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Wednesday 27 March 2013
DSM-5 : British Medical Journal Press Release - Refers to Professor Allen Frances - Courtesy of BMJ website - ALLEN FRANCES IS A MEMBER OF THE INTERNATIONAL RESPONSE COMMITTEE TO DSM-5 SEE BLOG BELOW..
disorder could classify millions of people as mentally ill
Monday, March 18, 2013
condition that may lead to “inappropriate medical decision making” warns expert
View: The new somatic symptom disorder in DSM-5 risks mislabelling many people
as mentally ill
of people could be mislabelled as mentally ill when psychiatry's bible of
diagnoses is updated in May, warns a senior doctor in this week’s BMJ.
next edition of the American Psychiatric Association’s Diagnostic and
Statistical Manual of Mental Disorders (DSM-5) – used around the world to
classify mental disorders - will include a new category of somatic symptom
Allen Frances, Chair of the current (DSM-IV) task force warns that the DSM-5
definition of somatic symptom disorder “may result in inappropriate diagnoses
of mental disorder and inappropriate medical decision making.”
new category will extend the scope of mental disorder classification by
eliminating the requirement that somatic symptoms must be “medically unexplained”
he explains. In DSM-5, the focus shifts to “excessive” responses to
distressing, chronic, somatic symptoms with associated “dysfunctional thoughts,
feelings, or behaviours.”
concern is supported by the results of the DSM-5 field trial study. Somatic
symptom disorder captured 15% of patients with cancer or heart disease and 26%
with irritable bowel syndrome or fibromyalgia, and had a very high
false-positive rate of 7% among health people in the general population.
points out that, previous DSM criteria “have always included reminders to
clinicians to rule out other explanations before concluding that any mental
disorder is present. But his suggestions to the DSM-5 work group that similar
reminders should be included this time were rejected.
diagnostic decision is a delicate balancing act between definitions that will
result in too much versus too little diagnosis - the DSM-5 work group “chose a
remarkably sensitive definition that is also remarkably non-specific,” warns
he argues “reflected a consistent bias throughout DSM-5 to expand the
boundaries of psychiatric diagnosis with what I believe was insufficient
attention to the risks of the ensuing false positive mislabeling.”
DSM-5 diagnosis of somatic symptom disorder is based on subjective and
difficult to measure cognitions that will enable a “bolt-on” diagnosis of
mental disorder to be applied to all medical conditions, irrespective of
cause,” he adds.
are best advised to ignore this new category. When a psychiatric diagnosis is
needed for someone who is overly worried about medical problems the more benign
and accurate diagnosis is adjustment disorder.”