Somatic Symptom Disorder – The DSM V debacle

Here are three articles chronicling the controversy around the new DSM V diagnosis of Somatic Symptom Disorder, which can label all people with undiagnosed illnesses as mentally ill.

Mislabeling Medical Illness As Mental Disorder | Psychology Today

by Allen Frances  12/8/12

Ms. Chapman writes, “…The DSM-5 Somatic Symptom Disorders Work Group is planning to eliminate several little used DSM-IV Somatoform Disorders and replace them instead with an extremely broad new category that is likely to be wildly overused (‘Somatic Symptom Disorder’ – SSD).

A person will meet the criteria for SSD by reporting just one bodily symptom that is distressing and/or disruptive to daily life and having just one of the following three reactions to it that persist for at least six months: 1) ‘disproportionate’ thoughts about the seriousness of their symptom(s); or 2) a high level of anxiety about their health; or, 3) devoting excessive time and energy to symptoms or health concerns.

Private health insurance companies must be taking great delight in this turn of events.  Using this diagnosis, they will be able to dispose of their most difficult and long-term cases of chronic illness and pain with a simple prescription for antidepressants.

“The DSM-5 Work Group is taking a flying leap into the unknown. There are no published research data on the likely prevalence rates, clinical characteristics or treatment of ‘Somatic Symptom Disorder,’ or its validity and safety as a construct.

Decisions to code or not to code will hang on the arbitrary and subjective perceptions of DSM end-users who often spend very little time with the patient and lack training in psychiatry.

To meet requirements for Somatization Disorder (300.81) in DSM-IV, a considerably more rigorous criteria set needed to be fulfilled.

“In DSM-5, the requirement of eight symptoms is dropped to just one. And the requirement of ‘medically unexplained’ symptoms is replaced by much looser and more subjective ‘excessive thoughts, behaviors and feelings’ and the clinician’s perception of “dysfunctional illness belief’ or ‘excessive preoccupation’ with the bodily symptom.

From http://www.psychologytoday.com/blog/dsm5-in-distress/201212/mislabeling-medical-illness-mental-disorder

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Bad News: DSM 5 Refuses to Correct Somatic Symptom Disorder | Psychology Today

by Allen Frances  1/16/13

the new DSM 5 diagnosis ‘Somatic Symptom Disorder.’SSD is defined so over inclusively by DSM 5 that it will mislabel 1 in 6 people with cancer and heart disease; 1 in 4 with irritable bowel and fibromyalgia; and 1 in 14 who are not even medically ill.

Its startling failure to correct this obvious and harmful mistake is breathtakingly wrongheaded and exceeds even my most pessimistic expectations about DSM 5’s lack of competence and credibility.

Suzy Chapman is not surprised. For three years, she has been engaged in a determined effort to educate professionals and the public about the problems in DSM 5 and has been doing her best to help correct them. Her website provides the most complete documentation of everything related to DSM 5 and ICD 11. (http://dxrevisionwatch.com/ )

Unfortunately, the DSM 5 invitation for comments from the field turned out to be no more than an empty public relations show.

shrugging off criticism from professionals and remaining completely unreceptive to advocacy organization and patient concern.

its cavalier treatment of the medically ill. The DSM 5 debacle is a sad moment in the history of psychiatry. Patients deserve better and so does the profession of psychiatry.

Psychiatric diagnosis has become too important in peoples’ lives to be left in the hands of one small and insulated professional organization. It is time for a change. Toni Bernhard has interesting thoughts on this…

From http://www.psychologytoday.com/blog/dsm5-in-distress/201301/bad-news-dsm-5-refuses-correct-somatic-symptom-disorder

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Your Physical Illness May Now Be Labeled a Mental Disorder | Psychology Today

by Toni Bernhard 1/17/13

…I described Somatic Symptom Disorder, a new mental illness that was being proposed for the new edition of the DSM. I wrote:

“People can be diagnosed with Somatic Symptom Disorder if, for at least six months, they’ve had one or more symptoms that are distressing and/or disruptive to their daily life, and if they have one [only one] of the following three reactions:

Criteria #1: disproportionate thoughts about the seriousness of their symptom(s);

Criteria #2: a high level of anxiety about their symptoms or health; or

Criteria #3: devoting excessive time and energy to their symptoms or health concerns.

Despite the vehement opposition of many in the health care field—including many therapists—the American Psychiatric Association (who publishes the DSM) has included Somatic Symptom Disorder in the its fifth edition—DSM-5

UPDATE, May 4, 2013: Two weeks before the DSM-5 is due to appear, the National Institute of Mental Health (NIMH), the world’s largest mental health research institute, has announced that it is withdrawing support for the DSM. According to a news release from Thomas R. Insel, M.D., Director of the NIMH, the institute will no longer fund research that relies exclusively on DSM criteria.

I certainly hope this renders the SSD diagnosis unusable in this country, since the NIMH should be the final arbitrator on how diagnoses are categorized for Medicare reimbursement.

From http://www.psychologytoday.com/blog/turning-straw-gold/201301/your-physical-illness-may-now-be-labeled-mental-disorder

4 thoughts on “Somatic Symptom Disorder – The DSM V debacle

  1. admindxrw

    Thanks for highlighting the concerns around DSM-5’s new disorder, SSD, which in the now published DSM-5, has been cross-walked to ICD-9-CM code 300.82 (ICD-10-CM F45.1).

    In September, a proposal was included in the Diagnosis Agenda for the fall meeting of the NCHS/CMS ICD-9-CM Coordination and Management Committee to insert Somatic Symptom Disorder as an inclusion term into the forthcoming ICD-10-CM.

    ICD-10-CM has been adapted by NCHS from the WHO’s ICD-10 and will replace ICD-9-CM as the U.S.’s official mandated code set, following implementation on October 1, 2014. It is the ICD codes or equivalent codes that are required for billing, records and reimbursement.

    See: http://dxrevisionwatch.com/2013/11/01/keep-ssd-out-of-icd-10-cm-november-15-deadline-for-objections/

    and the earlier report: http://wp.me/pKrrB-3tq

    If NCHS rubber stamps the addition of Somatic Symptom Disorder as an official codable diagnostic term within ICD-10-CM, it could leverage the future replacement of several existing ICD-10-CM Somatoform disorders categories with this new, poorly validated, single diagnostic construct, bringing ICD-10-CM in line with DSM-5.

    Suzy Chapman, Dx Revision Watch

    Reply
  2. admindxrw

    Yes, please do. Some key posts are:

    APA petitions CMS for additions to ICD-10-CM: Deadline for public comment and objections November 15: http://wp.me/pKrrB-3tq

    Videos and meeting materials: September 18–19 ICD-9-CM Coordination and Maintenance Committee meeting: http://wp.me/pKrrB-3tV

    Keep SSD out of ICD-10-CM – November 15 deadline for objections: http://wp.me/pKrrB-3vK

    Key document (SSD inclusion proposal on PDF Page 45):

    (Diagnosis Agenda) Proposals document [PDF - 342 KB]: http://www.cdc.gov/nchs/data/icd/icd_topic_packet_sept_181913.pdf

    Suzy

    Reply
  3. Pingback: “Somatic Symptom Disorder” to replace more specific ICD billing codes | EDS Info (Ehlers-Danlos Syndrome)

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