DSM-5 Somatic Symptoms Work Group submissions 2012: Last chance to tell SSD Work Group why it needs to ditch flawed, unsafe and unscientific proposals

DSM-5 Somatic Symptoms Work Group submissions 2012: Last chance to tell SSD Work Group why it needs to ditch unsafe and scientifically flawed proposals

Post #165 Shortlink: http://wp.me/pKrrB-26q

Under the guise of “eliminating stigma” and eradicating “terminology [that] enforces a dualism between psychiatric and medical conditions” the American Psychiatric Association appears hell bent on colonising the entire medical field by licensing the application of a mental health diagnosis to all medical diseases and disorders.

 

Last chance to tell the SSD Work Group why it needs to ditch its unsafe and scientifically flawed proposals

The third DSM-5 Development public review of proposals for revisions to DSM-IV categories and criteria runs through May 2 – June 15. This will be the last opportunity for stakeholders to submit feedback.

Register on the DSM-5 Development site to submit comment or use your previous user name and log in details if you submitted during the earlier reviews. For information on registration see this post from 2011.

One again, I’m collating copies of submissions to the Somatic Symptom Disorders Work Group on a dedicated page from international patient organizations, medical, allied health and other professional stakeholders, patients, advocates and professional bodies.

Any consumer groups, medical professionals, allied health professionals, social workers, lawyers etc with concerns for the Somatic Symptom Disorders proposals are welcome to forward copies of submissions for publication here.

If you are looking for submissions for the first and second public reviews, you need these pages:

Submissions to first public review (February 10 – April 20, 2010): http://wp.me/PKrrB-AQ

Submissions to second public review (May 4 – July 15, 2011): http://wp.me/PKrrB-19a

This year’s submissions are being collated here as they come to my attention:

DSM-5 SSD Work Group submissions 2012 

Shortlink for submissions page is: http://wp.me/PKrrB-1Ol

Today I am publishing UK patient and advocate, Peter Kemp’s submission to the SSD Work Group:

Submission from Peter Kemp, UK advocate

How people with M.E. and CFS (and other illnesses) could be misdiagnosed as Somatic Symptom Disorder using DSM-5

Misdiagnosis is a common occurrence by all accounts. Therefore medical definitions or criteria should not only assist diagnosis – they should positively aim to prevent or reduce misdiagnosis.

Somatic Symptom Disorder (SSD) as proposed for DSM-5 allows too many possibilities for misdiagnosis. Misdiagnosis that could have disastrous consequences. This is so readily foreseeable that this must be addressed.

Once a physician diagnoses SSD, they have effectively judged the patient incompetent to interpret their own symptoms. If the patient has an unrecognised disease that progresses, or develops a new disease and reports the new symptoms to the doctor, what will the doctor do? The patient is untrustworthy. The doctor is busy and has ‘real’ patients to treat.

It is inevitable that even patients that are correctly diagnosed with SSD will sooner or later present with actual physical disease. The diagnosis of SSD could predictably obstruct investigation and treatment of their disease. This obstruction could be directly attributed to the use of an SSD diagnosis.

SSD should not be included in DSM-5 unless specific guidance to prevent misdiagnosis are included and these have been proven effective.

Imagine a doctor with a patient presenting in the early stages of MS. MS can be difficult to diagnose. When Professor Poser reviewed 366 MS diagnoses made by board certified neurologists, he found that only 65% had been correctly diagnosed (http://www.cfids.org/archives/2000rr/2000-rr4-article03.asp ).

It can take years before the signs, symptoms and tests are clear enough to make a diagnosis (http://ms.about.com/popular.htm ). The symptoms of ‘pre-diagnosis’ MS can be very distressing and the lack of a laboratory test or firm diagnosis may add to a patient’s worries. The patient may try all sorts of strategies to try and find out about, and improve what is happening to them. They may appear to pester their GP, they may appear neurotic and irrational.

Now imagine that in accordance with DSM-5, a doctor gives them a diagnosis of the proposed SSD. The patient has an official diagnosis in their medical records that amounts to ‘hypochondriac’. What effect will that have on the patient’s chances of getting the necessary investigations as the disease progresses? How is it going to help them to cope with their distressing physical symptoms now they have been explained as psychosomatic? The time it will take for them to get a true diagnosis may be further prolonged, and the years spent waiting could be made even more harrowing because of inaccurate psychological labelling.

Therefore sensible doctors will avoid diagnosing SSD. Foolish doctors risk spending their time at professional disciplinary hearings and in court; and this still might not adequately reflect the amount of suffering their diagnosis of SSD could cause.

The rationale for SSD also states: “The proposed classification for Somatic Symptom Disorders deemphasizes the central role of medically unexplained symptoms. Instead, it defines disorders on the basis of positive symptoms (distressing somatic symptoms + excessive thoughts, feelings, and behaviors in response to these symptoms).”

I believe it safe to say that ‘positive symptoms’ does not mean ‘good symptoms’ or ‘symptoms with the right attitude’. I imagine it means definite, definable, testable and maybe even measurable. But when terms like ‘distressing’ and ‘excessive’ are used to measure symptoms, the definition is not a definition. It is not even a convincing concept.

The idea is right, to base the definition on signs and symptoms that are actually present, as long as these sufficiently differentiate the condition from other conditions and do not lead to too many misdiagnoses. Unfortunately, they would predictably fail to achieve this because the definition proposed is significantly subjective.

The ‘DSM-5 Proposed Revision’ could certainly misdiagnose M.E. This would be a serious matter as M.E. is classified by the WHO ICD as a neurological illness. A doctor whose diagnosis of SSD was contradicted by a doctor that diagnosed M.E could find themselves in an awkward legal situation. The implications to the proper care of a patient, due to misdiagnosing a serious neurological illness as a neurotic illness hardly bear thinking about. Hindering necessary investigations and treatment might only be a small part of the problems this might create.

The latest proposal states:

“Somatic Symptom Disorder

Criteria A, B, and C must all be fulfilled to make the diagnosis:”

“A. Somatic symptoms: One or more somatic symptoms that are distressing and/or result in significant disruption in daily life.”

The Myalgic Encephalomyelitis: International Consensus Criteria – states:
(http://www.meassociation.org.uk/?p=7173)

“A patient will meet the criteria for post-exertional neuroimmune exhaustion (A), at least one symptom from three neurological impairment categories (B), at least one symptom from three immune/gastro-intestinal/genitourinary impairment categories (C), and at least one symptom from energy metabolism/transport impairments (D).”

The Canadian Expert Consensus Panel Clinical Case Definition for ME/CFS states:
(http://www.cfids-cab.org/MESA/ccpccd.pdf)

“A patient with ME/CFS will meet the criteria for fatigue, post-exertional malaise and/or fatigue, sleep dysfunction, and pain; have two or more neurological/cognitive manifestations and one or more symptoms from two of the categories of autonomic, neuroendocrine and immune manifestations; and adhere to item 7.”

Therefore every patient with M.E. or CFS or ME/CFS will present with ample distressing and disruptive symptoms to satisfy DSM-5 Somatic Symptom Disorder Part A.

“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) Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
(2) Persistently high level of anxiety about health or symptoms
(3) Excessive time and energy devoted to these symptoms or health concerns”

The NICE Guidelines for CFS/ME state:
(http://www.nice.org.uk/nicemedia/live/11824/36191/36191.pdf )

“People with mild CFS/ME are mobile, can care for themselves and can do light domestic tasks with difficulty. Most are still working or in education, but to do this they have probably stopped all leisure and social pursuits. They often take days off, or use the weekend to cope with the rest of the week.”

Therefore even the mildest form of CFS sees persons who have often greatly reduced or stopped socializing, hobbies, sports etc.; and spend much of the time formerly devoted to these pursuits in resting and recuperating their energy to continue working.

When this level of disruptive illness goes on for more than 6 months, people will naturally and rationally become worried. They will be fearful of what is happening and what is going to happen. They will be anxious about their responsibilities, their job, their family and friend connections – everything. They may quite naturally seek help from their GP. They may be given antidepressants, sleeping medications, pain killers, etc. All these combined with a chronic illness necessitate frequent visits to their GP. They may try alternative therapies (possibly after having found what their GP offered did not help them). They may alter their diet, take nutritional supplements, go for acupuncture, homeopathy or other type of therapy.

And here is the rub; if one does not believe they are actually physically ill, their ‘thoughts, feelings and behaviours’ will certainly appear ‘excessive’. This could apply not just to CFS, but many other high impact and distressing illnesses.

The ‘Rationale’ for SSD states: “Undifferentiated Somatoform Disorder has such a low threshold that it is applicable to a very large proportion of patients attending primary care. The same low threshold issue occurs with Somatoform Disorder NOS.”

The proposed definition does not address this problem. It might actually make it worse. If doctors believe that SSD has a valid definition they may start actually using it – then God help us.

If a person with just ‘mild’ CFS is justified in being worried, justified in resting so they can keep working, justified in searching for something that will improve their health – then anyone with the illnesses mentioned could meet the criteria to satisfy DSM-5 Somatic Symptom Disorder Part B.

The only proviso is that to some extent this could depend on interpretation of the subjective aspects of part B (there may be more detailed explanations elsewhere – this essay is based on what is included here). What is ‘excessive’, ‘persistantly’, ‘disproportionate’, ‘seriousness’?*

The same ‘Rationale’ for SSD remarks on: “The lack of positive psychological features in the definition”. Unfortunately the proposed criteria attempt to define “positive psychological features” based entirely upon a physician’s subjectivity. That is not, in any sense, a definition.

This is why I believe the circular-reasoning trap constructed with SSD makes it risible. They construct a concept for SSD. They construct criteria for the concept. Chicken-egg or egg-chicken, take your pick.

The problem with this approach is that it does not IDENTIFY the psychological condition they are trying to define. SSD cannot exist only by differentiating features, this is true. Yet differentiating is an essential step. SSD must discern from other anxiety or depressive disorders. It must be discern from normal or rational anxiety, whether that anxiety is acute, chronic or fluctuating. It must discern from anxiety or depressive disorders due to neurological illness or injury. It must discern from physical illness that has not yet been diagnosed, or from physical illness for which diagnosis is complex or often delayed. It must discern from new or emerging diseases. If SSD cannot discern from these, then misdiagnosis could be a common and predictable result.

The criteria should define the disorder but they don’t. They attempt to define the criteria. The disorder should inform the criteria, but it doesn’t. The disorder is lost in a confusion of subjective terms, ‘excessive’, ‘persistantly’, ‘disproportionate’, ‘seriousness’.

The only way it can work is if someone (and here’s another trap); someone who believes that SSD exists and is defined by the DSM, decides what ‘excessive’ and ‘disproportionate’ etc., mean. Then all they have to do, is reach exactly the same conclusion that every other physician using the DSM would reach in the same position. Bingo. A diagnosis that does not mean anything other than what the ‘diagnoser’ decides that it means. And they better hope they got it right, otherwise a good lawyer will wipe the floor with them.

“C. Chronicity: Although any one symptom may not be continuously present, the state of being symptomatic is persistent (typically >6 months).”

This is either synchronicity, or they got this direct from the NICE Guidelines for ‘CFS/ME’. The NICE Guidelines ‘Making a diagnosis’ state:

“The range of presenting symptoms is wide, and fatigue and pain may not always be the prominent disabling features at initial presentation.”

“Symptoms tend to vary in intensity and type over a period of weeks or months (and evolve into what is more clearly CFS/ME with time)”

Mild CFS will satisfy DSM-5 Somatic Symptom Disorder Part C. Therefore every person with M.E. or CFS could get a diagnosis of SSD unless they can convince any psychiatrist they encounter that they are not ‘excessive’, ‘persistent’, ‘disproportionate’, or that they don’t believe they are seriously ill.

A serious anomaly might arise with SSD in both M.E. and CFS. These illnesses can start with only fatigue or just a few symptoms. Extreme fatigue and pain might be all that a patient reports. However, if the illness continues over years, some symptoms may improve whilst new ones appear. Problems such as sensory impairments, bladder and bowel problems, immune dysfunction, and a host of neurological symptoms (to name but a few) can develop.

Will the M.E. or CFS patient then be vulnerable to having their previous diagnosis ‘cancelled-out’ by a new diagnosis of SSD, because they developed too many symptoms and are worried about them?

The SSD development group have repeated previous flaws they identified as creating the need for new definitions. They have not defined anything. Yet there may be some positive outcome from their efforts. I imagine that some medical insurance company executives must be rubbing their hands together in glee, but medical negligence lawyers should be turning cartwheels.

Peter Kemp

*Editor: Accompanying the first and second release of draft proposals for the Somatic Symptom Disorders categories, two quite lengthy PDF documents that expanded on the disorder descriptions and validity/rationales were published in conjunction with the webpage Proposed Revision, Rationale and Severity texts.

For this third draft, no PDFs have been published that reflect the Work Group’s revisons since release of the second draft, last May, or set out its rationales in detail. No draft DSM-5 textual content, more comprehensive disorder descriptions or field trial evaluations are available for public scrutiny other than brief, revised Rationale texts:

Criteria for Proposed Revision J00 Somatic Symptom Disorder

Rationale text for category J00 Somatic Symptom Disorder:

Rationale

The proposed classification for Somatic Symptom Disorders deemphasizes the central role of medically unexplained symptoms. Instead, it defines disorders on the basis of positive symptoms (distressing somatic symptoms + excessive thoughts, feelings, and behaviors in response to these symptoms).
The group considers that the current DSM-IV somatoform diagnoses (Somatization Disorder, Somatoform Disorder NOS, Undifferentiated Somatoform Disorder, Hypochondriasis and the Pain Disorders) are so flawed that complete restructuring of these diagnoses is required. Change is needed as:

- The DSM-IV somatoform diagnoses are used rarely in clinical practice in most countries; the terms cause confusion among doctors and are resented by many patients.

- The criteria for DSM-IV somatization disorder are too restrictive. Undifferentiated Somatoform Disorder has such a low threshold that it is applicable to a very large proportion of patients attending primary care. The same low threshold issue occurs with Somatoform Disorder NOS.

- These diagnoses are based on “medically unexplained symptoms,” but this term is unreliable, especially in the presence of medical illness. Doctors disagree on the use of the term and patient recall of such symptoms is variable, so reliability of these diagnoses is low.

- The lack of positive psychological features in the definition of these disorders means they fail to satisfy one of the criteria for a mental disorder.

The new diagnoses of Somatic Symptom Disorder (SSD) is proposed to overcome these problems with relevant DSM-IV diagnoses.

The previous posting proposed diagnoses of Complex Somatic Symptom Disorder (CSSD) and Simple Somatic Symptom Disorder (SSSD). In this revision, we have merged the two disordes [sic], recognizing that SSSD is a less severe variant of CSSD. The work group is considering dropping the adjective “complex” from the name of the resulting disorder and is desirous of feedback.   Accessed May 4, 2012

Related material:

1] DSM-5 proposals for Somatoform Disorders revised on April 27, 2012

2] DSM-5 Development site

3] Somatic Symptom Disorders proposals

APA Press Release: DSM-5 Draft Criteria Open for Public Comment

APA Press Release: DSM-5 Draft Criteria Open for Public Comment

Post #164 Shortlink: http://wp.me/pKrrB-20I

Commentaries and media, followed by APA Press Release No. 24

(Not specific to DSM-5 third draft: Ethics complaints filed against APA.)

Psychology Today

Science Isn’t Golden
Matters of the mind and heart

Patients Harmed by Diagnosis Find Their Voices
Victims of psychiatric labeling file ethics complaints.

Paula J. Caplan, Ph.D. | April 28, 2012

The American Psychiatric Association’s 2012 Annual Meeting

This coverage is not sanctioned by, nor a part of, the American Psychiatric Association.

From Medscape Medical News > Conference News
DSM-5 Field Trial Results a Hot Topic at APA 2012 Meeting

Deborah Brauser | May 3, 2012

May 3, 2012 — Telepsychiatry, neuromodulation, the role of genetics, and updates for the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are just some of the hot items on the agenda of this year’s American Psychiatric Association’s 2012 Annual Meeting in Philadelphia…

(Not specific to DSM-5 third draft: Letter, AJP re DSM-5 field trial reliability and kappas.)

American Journal of Psychiatry

Letters to the Editor | May 01, 2012
Standards for DSM-5 Reliability

Am J Psychiatry 2012;169:537-537. 10.1176/appi.ajp.2012.12010083

Robert L. Spitzer, M.D.; Janet B.W. Williams, Ph.D.; Jean Endicott, Ph.D.
Princeton, N.J.
New York City

DSM5 in Distress
The DSM’s impact on mental health practice and research.

DSM 5 Rejects ‘Hebephilia’ Except for the Fine Print

Alan Frances MD | May 3, 2012

Scientific American blogs

APA Announces New Changes to Drafts of the DSM-5, Psychiatry’s New “Bible”

Ferris Jabr | May 3, 2012

Observations

Opinion, arguments & analyses from the editors of Scientific American

“…This year, the APA is holding its annual meeting from May 5 to 9 in Philadelphia, where much of the discussion will focus on the drafts of the DSM-5 and the results of “Field Trials”—dry runs of the new diagnostic criteria in clinical settings. I am attending the conference to learn more and, next week, my colleague Ingrid Wickelgren at Scientific American MIND and I will bring you a series of blogs about the DSM-5 authored by ourselves and some well-known researchers and psychiatrists. For the duration of next week, we will also publish my feature article about DSM-5 in its entirety on our website. After next week, you can still read the feature in the May/June issue of MIND. Stay tuned!”

About the Author: Ferris Jabr is an associate editor focusing on neuroscience and psychology.

1 boring old man

1 boring old man | May 3, 2012

the future of an illusion IV½…

and

the future of an illusion IV

1 boring old man | May 2, 2012

Psychology Today | DSM 5 in Distress

Wonderful News: DSM 5 Finally Begins Its Belated and Necessary Retreat
Perhaps this will be the beginning of real reform.

Alan Frances MD | May 2, 2012

MindFreedom International Newswire

Protesters, Rejecting Mental Illness Labels, Vow to “Occupy” the American Psychiatric Association Convention

MindFreedom International
Last modified: 2012-05-01T16:46:46Z
Published: Tuesday, May. 1, 2012 – 9:46 am

PHILADELPHIA, May 1, 2012 — /PRNewswire-USNewswire/ — On Saturday, May 5, 2012, as thousands of psychiatrists congregate for the American Psychiatric Association (APA) Annual Meeting, individuals with psychiatric labels and others will converge in a global campaign to oppose the APA’s proposed new edition of its “bible,” the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), scheduled for publication in 2013. Occupy the APA will include distinguished speakers from 10 a.m. to noon at Friends Center (1515 Cherry Street, Philadelphia), and a march at approximately 12:15 p.m. to the Pennsylvania Convention Center (12th and Arch Streets), where the group will protest from approximately 1 p.m. while the APA meets inside…

http://www.psychiatry.org/advocacy–newsroom/newsroom/dsm-5-draft-criteria-open-for-public-comment

Wed May 02, 2012

Contact: For Immediate Release                                  
Eve Herold, 703-907- 8640 Release No. 24
press@psych.org
Erin Connors, 703-907-8562
econnors@psych.org

DSM-5 Draft Criteria Open for Public Comment
Mental health diagnostic manual available for final online comment period

ARLINGTON, Va. (May 2, 2012) – For a third and final time, the American Psychiatric Association (APA) invites public comment on the proposed criteria for the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). DSM is the handbook used by health care professionals as an authoritative guide to the diagnosis of mental disorders.

The public comment period will last six weeks, beginning May 2 and continuing until June 15. All responses submitted via the DSM-5 website will be considered by the DSM-5 Work Groups, which are charged with assessing the latest scientific evidence and recommending the disorder definitions and criteria to be included in the manual. Nearly 10,800 comments from health care professionals, mental health advocates, families and consumers were submitted in the first two public comment periods in 2010 and 2011.

“The comments we have received over the past two years have helped sharpen our focus, not only on the strongest research and clinical evidence to support DSM-5 criteria but on the real-world implications of these changes,” said APA President John M. Oldham, M.D. “We appreciate the public’s interest and continued participation in the DSM-5 development process.”

In preparation for this final comment period, members of the DSM-5 Task Force and Work Groups have updated their proposals for diagnostic criteria. The revised criteria reflect recently published research, results from DSM-5 field testing of the criteria and public comments received since 2010.

Key changes posted for this round of public review include:

• Revised proposals to place Attenuated Psychosis Syndrome and Mixed Anxiety Depressive Disorder in Section III of the manual, covering conditions that require further research before their consideration as formal disorders

•  Added language to Major Depressive Disorder criteria to help differentiate between normal bereavement associated with a significant loss and a diagnosis of a mental disorder

• Added rationale for changes to Personality Disorders, with field trial data now supporting the reliability of dimensional measures and the categorical diagnosis of Borderline Personality Disorder

• Modified diagnostic criteria for Pedophilic Disorder to make the category more consistent with the World Health Organization’s International Classification of Diseases

• Condensed diagnoses within Communication Disorders to only include Language Disorders and Speech Disorders

• A proposal for a new diagnosis of Suicidal Behavioral Disorder

• Modified diagnostic criteria for numerous disorders, including some in the Neurocognitive Disorders and Anxiety Disorders chapters

• A proposed Cultural Formulation Interview, which includes specific questions to help clinicians more effectively assess cultural aspects of psychiatric diagnosis

• A detailed list of changes made to draft proposals since July 2011 can be found on www.DSM5.org .

Revisions to DSM reflect scientific advances in the field and new knowledge gained since the last manual was published in 1994. Since 1999, more than 500 mental health and medical researchers and clinicians from the United States and abroad have been involved in the planning, review and deliberations for DSM-5. Field trials in both large academic medical centers and routine clinical practices have tested select criteria.

Feedback to the proposed diagnostic criteria can be submitted through www.DSM5.org , which will be available until the comment period ends June 15. After that, the site will remain viewable but will be closed to comments as the Work Groups and Task Force complete revisions and submit criteria for evaluation by the Scientific Review Committee and the Clinical and Public Health Committee. The Task Force will then make final recommendations to the APA Board of Trustees. The final version of DSM-5 is expected to go before the Board of Trustees in December 2012.

“As with every stage in this thorough development process, DSM-5 is benefiting from a depth of research, expertise and diverse opinion that will ultimately strengthen the final document,” noted David J. Kupfer, M.D., chair of the DSM-5 Task Force.

Publication of DSM-5 is expected in May 2013.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org  and www.HealthyMinds.org .

APA releases third draft of DSM-5 for final stakeholder review and comment

American Psychiatric Association (APA) releases third draft of DSM-5 for final stakeholder review and comment

Post #163 Shortlink: http://wp.me/pKrrB-20I

 

The American Psychiatric Association, publishers of the Diagnostic and Statistical Manual of Mental Disorder (DSM), has today released its third draft of proposed revisions to DSM-IV diagnostic categories and criteria.

The next edition of the DSM, which will be known as DSM-5, is due for publication in May 2013.

This third and final stakeholder review and comment period runs for six weeks until June 15, 2012

Revised proposals can be found on the DSM-5 Development website here:

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

Submitting comment

As with the two previous feedback exercises, comments from professionals, professional bodies, consumer groups and individuals are being accepted via a registration process on the DSM-5 Development website, for which a valid email address is required for validation purposes. Comments are uploaded via a WYSIWYG/html editor.

(If you had registered to submit comment for either of the earlier feedback exercises your log in details may still work.)

These review and feedback exercises are open to all stakeholders in DSM-5  – medical professionals, clinicians, researchers, psychiatrists, psychologists, allied mental health and health professionals, counselors, social workers, OTs, lawyers, teachers, patients and their families, caregivers, advocates and patient organizations.

These public reviews are not run as formal consultation exercises and the DSM-5 Task Force does not publish comments received nor lists of the names of professional bodies, organizations, institutions and individuals who have submitted feedback.

This page on the DSM-5 Development site says:

“…At this time, we are accepting comment submissions on this Web site until June 15, 2012. Comments about specific diagnoses can be made on the pages below, while you may leave feedback about non-diagnostic specific issues in DSM-5 in the Overall Comments section. The work group members will review all feedback and make decisions about further revisions based in part on the comments provided as well as on results from field trial testing, which is currently underway. Once the next edition of changes have been implemented, we will post the revised criteria on this site to allow commentary once again…”

However, the Home Page announcement states,

“…This commenting period marks the third and final time DSM-5 draft criteria will be available for your feedback. Following this period the site will remain viewable with the draft proposals until DSM-5’s publication…”

The second public review exercise ran from May 4 to June 15, 2011 but was extended a further month until July 15. If the closure date for receipt of submissions for this third review is extended I will update this site.

 

THIRD and FINAL stakeholder review published

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

Final Updates to DSM5.org

For the next 6 weeks we are pleased to once again offer the opportunity to submit comments on the draft fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This commenting period marks the third and final time DSM-5 draft criteria will be available for your feedback. Following this period the site will remain viewable with the draft proposals until DSM-5’s publication.

Following the previous commenting period (May-July 2011), members of the DSM-5 Task Force and Work Groups reviewed feedback submitted to this site and, where appropriate, revised their proposed diagnostic criteria and made other changes. With the completion of the DSM-5 Field Trials, Work Group members have spent the past several months examining data and findings from these important studies. Therefore, the proposed diagnostic criteria found on this site are the result of the DSM-5 Work Groups’ ongoing deliberations, based on findings from scientific field studies, patient and clinician perspectives, and views from the general public. We want to stress that revisions will continue to be made, as necessary, over the next several months.

What’s New?

What specifically has changed on this site over the past year? Visitors may notice differences in the ways in which some proposed disorders are classified. Below are some of the changes.

Based on concerns about the reliability of the proposed Attenuated Psychosis Syndrome and Mixed Anxiety Depressive Disorder in the field trials, these two conditions are being recommended for further study in Section III, an area of DSM-5 for conditions that require further research before consideration as formal disorders.

We also added a footnote to the Major Depressive Disorder criteria to clarify the difference between normal bereavement associated with a significant loss and a diagnosis of a mental disorder. Many commentators noted the previous criteria erroneously implied that bereavement could be assumed to only last 2 months and we wanted to correct that misunderstanding and provide more information on how bereavement and other loss reactions differ from Major Depressive Disorder. The extensive public comment also highlighted the need to clarify that use of a checklist of the diagnostic criteria by people without clinical training is insufficient to make a clinical diagnosis.

Among the other significant changes in this posting is a more extensive Personality Disorders rationale for change with the reliability of dimensional measures and the categorical diagnosis of Borderline Personality Disorder now supported by Field Trial data. However, additional data analysis in this area is ongoing.

Diagnostic criteria for Pedophilic Disorder have been modified. The adjusted boundaries of this disorder are based more on biological developmental indicators of early puberty in victims to avoid implications that the disorder involves post-pubertal adolescent victims and to make the criteria consistent with the International Classification of Diseases.

Communication Disorders now include two diagnoses – Language Disorders and Speech Disorders – each with appropriate subtypes to cover all seven of the disorders previously proposed for categorization here.

Similarly, based on clinical feedback and the field trial documentation that Simple Somatic Symptom Disorder was a milder form of Complex Somatic Symptom Disorder, the two have now been combined as a single disorder: Somatic Symptom Disorder.

The diagnosis of Suicidal Behavioral Disorder is a newly proposed disorder that is intended to complement the previous proposal for Non-Suicidal Self Injury Disorder. The latter disorder was tested in the Field Trials with highly variable levels of reliability—final decisions about its placement in Section III for further study have not been made. Another disorder suggested for placement in Section III includes Persistent Complex Bereavement Disorder which has had conflicting disorder criteria proposed from previous studies of this condition. The Work Group has suggested a new criteria set that builds on previous research prior to full endorsement of this condition.

Readers will also notice changes in specific criteria for some of the disorders, including those in the Neurocognitive Disorders and the Anxiety Disorders chapters. Finally, we have also now included a proposed Cultural Formulation Interview for DSM-5, which also includes some specific questions for visitors to consider in thinking about how the manual can help clinicians more effectively assess cultural aspects of psychiatric diagnosis.

A detailed listing of changes to draft proposals that have been made since July 2011 can be found on the Recent Updates page. We also encourage readers to visit each diagnostic section, which includes a brief introductory statement about changes within that section, as well as a listing of the proposed disorders for that particular section.

Next Steps

It is important to note that the proposed changes listed here do not represent the final changes for DSM-5. The proposals listed here reflect the most up-to-date drafts, final versions of which will be put forth for review and approval by the Board of Trustees of the American Psychiatric Association (APA) later this year. However, these proposed changes will undergo further revisions between now and the end of 2012, in part generated from your input, and also because results from the DSM-5 Field Trials continue to be analyzed, discussed, and integrated into proposals, along with an extensive review process that is taking place for these proposals. This review process includes: a Scientific Review Committee which will review the scientific validating evidence for revisions; an extensive peer review process where hundreds of expert reviewers will consider the clinical and public health risks and benefits of making changes from DSM-IV; and a review by an Assembly DSM-5 committee. Revisions will continually be made based on feedback from these various groups. This represents an unprecedented level of internal and external review for the DSM including the public review via the three postings on the DSM5.org.

Finally, there will be an overall review by the DSM-5 Task Force that integrates these assessments and sends final recommendations along with all supporting data to the APA’s Board of Trustees for a final review. The Board of Trustees will consider the recommendations of the Task Force along with those from the Scientific Review Committee as well as other review committees mentioned above and the public comments. The final manual approved by the Board will be submitted to the American Psychiatric Publishing for publication by December 31, 2012. The 166th APA Annual Meeting in San Francisco, May 18-22, 2013, will mark the official release of DSM-5.

(Ed: See DSM-5 Development site for links)

Neurodevelopmental Disorders
Schizophrenia Spectrum and Other Psychotic Disorders
Bipolar and Related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive and Related Disorders
Trauma and Stressor Related Disorders
Dissociative Disorders
Somatic Symptom Disorders
Feeding and Eating Disorders
Elimination Disorders
Sleep-Wake Disorders
Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse Control, and Conduct Disorders
Substance Use and Addictive Disorders
Neurocognitive Disorders
Personality Disorders
Paraphilias
Other Disorders

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

Proposed Draft Revisions to DSM Disorders and Criteria

The draft disorders and disorder criteria proposed by the DSM-5 Work Groups for new and existing mental disorders can be found on these pages. You will notice that the diagnostic chapters listed below are no longer organized according to DSM-IV. Instead, we have restructured the diagnostic chapters in DSM-5 to better reflect advances in our scientific understanding of psychiatric disorders, as well as to make diagnosis easier and more feasible for clinicians. You can read more about the proposed chapter structure by clicking here.

Use the links below to read about proposed changes to the disorders that interest you. Although the disorders listed below are listed according to their proposed placement in DSM-5, you may click here if you are interested in seeing which work groups are addressing which disorders. Please note that the proposed criteria listed here are not final. These are initial drafts of the recommendations that have been made to date by the DSM-5 Work Groups.

You will also notice for each disorder a section pertaining to the assessment of disorder severity. The severity criteria being proposed differs somewhat across disorders, largely because the work groups are in different stages in their deliberation processes. Therefore, you will notice some variability in the range of options presented across disorders, as well as differences in the severity scales being proposed. However, by DSM-5’s completion, we look forward to presenting a standardized method for assessing severity for all diagnoses, with an emphasis on simplicity and clinical utility. Finally, in addition to pages on each of the DSM-IV diagnostic categories, please be sure to review the sections on proposed revisions to the definition of a mental disorder, a listing of Conditions Proposed by Outside Sources that are still under consideration, and Other Clinical Conditions that may be the Focus of Clinical Attention. Please be sure to review these sections in addition to the diagnostic categories.

At this time, we are accepting comment submissions on this Web site until June 15, 2012. Comments about specific diagnoses can be made on the pages below, while you may leave feedback about non-diagnostic specific issues in DSM-5 in the Overall Comments section. The work group members will review all feedback and make decisions about further revisions based in part on the comments provided as well as on results from field trial testing, which is currently underway. Once the next edition of changes have been implemented, we will post the revised criteria on this site to allow commentary once again.*

*Please note that all input we receive will be reviewed, though we can not guarantee that your suggestions will be incorporated into any revisions.

*Ed: Update @ May 3, 2012

I am advised that APA has clarified that the paragraph above contained erroneous text; the webpage has since been amended to read:

“…At this time, we are accepting comment submissions on this Web site until June 15, 2012. Comments about specific diagnoses can be made on the pages below, while you may leave feedback about non-diagnostic specific issues in DSM-5 in the Overall Comments section. The work group members will review all feedback and make decisions about further revisions based in part on the comments provided as well as on results from field trial testing, which is currently underway.”

*Please note that all input we receive will be reviewed, though we can not guarantee that your suggestions will be incorporated into any revisions.

 

(Ed: One focus of this site has been the monitoring of proposals for the Somatic Symptom Disorders. The categories and criteria proposals for Somatic Symptom Disorders, as published today, do not appear to have changed since April 27, other than an edit to the introduction reflecting the proposal to merge CSSD with SSSD and name “Somatic Symptom Disorder”. See Post #162: DSM-5 proposals for Somatoform Disorders revised on April 27, 2012 )

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

Somatic Symptom Disorders

Please find below a list of disorders that are currently proposed for the diagnostic category, Somatic Symptom Disorders. This category contains diagnoses that were listed in DSM-IV under the chapter of Somatoform Disorders. The Somatic Symptom Disorders Work Group has been responsible for addressing these disorders. Among the work group’s recommendations is the proposal to rename this category Somatic Symptom Disorders. Because the current terminology for somatoform disorders is confusing and because somatoform disorders, psychological factors affecting medical condition, and factitious disorders all involve presentation of physical symptoms and/or concern about medical illness, the work group suggests renaming this group of disorders Somatic Symptom Disorders. In addition, because of the implicit mind-body dualism and the unreliability of assessments of “medically unexplained symptoms,” these symptoms are no longer emphasized as core features of many of these disorders. Since Somatization Disorder, Hypochondriasis, Undifferentiated Somatoform Disorder, and Pain Disorder share certain common features, namely somatic symptoms and cognitive distortions, the work group is proposing that these disorders be grouped under a common rubric called Somatic Symptom Disorder. The work group had previously suggested separate diagnoses of Complex Somatic Symptom Disorder and Simple Somatic Symptom Disorder, but they are now proposing that these be combined into a singular diagnosis of Somatic Symptom Disorder. The work group has also proposed that Factitious Disorder be moved from its previous location under Other Disorders to this chapter. Lastly, the work group is proposing that Conversion Disorder now be named Conversion Disorder (Functional Neurological Symptom Disorder) . We appreciate your review and comment on these 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 |

DSM-5 proposals for Somatoform Disorders revised on April 27, 2012

DSM-5 proposals for Somatoform Disorders revised on April 27, 2012

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

Update @ May 02, 2012: Since publication of this post, APA has posted its third draft (see Post #163)

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 discovered, today, that proposals for the revision of the Somatoform Disorders were updated yesterday, April 27.

The APA’s 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 Timeline remains unspecific – other than “Spring” and “for two months.”

Revisions to other DSM-IV categories may also have been published prior to the launch of the third public review and I would advise readers to check the DSM-5 Development site for potential changes to other categories.

 

Somatic Symptom Disorders

Earlier proposals for two new categories, “Complex Somatic Symptom Disorder” (CSSD) and “Simple Somatic Symptom Disorder” (SSSD); “Functional Neurological Disorder (Conversion Disorder)” and proposed revisions to selected other categories, as they had stood at the time of the second public review (May 4 – July 15, 2011), are archived on Dx Revision Watch site here, for comparison:

http://dxrevisionwatch.wordpress.com/dsm-5-proposals/dsm-5-proposals-sub-page-1/dsm-5-drafts-2/

and in this Dx Revision Watch post from May 10, 2011: http://wp.me/pKrrB-13z

 

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

Please find below a list of disorders that are currently proposed for the diagnostic category, Somatic Symptom Disorders. This category contains diagnoses that were listed in DSM-IV under the chapter of Somatoform Disorders. The Somatic Symptom Disorders Work Group has been responsible for addressing these disorders. Among the work group’s recommendations is the proposal to rename this category Somatic Symptom Disorders. Because the current terminology for somatoform disorders is confusing and because somatoform disorders, psychological factors affecting medical condition, and factitious disorders all involve presentation of physical symptoms and/or concern about medical illness, the work group suggests renaming this group of disorders Somatic Symptom Disorders. In addition, because of the implicit mind-body dualism and the unreliability of assessments of “medically unexplained symptoms,” these symptoms are no longer emphasized as core features of many of these disorders. Since Somatization Disorder, Hypochondriasis, Undifferentiated Somatoform Disorder, and Pain Disorder share certain common features, namely somatic symptoms and cognitive distortions, the work group is proposing that these disorders be grouped under a common rubric called Complex Somatic Symptom Disorder.*

[*Ed: The Work Group now 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." Update @ May 02, 2012: The text above has been revised by the Somatic Symptom Disorder Work Group since publication of this post. See Post #163 for revised text.]

[Ed: Note: There have been two key PDF documents associated with the proposals for the "Somatic Symptom Disorders" – the "Disorders Description" and "Rationale/Validity" documents. 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 page. These updated proposal texts, below, are littered with typos.]

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

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

Criteria A, B, and C must all be fulfilled to make the diagnosis:

A. Somatic symptoms: One or more somatic symptoms that are distressing and/or result in significant disruption in daily life.

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 one’s symptoms.

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

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

C. Chronicity: Although any one symptom may not be continuously present, the state of being symptomatic is persistent (typically >6 months).

Specifiers

Predominant Pain (previously pain disorder). This category is reserved for individuals presenting predominantly with pain complaints who also asatisfy criteria B and C of this diagnosis. Some patients with pain may better fit other psychiatric diagnoses such as adjustment disorder or psychological factors affecting a medical condition.

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

Rationale

The proposed classification for Somatic Symptom Disorders deemphasizes the central role of medically unexplained symptoms. Instead, it defines disorders on the basis of positive symptoms (distressing somatic symptoms + excessive thoughts, feelings, and behaviors in response to these symptoms).

The group considers that the current DSM-IV somatoform diagnoses (Somatization Disorder, Somatoform Disorder NOS, Undifferentiated Somatoform Disorder, Hypochondriasis and the Pain Disorders) are so flawed that complete restructuring of these diagnoses is required. Change is needed as:

- The DSM-IV somatoform diagnoses are used rarely in clinical practice in most countries; the terms cause confusion among doctors and are resented by many patients.

- The criteria for DSM-IV somatization disorder are too restrictive. Undifferentiated Somatoform Disorder has such a low threshold that it is applicable to a very large proportion of patients attending primary care. The same low threshold issue occurs with Somatoform Disorder NOS.

- These diagnoses are based on “medically unexplained symptoms,” but this term is unreliable, especially in the presence of medical illness. Doctors disagree on the use of the term and patient recall of such symptoms is variable, so reliability of these diagnoses is low.

- The lack of positive psychological features in the definition of these disorders means they fail to satisfy one of the criteria for a mental disorder.

The new diagnoses of Somatic Symptom Disorder (SSD) is proposed to overcome these problems with relevant DSM-IV diagnoses.

The previous posting proposed diagnoses of Complex Somatic Symptom Disorder (CSSD) and Simple Somatic Symptom Disorder (SSSD). In this revision, we have merged the two disordes, recognizing that SSSD is a less severe variant of CSSD. The work group is considering dropping the adjective “complex” from the name of the resulting disorder and is desirous of feedback.

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

Severity

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]

Somatic Symptom Disorder is a disorder characterized by persistency, symptom burden, and excessive or maladaptive response to somatic symptoms. There is a considerable range of severity. Typically, the disorder is more severe when multiple somatic syptoms are present. In addition to fulfilling criteria A and C, the following metrics may be used to rate severity:

Mild: only 1 of the B criteria fulfilled
Moderate: 2 or more B criteria fulfilled
Severe: 2 or more B criteria fulfilled plus multiple somatic symptoms

PHQ Somatic Symptom Short Form (PHQ-SSS)*

*Ed: Kroenke K, Spitzer RL, Williams JBW. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine 2002;64:258-266.
Abstract: http://www.ncbi.nlm.nih.gov/pubmed/11914441
PDF: http://www.psychosomaticmedicine.org/content/64/2/258.full.pdf+html

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

A. Somatic symptoms are not present or, if present, are only mild in intensity.

B. Preoccupation with having or acquiring a serious illness. If another medical condition or high risk for developing a medical condition (e.g. strong family history) is present, the preoccupation is clearly excessive or disproportionate.

C. High level of anxiety about health and a low threshold for becoming alarmed about their health.

D. The individual performs excessive health-related behaviors (e.g., repeatedly checking one’s body for signs of illness), or exhibits maladaptive avoidance (e.g., avoiding doctors’ appointments and hospitals).

E. Although the specific preoccupation may not be continuously present, the state of being preoccupied is chronic (at least 6 months).

F. The illness-related preoccupation is not better accounted for by another psychiatric disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, or obsessive-compulsive disorder.

Subtypes

Care-seeking subtype: care-seeking individuals have elevated rates of medical utilization.

Care-avoidant subtype: avoidant individuals rarely seek medical care because seeing a physician and undergoing laboratory tests and diagnostic procedures heighten their anxiety to intolerable levels.

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

Rationale

Studies suggest that patients with hypochondriasis fall into two distinct subgroups. In one subgroup (75% of hypochondriasis patients), somatic symptoms predominate and form the patient’s primary concern. The other subgroup (25% of hypochondriacs) is composed of patients with minimal somatic symptoms but who are highly anxious about and suspicious of the presence of an undiagnosed, serious medical illness.

In our proposal for DSM 5, the former subgroup of patients would be subsumed under the new diagnosis of Somatic Symptom Disorder (SSD), while the latter subgroup would now be subsumed under the proposed Illness Anxiety Disorder (IAD). IAD is closely related to other somatic symptom disorders, anxiety disorders, and depressive disorders, but it is included here because of its close relationship to the other somatic symptom disorders in clinical presentation, phenomenology, and in cognitive, affective and behavioral characteristics.

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

Severity

Recommendations for severity criteria for this disorder are forthcoming. We encourage you to check our website regularly for updates.

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)

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/Pages/proposedrevision.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.

Removal of previous criterion B. “Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts or other stressors” We propose that this criterion be eliminated and discussion of etiologic factors placed in accompanying text. This DSM IV criterion reduces the utility and reliability of the diagnosis in practice because:

(a) It confounds clinical description with a proposed but unproven etiology.

(b) The research evidence indicates that observed psychological factors are often non-specific; that is, they occur in patients with other conditions, often with a similar frequency; this non-specificity makes a judgment of their relevance in an individual case of ‘conversion’ subjective and potentially unreliable.

(c) In a substantial proportion of apparent cases of conversion – as defined by neurological symptoms not explained by disease – psychological factors cannot be convincingly or reliably demonstrated.

Removal of previous criterion C. “The symptom or deficit is not intentionally produced or feigned (as in Factitious Disorder or Malingering)”. This criterion reduces the utility and reliability of the diagnosis because:

(a) It is difficult, and probably clinically impossible, to prove reliably that a patient is not feigning.

(b) While the clinician needs to be aware of the possibility of feigning, and to make an appropriate diagnosis if it is found, there is no evidence that feigning is more common in patients with possible conversion disorder than with other mental disorders. Highlighting it for conversion alone is unnecessarily stigmatizing and may be detrimental to the physician-patient relationship.

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

Severity

- Minor and brief impairment (i.e., non-incapacitating symptom such as aphonia lasting less than 2 days)

- Minor impairment and persistent/recurrent (i.e., from 3 days to 3 months)

- Moderate impairment and brief duration

- Severe and persistent/recurrent (e.g., more than 3 months bedbound with contractures and/or muscle wasting)

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

To meet criteria for Psychological Factors Affecting Medical Condition, both criteria A and B are necessary.

A general medical condition is present.

B Psychological or behavioral factors adversely affect the general medical condition in one of the following ways:

1 the factors have influenced the course of the general medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the general medical condition

2 the factors interfere with the treatment of the general medical condition (e.g., poor adherence)

3 the factors constitute additional well-established health risks for the individual

4 the factors influence the underlying pathophysiology to precipitate or exacerbate symptoms or to necessitate medical attention.

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

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

Rationale

The work group recommends retaining the diagnosis of Psychological Factors Affecting a Medical Condition (PFAMC) with only minor wording changes in the criteria.

In DSM-IV, PFAMC had 6 subtypes; since there is no evidence the subtypes have been used, we have recommended eliminating them. Finally, we have advocated moving PFAMC from its obscure place in the back of prior DSM editions into the Somatic Symptom Disorders chapter.

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

Severity

1 = increases medical risk (e.g. inconsistent adherence with anti-hypertension treatment)

2 = aggravates underlying medical condition (e.g. anxiety aggravating asthma)

3 = results in medical hospitalization or emergency room visit

4 = results in severe life-threatening risk (e.g. ignoring heart attack symptoms)

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

To meet criteria for Factitious Disorder Imposed on Self, all four criteria must be met.

A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified perception.

B. Presenting oneself to others as ill, impaired, or injured.

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The abnormal illness behavior is not better accounted for by another mental disorder such as delusional disorder or other psychotic disorder.

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

To meet criteria for Factitious Disorder Imposed on Another, all four criteria must be met. Note that the perpetrator, not the victim, receives this diagnosis.

A. Falsification of physical or psychological signs or symptoms or of induction of injury or disease in another, associated with identified deception.

B. Presenting another (victim) to others as ill, impaired, or injured.

C. The deceptive behavior is evident even in the absence of obvious external rewards.

D. The abnormal illness behavior is not better accounted for by another mental disorder such as delusional disorder or other psychoitc disorder.

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

Rationale

The Somatic Symptom Disorders workgroup requests that Factitious Disorders be grouped within the Somatic Symptom chapter of DSM V. Such a grouping is more logical than the status quo where factitious disorders appear in their own chapter. Our proposed grouping supports clinical utility and facilitates future research.

Utility: This grouping would help physicians with the differential diagnosis of patients who present with persistent problems related to illness perception, frequently including unexpected and/or unexplained psychological and/or physical symptoms. In making a differential diagnosis, it is conceptually and pragmatically useful to group disorders that show diagnostic overlap with one another in the same section. This grouping will be particularly advantageous in terms of comparing and contrasting Factitious Disorder with Conversion Disorder and, to a lesser extent, with Complex Somatic Symptom Disorder.

Research: The grouping of Factitious Disorders with the other Somatic Symptom Disorders would facilitate research progress on the broad spectrum of symptom reporting phenomena, including the feigning of symptoms. In the status quo, Factitious Disorder is listed in a separate chapter, where it is not routinely considered.

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

Severity

There are few widely employed measures of severity in factitious disorder or conversion disorder.

For factitious disorder, one might grade severity levels as “1” when symptoms alone are reported (“bright red blood in stool”), as “2” when a lab test was modified (e.g. introducing blood into a urine sample), as “3” when patients make themselves sick or as “4” when patients’ actions lead to life threatening illness.

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

J 05 Somatic Symptom Disorder Not Elsewhere Classified

Proposed Revision

Updated April-27-2012

Somatic Symptom Disorder Not Elsewhere Classified

Pseudocyesis A false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy.

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

Rationale

Pseudocyesis is a rare disorder with characteristic somatic features. Because of its prominent somatic presentation, pseudocyesis is included in the NEC section of Somatic Symptom Disorder.

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

Severity

The work group has not yet finalized their severity for this disorder. Please continue to check this Web site for updates, as this will be forthcoming.

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.

The six most essential questions in psychiatric diagnosis: a pluralogue: conceptual and definitional issues in psychiatric diagnosis Parts 1 and 2

The six most essential questions in psychiatric diagnosis: a pluralogue: conceptual and definitional issues in psychiatric diagnosis, Parts 1 and 2

Post #161 Shortlink: http://wp.me/pKrrB-248

Below, I am posting the Abstract and Introduction to Parts 1 and 2 of Philos Ethics Humanit Med Review “The six most essential questions in psychiatric diagnosis: a pluralogue: conceptual and definitional issues in psychiatric diagnosis.”

Part 1 of this Review was published on January 13, 2012; Part 2 was published (as a provisional PDF) on April 18, 2012. I will post Part 3 when it becomes available.

Below Parts 1 and 2, I have posted the PDFs for Phillips J (ed): Symposium on DSM-5: Part 1. Bulletin of the Association for the Advancement of Philosophy and Psychiatry 2010, 17(1):1–26 and Phillips J (ed): Symposium on DSM-5: Part 2. Bulletin of the Association for the Advancement of Philosophy and Psychiatry 2010, 17(2):1–75 out of which grew the concept for the Philos Ethics Humanit Med Review Parts 1 and 2.

This is an interesting series of exchanges which expand on conceptual and definitional issues discussed in these two Bulletins but these are quite lengthy documents, 29 and 30 pp, respectively; PDFs are provided rather than full texts.

Review Part One

The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305603/

Philos Ethics Humanit Med. 2012; 7: 3.
Published online 2012 January 13. doi: 10.1186/1747-5341-7-3 PMCID: PMC3305603

Copyright ©2012 Phillips et al; licensee BioMed Central Ltd.
Received August 15, 2011; Accepted January 13, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

      The six most essential questions Part 1

or: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305603/pdf/1747-5341-7-3.pdf

Html: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305603/

or http://www.peh-med.com/content/7/1/3

James Phillips,¹ Allen Frances,² Michael A Cerullo,³ John Chardavoyne,¹ Hannah S Decker,⁴ Michael B First,⁵ Nassir Ghaemi,⁶ Gary Greenberg,⁷ Andrew C Hinderliter,⁸ Warren A Kinghorn,^2,9 Steven G LoBello,¹⁰ Elliott B Martin,¹ Aaron L Mishara,¹¹ Joel Paris,¹² Joseph M Pierre,^13,14 Ronald W Pies,^6,15 Harold A Pincus,^5,16,17,18 Douglas Porter,¹⁹ Claire Pouncey,²⁰ Michael A Schwartz,²¹ Thomas Szasz,¹⁵ Jerome C Wakefield,^22,23 G Scott Waterman,²⁴ Owen Whooley,²⁵ and Peter Zachar¹⁰

 

¹Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT 06511, USA

²Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St., Durham, NC 27710, USA

³Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH 45219, USA

⁴Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA

⁵Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA

⁶Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA

⁷Human Relations Counseling Service, 400 Bayonet Street Suite #202, New London, CT 06320, USA

⁸Department of Linguistics, University of Illinois, Urbana-Champaign 4080 Foreign Languages Building, 707 S Mathews Ave, Urbana, IL 61801, USA

⁹Duke Divinity School, Box 90968, Durham, NC 27708, USA

¹⁰Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL 36117, USA

¹¹Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago IL, 60654, USA

¹²Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Department of Psychiatry, McGill University, 4333 cote Ste. Catherine, Montreal H3T1E4 Quebec, Canada

¹³Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, USA

¹⁴VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA

¹⁵Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY 13210, USA

¹⁶Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA

¹⁷New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY 10032, USA

¹⁸Rand Corporation, 1776 Main St Santa Monica, California 90401, USA

¹⁹Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA 70113, USA

²⁰Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320 Philadelphia, PA 19104, USA

²¹Department of Psychiatry, Texas AMHSC College of Medicine, 4110 Guadalupe Street, Austin, Texas 78751, USA

²²Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA

²³Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY 10016, USA

²⁴Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, Vermont 05405, USA

²⁵Institute for Health, Health Care Policy, and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St., New Brunswick, NJ 08901, USA

Abstract

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

General Introduction

This article has its own history, which is worth recounting to provide the context of its composition.

As reviewed by Regier and colleagues [1], DSM-5 was in the planning stage since 1999, with a publication date initially planned for 2010 (now rescheduled to 2013). The early work was published as a volume of six white papers, A Research Agenda for DSM-V [2] in 2002. In 2006 David Kupfer was appointed Chairman, and Darrel Regier Vice-Chairman, of the DSM-5 Task Force. Other members of the Task Force were appointed in 2007, and members of the various Work Groups in 2008.

From the beginning of the planning process the architects of DSM-5 recognized a number of problems with DSM-III and DSM-IV that warranted attention in the new manual. These problems are now well known and have received much discussion, but I will quote the summary provided by Regier and colleagues:

Over the past 30 years, there has been a continuous testing of multiple hypotheses that are inherent in the Diagnostic and Statistical Manual of Mental Disorders, from the third edition (DSM-III) to the fourth (DSM-IV)… The expectation of Robins and Guze was that each clinical syndrome described in the Feighner criteria, RDC, and DSM-III would ultimately be validated by its separation from other disorders, common clinical course, genetic aggregation in families, and further differentiation by future laboratory tests–which would now include anatomical and functional imaging, molecular genetics, pathophysiological variations, and neuropsychological testing. To the original validators Kendler added differential response to treatment, which could include both pharmacological and psychotherapeutic interventions… However, as these criteria have been tested in multiple epidemiological, clinical, and genetic studies through slightly revised DSM-III-R and DSM-IV editions, the lack of clear separation of these syndromes became apparent from the high levels of comorbidity that were reported… In addition, treatment response became less specific as selective serotonin reuptake inhibitors were found to be effective for a wide range of anxiety, mood, and eating disorders and atypical antipsychotics received indications for schizophrenia, bipolar disorder, and treatment-resistant major depression. More recently, it was found that a majority of patients with entry diagnoses of major depression in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study had significant anxiety symptoms, and this subgroup had a more severe clinical course and was less responsive to available treatments… Likewise, we have come to understand that we are unlikely to find single gene underpinnings for most mental disorders, which are more likely to have polygenetic vulnerabilities interacting with epigenetic factors (that switch genes on and off) and environmental exposures to produce disorders. [[2], pp. 645-646]

As the work of the DSM-5 Task Force and Work Groups moved forward, a controversy developed that involved Robert Spitzer and Allen Frances, Chairmen respectively of the DSM-III and DSM-IV Task Forces. The controversy began with Spitzer’s Letter to the Editor, “DSM-V: Open and Transparent,” on July 18, 2008 in Psychiatric Times [3], detailing his unsuccessful effort to obtain minutes of the DSM-5 Task Force meetings. In ensuing months Allen Frances joined him in an exchange with members of the Task Force. In a series of articles and blog postings in Psychiatric Times, Frances (at times with Spitzer) carried out a sustained critique of the DSM-5 work in which he focused both on issues of transparency and issues of process and content [4-16]. The latter involved the Task Force and Work Group efforts to address the problems of DSM-IV with changes that, in Frances’ opinion, were premature and not backed by current scientific evidence. These changes included new diagnoses such as mixed anxiety-depression, an expanded list of addictive disorders, the addition of subthreshold conditions such as Psychosis Risk Syndrome, and overly inclusive criteria sets – all destined, in Frances’ judgment, to expand the population of the mentally ill, with the inevitable consequence of increasing the number of false positive diagnoses and the attendant consequence of exposing individuals unnecessarily to potent psychotropic medications. The changes also included extensive dimensional measures to be used with minimal scientific foundation.

Frances pointed out that the NIMH was embarked on a major effort to upgrade the scientific foundation of psychiatric disorders (described below by Michael First), and that pending the results of that research effort in the coming years, we should for now mostly stick with the existing descriptive, categorical system, in full awareness of all its limitations. In brief, he has argued, we are not ready for the “paradigm shift” hoped for in the 2002 A Research Agenda.

We should note that as the DSM-5 Work Groups were being developed, the Task Force rejected a proposal in 2008 to add a Conceptual Issues Work Group [17] – well before Spitzer and Frances began their online critiques.

In the course of this debate over DSM-5 I proposed to Allen in early 2010 that we use the pages of the Bulletin of the Association for the Advancement of Philosophy and Psychiatry (of which I am Editor) to expand and bring more voices into the discussion. This led to two issues of the Bulletin in 2010 devoted to conceptual issues in DSM-5 [18,19]. (Vol 17, No 1 of the AAPP Bulletin will be referred to as Bulletin 1, and Vol 17, No 2 will be referred to as Bulletin 2. Both are available at http://alien.dowling.edu/~cperring/aapp/bulletin.htm. webcite) Interest in this topic is reflected in the fact that the second Bulletin issue, with commentaries on Frances’ extended response in the first issue, and his responses to the commentaries, reached over 70,000 words.

Also in 2010, as Frances continued his critique through blog postings in Psychiatric Times, John Sadler and I began a series of regular, DSM-5 conceptual issues blogs in the same journal [20-33].

With the success of the Bulletin symposium, we approached the editor of PEHM, James Giordano, about using the pages of PEHM to continue the DSM-5 discussion under a different format, and with the goal of reaching a broader audience. The new format would be a series of “essential questions” for DSM-5, commentaries by a series of individuals (some of them commentators from the Bulletin issues, others making a first appearance in this article), and responses to the commentaries by Frances. Such is the origin of this article. (The general introduction, individual introductions, and conclusion are written by this author (JP), the responses by Allen Frances.

For this exercise we have distilled the wide-ranging discussions from the Bulletin issues into six questions, listed below with the format in which they were presented to commentators. (As explained below, the umpire metaphor in Question 1 is taken from Frances’ discussion in Bulletin 1.)…

Full document in PDF format

 

Review Part Two

(Note: Part Two was published on April 18, 2012 and addresses Questions 3 and 4. The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production. I will replace with the final version when available.)

The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis

Philosophy, Ethics, and Humanities in Medicine 2012, 7:8 doi:10.1186/1747-5341-7-8

http://www.peh-med.com/content/7/1/8/abstract

Published: 18 April 2012

      The six most essential questions Part 2 Provisional

The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis

James Phillips, Allen Frances, Michael A Cerullo, John Chardavoyne, Hannah S Decker, Michael B First, Nassir Ghaemi, Gary Greenberg, Andrew C Hinderliter, Warren A Kinghorn, Steven G LoBello, Elliott B Martin, Aaron L Mishara, Joel Paris, Joseph M Pierre, Ronald W Pies, Harold A Pincus, Douglas Porter, Claire Pouncey, Michael A Schwartz, Thomas Szasz, Jerome C Wakefield, G Scott Waterman, Owen Whooley and Peter Zachar

Abstract (provisional)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 

Symposium on DSM-5: Parts 1 and 2

      Bulletin Vol 17 No 1

Phillips J (ed): Symposium on DSM-5: Part 1. Bulletin of the Association for the
Advancement of Philosophy and Psychiatry 2010, 17(1):1–26

      Bulletin Vol 17 No 2

Phillips J (ed): Symposium on DSM-5: Part 2. Bulletin of the Association for the Advancement of Philosophy and Psychiatry 2010, 17(2):1–75

 

One focus for this site has been the monitoring of the various iterations towards the revision of the Somatoform Disorders categories of DSM-IV, for which radical reorganization of existing DSM categories and criteria is proposed.

As the DSM-5 Development site documentation currently stands (April 27, 2012), the “Somatic Symptom Disorders” Work Group (Chaired by Joel E. Dimsdale, M.D.) proposes to rename Somatoform Disorders to “Somatic Symptom Disorders” and to fold a number of existing somatoform disorders together under a new rubric, which the Work Group proposes to call “Complex Somatic Symptom Disorder.”

Complex Somatic Symptom Disorder (CSSD) would include the previous DSM-IV diagnoses of somatization disorder [DSM IV code 300.81], undifferentiated somatoform disorder [DSM IV code 300.81], hypochondriasis [DSM IV code 300.7], as well as some presentations of pain disorder [DSM IV code 307].

There is a more recently proposed, Simple Somatic Symptom Disorder (SSSD), which requires symptom duration of just one month, as opposed to the six months required to meet the CSSD criteria. There is also an Illness Anxiety Disorder (hypochondriasis without somatic symptoms); and a proposal to rename Conversion Disorder to Functional Neurological Disorder and possibly locate under Dissociative Disorders.

There is some commentary on the Somatoform Disorders in DSM-IV in this discussion from Bulletin 1:

Bulletin Vol 17 No 1, Page 19:

Doing No Harm: The Case Against Conservatism

G. Scott Waterman, M.D. David P. Curley, Ph.D.

Department of Psychiatry, University of Vermont College of Medicine

CFSAC announces dates of Spring meeting

CFSAC announces dates of Spring meeting

Post #160 Shortlink: http://wp.me/pKrrB-240

Chronic Fatigue Syndrome Advisory Committee (CFSAC)

http://www.hhs.gov/advcomcfs/index.html

The Chronic Fatigue Syndrome Advisory Committee (CFSAC) provides advice and recommendations to the Secretary of Health and Human Services via the Assistant Secretary for Health of the U.S. Department of Health and Human Services on issues related to chronic fatigue syndrome (CFS). These include:

• factors affecting access and care for persons with CFS;
• the science and definition of CFS; and
• broader public health, clinical, research and educational issues related to CFS.

Administrative and management support for CFSAC activities is provided by the Office of the Assistant Secretary for Health (OASH). However, staffing will continue to be provided primarily from the Office on Women’s Health, which is part of OASH.

Dr. Nancy C. Lee, Deputy Assistant Secretary for Health – Women’s Health, is the Designated Federal Officer for CFSAC.

Chronic Fatigue Syndrome Advisory Committee (CFSAC) Spring Meeting

http://www.hhs.gov/advcomcfs/advcomcfs-cfsacmeeting.html

The Chronic Fatigue Syndrome Advisory Committee (CFSAC), 2012 spring meeting will be held on Wednesday, June 13, 2012 from 9:00 a.m. until 5:00 p.m. EST and Thursday, June 14, 2012 from 9:00 a.m. until 5:00 p.m. EST.

The meeting will be held at the U.S. Department of Health and Human Services, Hubert Humphrey Building, 200 Independence Avenue, S.W., Room 800, Washington, D.C. 20201. For directions please visit
http://www.hhs.gov/about/hhhmap.html .

The meeting will be webcast live and available by audio (listening-only). Additional information and the CFSAC agenda will be posted to the CFSAC website by June 4, 2012.

Update: May 24, 2012

Above notice now reads:

The meeting will provide a live video stream and be available by audio (listening only). Additional information and the CFSAC agenda will be posted to the CFSAC website by June 4, 2012. Instructions for public testimony will be provided at a later date in a Federal Register Notice. We are not accepting requests or testimony at this time.

 

Related material

Most recent CFSAC postings:

CFSAC November 8-9, 2011 meeting: Minutes and Recommendations to HHS posted (January 14, 2012)

CFSAC November 2011 meeting: videos, presentations and Day One Agenda item (December 27, 2011)

International Classification of Diseases – Clinical Modification (ICD-CM): Presentation by Donna Pickett, RHIA, MPH, National Center for Health Statistics (NCHS)

Reminder: Comment period on ICD-10-CM proposed delay ends May 17

Reminder: Comment period on ICD-10-CM proposed delay ends May 17

Post #159 Shortlink: http://wp.me/pKrrB-23H

On April 9, the US Department of Health and Human Services issued a proposed rule calling for a one year delay in the ICD-10-CM/PCS compliance deadline.

The proposed rule would postpone the compliance date by which providers and industry have to adopt ICD-10-CM by one year, from October 1, 2013 to October 1, 2014. 

The proposed rule was published in the Federal Register on April 17, followed by a 30 day period during which CMS will take comments.

Comments should be submitted to HHS no later than 5:00 pm ET on May 17, 2012.

 

Proposed Rule

The Proposed Rule documentation can be found on this page in PDF and HTML formats:

http://www.regulations.gov/#!documentDetail;D=CMS-2012-0043-0001

Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD-10-CM and ICD-10-PCS Medical Data Code Sets

Document ID: CMS-2012-0043-0001 Document Type: Proposed Rule
Docket ID: CMS-2012-0043 RIN:

More information on the proposed rule is available from this CMS fact sheet

HHS PROPOSES ONE-YEAR DELAY OF ICD-10 COMPLIANCE DATE (CMS-0040-P)

Submitting comment

Submitting comment by post:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–0040–P
P.O. Box 8013
Baltimore, MD 21244–8013

Submitting comment online:

Go to the Federal Regulations website, here:

http://www.regulations.gov/#!documentDetail;D=CMS-2012-0043-0001

Hit the Submit a Comment button, top right of web page

http://www.regulations.gov/#!submitComment;D=CMS-2012-0043-0001

For delivery by hand see the Alternate Ways to Comment pop up, top right of Submit a Comment page.

Related material

Press release: April 9, 2012

Summary Proposal Rule

This proposed rule would implement section 1104 of the Patient Protection and Affordable Care Act (hereinafter referred to as the Affordable Care Act) by establishing new requirements for administrative transactions that would improve the utility of the existing Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions and reduce administrative burden and costs. It proposes the adoption of the standard for a national unique health plan identifier (HPID) and requirements or provisions for the implementation of the HPID. This rule also proposes the adoption of a data element that will serve as an other entity identifier (OEID), an identifier for entities that are not health plans, health care providers, or “individuals,” that need to be identified in standard transactions. This proposed rule would also specify the circumstances under which an organization covered health care provider must require certain noncovered individual health care providers who are prescribers to obtain and disclose an NPI. Finally, this rule proposes to change the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, including the Official ICD-10-CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, from October 1, 2013 to October 1, 2014. 

New APA website launched; APA Annual Meeting DSM-5 Track; Open letter opposing DSM-5 paraphilias expansion

DSM-5 Round-up:

New APA website launched; APA Annual Meeting DSM-5 Track; DSM-5 on Essential Public Radio; Open letter opposing DSM-5 paraphilias expansion; Editorial Commentary: Challenges and potential of DSM-5 and ICD-11 revisions; Commentary from Christopher Lane, Ph.D.

Post #158 Shortlink: http://wp.me/pKrrB-232

New APA website launched

The American Psychiatric Association (APA) website at http://psych.org/ has been redesigned. 

According to a (no longer available) webpage on the old APA website, the APA site will relaunch soon as http://psychiatry.org/ (both URLs point to the domain).  

The APA’s DSM-5 Development site at http://dsm5.org/ has not been redesigned.

APA may be intending to update the design of the DSM-5 Development site to coincide with the release of the third draft of revisions to DSM-IV diagnostic criteria for public review and feedback.

 

APA Annual Meeting DSM-5 Track

The APA’s 2012 Annual Meeting takes place May 5-9.

Meeting Schedules and Guides can be downloaded from this page:

http://www.psychiatry.org/learn/2012-annual-meeting

This is the DSM-5 Track:

http://www.psych.org/learn/dsm-5-track-at-the-2012-apa-annual-meeting

DSM-5 Track at the 2012 APA Annual Meeting
Philadelphia, PA; May 5-9, 2012

DSM-5: Research and Development
Saturday, May 5, at 9-10:30 a.m. in Room 117 at the Pennsylvania Convention Center
Chair: David Kupfer, M.D.; Co-Chair: Darrel A. Regier, M.D., M.P.H
Presenters:
          1. Darrel A. Regier, M.D., M.P.H.
          2. Lawson Wulsin, M.D.
          3. David Goldberg, M.D.
          4. William E. Narrow, M.D., M.P.H.

Field Trial Testing of Proposed Revisions to DSM-5: Findings and Implications
Saturday, May 5, at 2-5 p.m. in Room 103B in the Pennsylvania Convention Center
Chair: David J. Kupfer, M.D. Co-Chair: Darrel A. Regier, M.D., M.P.H.
Presenters:
          1. Helena Kraemer, Ph.D.
          2. Diana E. Clarke, M.Sc., Ph.D.
          3. Darrel A. Regier, M.D., M.P.H.
          4. William E. Narrow, M.D., M.P.H.
          5. Eve Mościcki, Sc.D., M.P.H.

The Future of Psychiatric Diagnosis: Updates on Proposed Diagnostic Criteria for DSM-5 (Part I)
Sunday, May 6, at 8-11 a.m., in Room 103B at the Pennsylvania Convention Center
Chair: Darrel A. Regier, M.D., M.P.H. Co-Chair: David J. Kupfer, M.D.
Presenters:
          1. Sue Swedo, M.D.
          2. Daniel Pine, M.D.
          3. David Shaffer, M.D.
          4. Andrew Skodol, M.D.
          5. Ron Petersen, M.D., Ph.D.

The Future of Psychiatric Diagnosis: Updates on Proposed Diagnostic Criteria for DSM-5 (Part II)
Sunday, May 6, from 1-4 p.m., in Room 103B at the Pennsylvania Convention Center
Chair: David J. Kupfer, M.D.; Co-Chair: Darrel A. Regier, M.D., M.P.H.;
Presenters:
          1. Will Carpenter, M.D.
          2. Jan Fawcett, M.D.
          3. Trisha Suppes, M.D.
          4. Katharine Phillips, M.D.
          5. Matthew Freidman, M.D., Ph.D.

The Future of Psychiatric Diagnosis: Updates on Proposed Diagnostic Criteria for DSM-5 (Part III)
Monday, May 7, at 9 a.m. – 12 noon, in Room 103B at the Pennsylvania Convention Center
Chair: Darrel A. Regier, M.D., M.P.H. Co-Chair: David J. Kupfer, M.D.
Presenters:
          1. Joel Dimsdale, M.D.
          2. Tim Walsh, M.D.
          3. Charles Reynolds, M.D.
          4. Ken Zucker, Ph.D.
          5. Charles O’Brien, M.D., Ph.D.

The following is not officially included in the track but highly relevant to DSM-5 development and includes presentations from DSM-5 Work Group members.

Combat-Related PTSD: Injury or Disorder?
Monday, May 7, 2012; 9-10:30 a.m.Room 107-B, Level 1, Pennsylvania Convention Center
Chair: John M. Oldham, M.D.
Presenters:
          1. General Peter W. Chiarelli (U.S. Army, Ret)
          2. LGen the Hon. Roméo A. Dallaire, (Ret’d), Senator
          3. Robert Ursano, M.D.
          4. Matthew Friedman, M.D., Ph.D.

 

DSM-5 on Essential Public Radio

On April 10, Dr David Kupfer, who chairs the DSM-5 Task Force, and Dr Ellen Frank, DSM-5 Mood Disorders Work Group member, spoke by phone link to Paul Guggenheimer for 90.5 Essential Public Radio (Pittsburg):

http://ww:w.essentialpublicradio.org/story/2012-04-10/future-psychiatric-diagnosis-10739

The Future of Psychiatric Diagnosis

Essential Pittsburgh | April 10, 2012

The Diagnostic Statistical Manual known as the DSM, is the official classification book for mental disorders. It’s used for diagnosing and defining conditions such as autism, generalized anxiety and Alzheimer’s. The DSM is currently in the process of a major revision. Dr. David Kupfer, chair of the department of psychiatry at the University of Pittsburgh and chair of the DSM-V Task Force, the group developing the revision, talks about the upcoming changes. And Dr. Ellen Frank, taskforce member and professor of psychiatry and psychology at the University of Pittsburgh talks about the wide reaching influence of the DSM.

Listen on site

or download 15 minute duration broadcast here [10.6 MB mp3]:

http://c295317.r17.cf1.rackcdn.com/ESSPGHTUES4-10SEGB.mp3

Although Dr Kupfer spoke about the first and second stakeholder review and comment periods that had taken place in February 2010 and May 2011 and the number of responses received, no mention was made of APA’s intention to post a third draft for public review and feeback, this Spring.

Dr Kupfer gave no indication whether a firm date for this third and final review of revised categories and criteria has been fixed by the Board of Trustees/Task Force, following completion and assessment of the DSM-5 field trials.

The only timeframe given so far by the Task Force  for the posting of the third and final public review is “no later than May 2012.” (Source: APA Answers DSM-5 Critics, Deborah Brauser for Medscape Medical News, November 9, 2011)

 

Open letter to APA President John Oldham opposing DSM-5 paraphilias expansion

In the news:

Forensic psychology, criminology, and psychology-law

Karen Franklin, Ph.D. | April 10, 201

http://forensicpsychologist.blogspot.co.uk/2012/04/open-letter-opposing-dsm-5-paraphilias.html

Tuesday, April 10, 2012

Dr Franklin writes:

Open letter opposing DSM-5 paraphilias expansion

As readers of this blog are aware, proposals to expand the sexual disorders in the American Psychiatric Association’s upcoming DSM-5 have generated significant controversy among forensic psychologists and psychiatrists. Now, forensic psychologists are banding together to urge APA President John Oldham to reject the proposed diagnoses of pedohebephilia, paraphilic coercive disorder and hypersexual disorder. The text of an open letter drafted by Richard Wollert, an Oregon psychologist with extensive experience in sex offender treatment and evaluation, follows. If, after reading it, you would like to become a signator, just click on the indicated link, and provide Dr. Wollert with your name and professional credentials. Don’t delay, as I understand that this important letter is being submitted very soon.

CLICK HERE TO READ FULL OPEN LETTER and instructions for professonals who wish to add their name to Dr Richard Wollert’s letter

 

Editorial Commentary: Challenges and potential of DSM-5 and ICD-11 revisions

Journal of Child Psychology and Psychiatry, Editorial Commentary: Challenges and potential of DSM-5 and ICD-11 revisions

Issue

Journal of Child Psychology and Psychiatry
Volume 53, Issue 5, pages 449–453, May 2012

James F. Leckman¹,², Daniel S. Pine³

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2012.02548.x/full

       http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2012.02548.x/pdf

Article first published online: 4 APR 2012

DOI: 10.1111/j.1469-7610.2012.02548.x

© 2012 The Authors. Journal of Child Psychology and Psychiatry © 2012 Association for Child and Adolescent Mental Health

 

Commentary on “Editorial Commentary: Challenges and potential of DSM-5 and ICD-11 revisions” by Christopher Lane, Ph.D.

Is Psychiatric Accuracy a Challenge? Producing accurate psychiatric diagnoses

Christopher Lane, Ph.D. in Side Effects, Psychology Today | April 9, 2012

What’s new in the ICD-11 Alpha drafting platform? (CFS, PVFS, ME)

What’s new in the ICD-11 Alpha drafting platform? (CFS, PVFS, ME)

Post #157 Shortlink: http://wp.me/pKrrB-22h

 

Screenshot: ICD-11 Alpha Browser Foundation view selected, logged in at April 10, 2012:

Chapter 6: Diseases of the nervous system

http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%23G93.3

Apr 09 – 11:02 UTC

 

ICD-11 Beta drafting platform to launch in May?

As reported in previous posts, according to the timeline, the ICD-11 Beta drafting platform is supposed to be launching this May.

ICD-11 Revision Steering Group has yet to announce whether the Beta platform remains on target for a May release and if so, on what date it will be launched – so I cannot give you a date yet.

Like the Alpha Drafting Browser, the Beta drafting platform will be a work in progress – not a final Beta draft. The final Beta isn’t scheduled until 2014, after the ICD-11 field trials have been undertaken.

When it does launch, the Beta platform is intended to be accessible to professionals and the public for viewing.

Registered or logged in users will have greater access to content and will be able to interact with the platform to read comments, comment on proposals and make suggestions, as part of the ongoing drafting process.  

In the meantime, the publicly viewable version of the Alpha drafting platform (known as the ICD-11 Alpha Browser) can still be accessed here:

http://apps.who.int/classifications/icd11/browse/f/en

The various ICD-11 Revision Topic Advisory Groups are carrying out their draft preparation work on a separate, more complex multi-author drafting platform that is accessible only to WHO and ICD Revision personnel.

 

Alpha drafting platform

As before, the publicly viewable version of the Alpha Browser should be viewed with the following caveats in mind:

the Alpha draft is a work in progress; it is incomplete; it may contain errors and omissions; it is in a state of flux and updated daily; textual content, codes and “Sorting labels” are subject to change as chapters are reorganized and content populated; the content has not been approved by Topic Advisory Groups, Revision Steering Group or WHO.

It is possible to register, or sign into the platform using existing accounts with several third party account providers such as Google, Yahoo and myOpenID, for increased access and functionality. Once signed in, Comments and Questions can be read and PDFs of the drafts of the top level linearizations can be downloaded from the Linearization tab.

See the Alpha Browser User Guide for information on how the Alpha Browser functions:

http://apps.who.int/classifications/icd11/browse/Help/en

 

The ICD-11 “Content Model”

ICD-11 will be available in both print and online versions and unlike most chapters of ICD-10, will include descriptive content for ICD terms.

For the online version of ICD-11, all ICD entities will include a definition and a number of additional key descriptive fields – between 7 and 13 pre-defined parameters, populated according to a common “Content Model” (Content Model Reference Guide January 2011).

For example, ICD entity Title, Definition, Synonyms, Narrower Terms, Exclusions, Body Site, Body System, Signs and Symptoms, Causal Mechanisms, and possibly Diagnostic Criteria for some entities.*

*According to the iCAT User Google Group message board, these fields may have been revised since the January 2011 Content Model Reference Guide was published; Content Model parameters in the Beta draft may therefore differ from those currently displaying in the public Alpha drafting platform.

The print version will use a concise version of Definition due to space constraints.

In the Alpha Browser, not all these Content Model parameters display in the Foundation and Linearization views and not all of the parameters that have been listed for individual entities have had their draft text added yet, as some chapters are more advanced for the population of proposed content than others.

So the Alpha draft is still very patchy and many entities have no Definition and little or no other proposed content filled in.

With no “Category Discussion Notes” or “Change history” pop-up windows visible in the public version of the Alpha, the viewer cannot determine the rationales behind the reorganization of terms and hierarchies within the various chapters.

 

Chapter location and hierarchy for CFS, PVFS and (Benign) ME in ICD-11

I have been reporting since June 2010 that the proposals for ICD-11 Alpha Draft, as far as one could determine, appeared to be:

1] That a change of hierarchy had been recorded in a “Category Discussion Note”, dated May 1, 2010, between ICD-10 Title term “Postviral fatigue syndrome” and “Chronic fatigue syndrome”. (“Category Discussion Notes” and “Change History” pop-ups did display in the earlier iCAT version of the Alpha drafting platform.)

You can view a screenshot from June 2010 of that “Change history” record here:

http://dxrevisionwatch.files.wordpress.com/2010/06/change-history-gj92-cfs.png

The Definition field on the “Chronic fatigue syndrome” description panel in the current Alpha Browser is currently blank but in June 2010, the Definition had stood as in this contemporaneous screenshot:

http://dxrevisionwatch.files.wordpress.com/2010/05/2icatgj92cfsdef.png

2] That “Chronic fatigue syndrome” had been designated as an ICD-11 Title term within ICD-11 Chapter 6: Diseases of the nervous system, with the capacity for a Definition and up to 10 additional descriptive parameters.

3] That “Benign myalgic encephalomyelitis” had been specified as an Inclusion term to ICD-11 Title term “Chronic fatigue syndrome” but that the relationships between the three terms, PVFS, (B) ME and CFS had yet to be specified, as in this screenshot from June 2010:

http://dxrevisionwatch.files.wordpress.com/2010/05/2icatgj92cfsterms.png

 

What is currently showing in the Chapter 6 Foundation Component?

It isn’t possible to bring up a discrete ICD Title listing for either “Benign myalgic encephalomyelitis” or “Postviral fatigue syndrome” in either the Foundation Component or the Linearization.

In the Foundation view only, for Chapter 6: Diseases of the nervous system, “Chronic fatigue syndrome” is listed as a Title term with the ICD-10 legacy ID “ID:http://who.int/icd#G93.3″;

the Definition field is currently blank;

a list of terms has recently been added under “Synonyms”;

one term has recently been added under “Narrower Terms”.

(Note: there is a small asterisk at the end of term “Benign myalgic encephalomyelitis” which is listed at the top of the “Synonyms” list. The asterisk “Hover text” reads “This term is an inclusion term in the linearizations.”)

If you want to view the listing directly on the Browser site (note the “Comment” and “Questions” icons which open up pop-up windows next to terms for reading/commenting won’t display unless you have already registered and logged in) go here:

ICD-11 Alpha Browser Foundation view:

http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%23G93.3

ID:http://who.int/icd#G93.3

Chronic fatigue syndrome

Parent(s)

Selected cause is Remainder of diseases of the nervous system in Condensed and selected Infant and child mortality lists
Selected Cause is All other diseases in the Selected General mortality list
Selected cause is Diseases of the nervous system

Definition

This entity does not have a definition at the moment.

Synonyms

Benign myalgic encephalomyelitis *  [Ed: Hover text over asterisk reads: "This term is an inclusion term in the linearizations."]
akureyri
akureyri disease
cfs – chronic fatigue syndrome
chronic fatigue syndrome nos   [Ed: from current proposals for ICD-10-CM, Chapter 18, R53.82]
chronic fatigue, unspecified   [Ed: from current proposals for ICD-10-CM, Chapter 18, R53.82]
epidemic neuromyasthenia
iceland disease
icelandic disease
me – myalgic encephalomyelitis
myalgic encephalomyelitis
myalgic encephalomyelitis syndrome
postviral fatigue syndrome
pvfs – postviral fatigue syndrome

Narrower Terms

neuromyasthenia

Body Site

Entire brain (body structure)
Brain structure (body structure)

Causal Mechanisms

Virus (organism)

 

What’s new in Chapter 5: Mental and behavioural disorders?

As reported in Dx Revision Watch post: http://wp.me/pKrrB-1Vx,  the category “Somatoform Disorders” in Chapter 5, Mental and behavioural disorders is currently renamed to “BODILY DISTRESS DISORDERS”, under which currently sit three new child categories:

5M0 Mild bodily distress disorder
5M1 Moderate bodily distress disorder
5M2 Severe bodily distress disorder.

Chapter 5 Linearization view:

http://apps.who.int/classifications/icd11/browse/l-m/en#/http%3a%2f%2fwho.int%2ficd%23F45

Chapter 5 Foundation view:

http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%23F45

(Click on the little grey arrows to display the child categories):

Child categories to parent ”BODILY DISTRESS DISORDERS”:

http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%231905_dd0250d2_e8cd_4c48_a93f_7997cc1c8b07

BODILY DISTRESS DISORDERS

5M0 Mild bodily distress disorder
5M1 Moderate bodily distress disorder
5M2 Severe bodily distress disorder
5M3 Somatization disorder
5M4 Undifferentiated somatoform disorder
5M5 Somatoform autonomic dysfunction
5M6 Persistent somatoform pain disorder
      > 5M6.0 Persistent somatoform pain disorder
      > 5M6.1 Chronic pain disorder with somatic and psycological [sic] factors
5M7 Other somatoform disorders
5M8 Somatoform disorder, unspecified

None of these three new (proposed) categories have had any Definitions or other textual content added to the description panels on the right hand side of the Alpha Browser page since I first reported this change in February.

It is still not possible to determine what disorders ICD-11 intends might be captured by these three new (proposed) terms, should ICD-11 Revision Steering Group and WHO classification experts consider these terms to be valid constructs and approve their progression through to the Beta draft.

Because no “Change Notes” or “Change history” pop-up windows display in this version of the Alpha Drafting browser, it is not possible to determine:

whether ICD-11 is proposing to introduce three new terms – 5M0 Mild bodily distress disorder; 5M1 Moderate bodily distress disorder; 5M2 Severe bodily distress disorder, in addition to retaining existing ICD-10 terms, 5M3 thru 5M8;

how ICD Revision intends to define these (proposed) new terms at 5M0, 5M1, 5M2;

how these three (proposed) new terms would relate to the existing ICD-10 “Somatoform Disorders” categories which remain listed as child categories to “BODILY DISTRESS DISORDERS” (apart from “Hypochondriacal disorder” [ICD-10: F45.2], which is now listed as “5H0.5 Illness Anxiety Disorder” in the ICD-11 Alpha Draft).

(See Page 1 and 2 of my report: “Bodily Distress Disorders” to replace “Somatoform Disorders” for ICD-11?: http://wp.me/pKrrB-1Vx  )

 

References:

ICD-11 Revision: http://www.who.int/classifications/icd/revision/en/

ICD-11 Alpha Browser User Guide: http://www.who.int/classifications/icd/revision/caveat/en/index.html
Alpha Browser Foundation view: http://apps.who.int/classifications/icd11/browse/f/en#
Alpha Browser Linearization view: http://apps.who.int/classifications/icd11/browse/l-m/en#
“Bodily Distress Disorders” to replace “Somatoform Disorders” for ICD-11?: http://wp.me/pKrrB-1Vx

HHS proposes one year delay for ICD-10-CM compliance

HHS proposes one year delay for ICD-10-CM compliance

Post #156 Shortlink: http://wp.me/pKrrB-22q

Yesterday, April 9, the US Department of Health and Human Services issued a proposed rule calling for a one year delay in the ICD-10-CM/PCS compliance deadline.

According to a Centers for Medicare and Medicaid Services (CMS) press release, the proposed rule would postpone the compliance date by which providers and industry have to adopt ICD-10-CM by one year, from October 1, 2013 to October 1, 2014. 

Official publication of the proposed rule is expected to be published in the Federal Register on April 17, followed by a 30 day period during which CMS will take comments.

Full proposal document (pre-publication PDF version)

      http://www.ofr.gov/OFRUpload/OFRData/2012-08718_PI.pdf

or at:

https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-08718.pdf

This document is scheduled to be published in the
Federal Register on 04/17/2012 and available online at
http://federalregister.gov/a/2012-08718 , and on FDsys.gov

Press release issued April 9, 2012:

http://www.hhs.gov/news/press/2012pres/04/20120409a.html

Details for: NEW HEALTH CARE LAW PROVISIONS CUT RED TAPE, SAVE UP TO $4.6 BILLION

For Immediate Release: Monday, April 09, 2012
Contact: CMS Office of Public Affairs
202-690-6145

NEW HEALTH CARE LAW PROVISIONS CUT RED TAPE, SAVE UP TO $4.6 BILLION

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a proposed rule that would establish a unique health plan identifier under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed rule would implement several administrative simplification provisions of the Affordable Care Act.

The proposed changes would save health care providers and health plans up to $4.6 billion over the next ten years, according to estimates released by the HHS today. The estimates were included in a proposed rule that cuts red tape and simplifies administrative processes for doctors, hospitals and health insurance plans.

“The new health care law is cutting red tape, making our health care system more efficient and saving money,” Secretary Sebelius said. “These important simplifications will mean doctors can spend less time filling out forms and more time seeing patients.”

Currently, when health plans and entities like third party administrators bill providers, they are identified using a wide range of different identifiers that do not have a standard length or format. As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility.

The rule simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems. This will allow provider offices to automate and simplify their processes, particularly when processing bills and other transactions.

The proposed rule also delays required compliance by one year– from Oct. 1, 2013, to Oct. 1, 2014– for new codes used to classify diseases and health problems. These codes, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.

Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date. The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.

The proposed rule announced today is the third in a series of administrative simplification rules in the new health care law. HHS released the first in July of 2011 and the second in January of 2012, and plans to announce more in the coming months.

More information on the proposed rule is available on fact sheets at

http://www.cms.gov/apps/media/fact_sheets.asp

The proposed rule may be viewed at www.ofr.gov/inspection.aspx . Comments are due 30 days after publication in the Federal Register.

Media coverage:

MedPage Today

HHS Announces ICD-10 Delay

Joyce Frieden, News Editor, MedPage Today | April 09, 2012

 

ICD10 Watch

Breaking News: HHS proposes 1-year delay in ICD-10 implementation deadline

Carl Natale | April 09, 2012

 

Healthcare Finance News

HHS proposes one-year ICD-10 delay

Tom Sullivan, Government Health IT | April 10, 2012