res/img/resources/CISSD%20project%20report%201.pdf  )
( http://www.afme.org.uk/res/img/resources/CISSD%20project%20report%202.pdf  )

In addition to its 13 Work Groups, DSM-V also uses external advisers whose names are not being disclosed. ICD Revision Topic Advisory Group Managing Editors (TAGMEs) will be networking for external peer reviewers for revision proposals and content.

( http://whoicd11.blogspot.com/2009/09/who-icd-11-googlesite.html#comments  )

One of the questions I raised, in October, with the WHO’s Dr Robert Jakob [Medical Officer (ICD) Classifications, Terminologies, and Standards] is whether those acting as independent peer reviewers to the various TAGs, and also external sources from whom input/opinion might otherwise be being sought, would be identified via iCAT to users outside the ICD revision process; whether the evaluations undertaken by external reviewers and input from external sources would be visible to those outside ICD revision and whether COI disclosures would be required of external reviewers.

——————

This represents about all that is available to me at the moment on the deliberations of the DSM-V Work Group – other than the Letters to the editor in response to “The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report”.

According to the APA, we can anticipate DSM-V draft proposals published in the New Year.

ICD-11 Alpha Draft is timelined for May 2010. We have no ETA yet for the launch of iCAT, the wiki-like electronic authoring platform through which ICD-11 will be developed so it is not yet evident what content will form the “Start-up list” for those categories of relevance to us.*

*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.

——————

For information, commentary and updates on the development of ICD-11 and DSM-V on ME agenda: https://meagenda.wordpress.com/dsm-v-directory/

For detailed information on the proposed structure of ICD-11, the Content Model and operation of iCAT, the collaborative authoring platform through which the WHO will be revising ICD-10, please scrutinise key documents on the WHO’s ICD-11 Revision Google site:

https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents

For ICD Revision iCamp YouTube videos:  http://www.youtube.com/user/WHOICD11

For DSM-V pages on the website of the American Psychiatric Association (APA): http://www.psych.org/MainMenu/Research/DSMIV/DSMV.aspx

Psychiatric Times for updates, articles and commentary on DSM-V:  http://www.psychiatrictimes.com/dsm-v

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