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WPI's DSM5 submission, 4/16/2010
April 16, 2010
DSM-5 Task Force
American Psychiatric Association
1000 Wilson Boulevard Suite 1825
Arlington, VA 22209
Members of the DSM-5 Task Force:
The Whittemore Peterson Institute would like to address the potential
revision of the American Psychiatric Association’s (APA)’s Diagnostic
and Statistical Manual for Mental Disorders (DSM-5). The APA’s
proposed changes would combine several existing somatic categories
into one larger category, Complex Somatic Symptom Disorder, adding
language that closely resembles the CDC’s criteria for Chronic Fatigue
Syndrome with additional sickness related behaviors that are often
evidenced by those who are ill with a disease when it is poorly
understood and characterized symptomatically.
The following language has been proposed:
To meet criteria for CSSD, criteria A, B, and C are necessary.
A. Somatic symptoms:
Multiple somatic symptoms that are distressing or one severe symptom
B. Misattributions, excessive concern or preoccupation with symptoms
and illness: At least two of the following are required to meet this
criterion:
- High level of health-related anxiety.
- Normal bodily symptoms are viewed as threatening and harmful
- A tendency to assume the worst about their health (catastrophizing).
- Belief in the medical seriousness of their symptoms despite evidence
to the contrary.
- Health concerns assume a central role in their lives
C. Chronicity: Although any one symptom may not be continuously
present, the state of being symptomatic is chronic and persistent (at
least six months).
Recent findings by researchers at the Whittemore Peterson Institute,
the Cleveland Clinic and the National Cancer Institute have found a
link between those who have been previously diagnosed with Chronic
Fatigue Syndrome, (ME/CFS) and a new human retrovirus, XMRV. Yet
ME/CFS is currently diagnosed symptomatically and requires the patient
experience 6 months of severe fatigue. This disease is chronic and often causes a great deal
of anxiety for those who suffer from its debilitating symptoms.
Therefore, an individual suffering from ME/CFS could be erroneously
classified within the new DSM-5 category as a somatic disorder when in
fact they clearly suffer from a chronic infectious disease process,
evidenced by many physical abnormalities. (Low grade fever, sore
throat, severe headache, cognitive dysfunction, and enlarged lymph
nodes, and painful joints and muscles).
The new language also adds undue concern about one’s health as
criteria for establishing the diagnosis of complex somatic disorder.
This is an immeasurable description of behavior that suggests that if
one is suffering from an unknown illness and expresses deep concern or
seeks answers from multiple sources (a potentially perfectly natural
response to such a circumstance) that one could then be classified as
having a somatic disorder. Yet, newly recognized diseases require time
to develop the appropriate conformational laboratory tests. During
that period of time, does it not remain the responsibility of
physicians to recognize the patient’s illness and reassure the patient
that they will do all they can to alleviate their suffering?
A person who is afflicted with Myalgic Encephalomyelitis/Chronic
Fatigue Syndrome is often incapable of taking care of their own most
basic needs. The swiftness with which one is incapacitated without
relief often results in accompanying depression and anxiety. If this
patient is advised not to believe their own symptoms of illness they
may become further traumatized by the
doctors whose sworn duty is to “first do no harm”.
The Whittemore Peterson Institute is deeply concerned that there will
be future complex biological diseases of unknown origin, which could
too easily be ignored as the result of the diagnosis of “complex
somatic disorders”. This would result in serious consequences for
those patients who continue to decline in health without appropriate
medical interventions.
The term CSSD may also serve as a diagnosis to be used by physicians
who currently lack the sophisticated diagnostic tools to describe a
new and emerging illness, causing serious harm to those who are ill.
Two such recent examples of diseases once categorized as somatic
illnesses are multiple sclerosis which was originally called,
“hysterical women’s disease” and gastrointestinal ulcers. Only after
these diseases were pursued by those who believed in their physical
causes with subsequent biological research, were medically effective
treatments made available. Thus creating a somatic diagnosis, when
there is in fact a physical illness, would relegate a population of
patients to many more years of suffering, while basic biological
research funding is denied.
For these reasons, the WPI requests that the APA thoughtfully examine
the purpose and possible unintended consequences for the encompassing
somatic category of illness, Complex Somatic Disorder, and
emphatically requests that the DSM-5 task force reject CSSD, as a
medical or psychiatric diagnosis.
Sincerely,
Annette Whittemore
Founder and CEO
Whittemore Peterson Institute
April 16, 2010
DSM-5 Task Force
American Psychiatric Association
1000 Wilson Boulevard Suite 1825
Arlington, VA 22209
Members of the DSM-5 Task Force:
The Whittemore Peterson Institute would like to address the potential
revision of the American Psychiatric Association’s (APA)’s Diagnostic
and Statistical Manual for Mental Disorders (DSM-5). The APA’s
proposed changes would combine several existing somatic categories
into one larger category, Complex Somatic Symptom Disorder, adding
language that closely resembles the CDC’s criteria for Chronic Fatigue
Syndrome with additional sickness related behaviors that are often
evidenced by those who are ill with a disease when it is poorly
understood and characterized symptomatically.
The following language has been proposed:
To meet criteria for CSSD, criteria A, B, and C are necessary.
A. Somatic symptoms:
Multiple somatic symptoms that are distressing or one severe symptom
B. Misattributions, excessive concern or preoccupation with symptoms
and illness: At least two of the following are required to meet this
criterion:
- High level of health-related anxiety.
- Normal bodily symptoms are viewed as threatening and harmful
- A tendency to assume the worst about their health (catastrophizing).
- Belief in the medical seriousness of their symptoms despite evidence
to the contrary.
- Health concerns assume a central role in their lives
C. Chronicity: Although any one symptom may not be continuously
present, the state of being symptomatic is chronic and persistent (at
least six months).
Recent findings by researchers at the Whittemore Peterson Institute,
the Cleveland Clinic and the National Cancer Institute have found a
link between those who have been previously diagnosed with Chronic
Fatigue Syndrome, (ME/CFS) and a new human retrovirus, XMRV. Yet
ME/CFS is currently diagnosed symptomatically and requires the patient
experience 6 months of severe fatigue. This disease is chronic and often causes a great deal
of anxiety for those who suffer from its debilitating symptoms.
Therefore, an individual suffering from ME/CFS could be erroneously
classified within the new DSM-5 category as a somatic disorder when in
fact they clearly suffer from a chronic infectious disease process,
evidenced by many physical abnormalities. (Low grade fever, sore
throat, severe headache, cognitive dysfunction, and enlarged lymph
nodes, and painful joints and muscles).
The new language also adds undue concern about one’s health as
criteria for establishing the diagnosis of complex somatic disorder.
This is an immeasurable description of behavior that suggests that if
one is suffering from an unknown illness and expresses deep concern or
seeks answers from multiple sources (a potentially perfectly natural
response to such a circumstance) that one could then be classified as
having a somatic disorder. Yet, newly recognized diseases require time
to develop the appropriate conformational laboratory tests. During
that period of time, does it not remain the responsibility of
physicians to recognize the patient’s illness and reassure the patient
that they will do all they can to alleviate their suffering?
A person who is afflicted with Myalgic Encephalomyelitis/Chronic
Fatigue Syndrome is often incapable of taking care of their own most
basic needs. The swiftness with which one is incapacitated without
relief often results in accompanying depression and anxiety. If this
patient is advised not to believe their own symptoms of illness they
may become further traumatized by the
doctors whose sworn duty is to “first do no harm”.
The Whittemore Peterson Institute is deeply concerned that there will
be future complex biological diseases of unknown origin, which could
too easily be ignored as the result of the diagnosis of “complex
somatic disorders”. This would result in serious consequences for
those patients who continue to decline in health without appropriate
medical interventions.
The term CSSD may also serve as a diagnosis to be used by physicians
who currently lack the sophisticated diagnostic tools to describe a
new and emerging illness, causing serious harm to those who are ill.
Two such recent examples of diseases once categorized as somatic
illnesses are multiple sclerosis which was originally called,
“hysterical women’s disease” and gastrointestinal ulcers. Only after
these diseases were pursued by those who believed in their physical
causes with subsequent biological research, were medically effective
treatments made available. Thus creating a somatic diagnosis, when
there is in fact a physical illness, would relegate a population of
patients to many more years of suffering, while basic biological
research funding is denied.
For these reasons, the WPI requests that the APA thoughtfully examine
the purpose and possible unintended consequences for the encompassing
somatic category of illness, Complex Somatic Disorder, and
emphatically requests that the DSM-5 task force reject CSSD, as a
medical or psychiatric diagnosis.
Sincerely,
Annette Whittemore
Founder and CEO
Whittemore Peterson Institute
TM