I've now found the other notes and transcribed extracts from Dr Joel Dimsdale's presentation at the APA's Annual Conference 2012 that I was looking for earlier today:
Somatic Symptom Disorder Work Group Chair, Joel E. Dimsdale, MD, gave an update on the progress of the SSD group at the APA's Annual Conference in Philadelphia, earlier this month [May 2012].
For testing reliability of CSSD criteria, three groups were studied for the field trials:
488 healthy people; 205 people with cancer and malignancy (some patients in this group were said to have severe coronary disease) and 94 people with irritable bowel and "chronic widespread pain" (a term used synonymously with Fibromyalgia).
It isn't clear from the limited data currently available whether the third study group (labelled the
"functional somatic" study group on Dimsdale's slides) had included CFS or CF patients.
In a Co-Cure mailing of May 11 2012, I reported that at the end of his presentation, Dimsdale had been asked whether there would be any place for Chronic fatigue syndrome in the DSM-5 and what would be the criteria to include some [CFS patients] and exclude others.
In his brief response, Dimsdale says that chronic fatigue [sic] is
"almost a poster child for medically unexplained symptoms as a diagnosis" and that the [SSD work] group felt some patients with chronic fatigue [sic] would meet the criteria for CSSD. But he does not clarify whether CFS or CF patients had been included within the
"functional somatic" study group.
During this presentation and the Q & A session that followed, he does not draw attention to the results of the
"functional somatic" group, other than mention that this third study group comprised subjects with irritable bowel and chronic widespread pain, which isn't explicit from the labelling of his slide for the unpublished CSSD field trial study data.
It strikes me as somewhat odd that although the
"functional somatic" arm of the study was the group most captured by the criteria being tested and given that SSD Work Group member, Francis Creed, and his EACLPP MUS Study Group have been discussing whether a number of so-called "functional somatic syndromes" might be dragged kicking and screaming from out of their current ICD chapter locations and relocated into Chapter 5 of ICD-11, that Dimsdale spoke only about the
"cancer and malignancy" group results and not at all about the third arm.
(...)
At the end of Joel Dimsdale's [JD] presentation, he is asked by a member of the audience to clarify how patients with chronic medical conditions who devote time and energy to improving their symptoms and maintaining optimum levels of functioning would be assessed under these criteria and differentiated from patients perceived as spending "excessive time and energy devoted to symptoms or health concerns."
JD replies: "...The issue is, if you have a chronic medical condition will you automatically have a psychiatric disorder? There really are a number of ways of looking at that. Number One: from a data point of view [refers to PP slide] if you look for instance ...at the first of the columns in purple - those 200 people all have a malignancy or severe coronary disease and about 15% of them in fact do meet criteria with "one of the B type criteria." If you change the threshold to "two B type criteria," that's about 10%. I think that's accurate.
"I think in fact, a lot of patients I see are in dreadful mental condition and there are a lot of patients who have dreadful diseases and they might be depressed but they're able to get on with their lives, they're concerned, they want to survive to their daughter's wedding, whatever, and yes, I'm depressed..., but they wouldn't meet the criteria and I think that's the reality. Some do, some do, and the issue is that whether or not you've got a malignancy, if your life is dominated by the somatic concerns and you cannot put it down, this is a disorder where we can help. So that's the perspective..."
JD is then asked the question about CFS and DSM-5.
The first questioner later asks JD if he would further define Criteria B (3)
"Excessive time and energy devoted to these symptoms or health concerns" and expand on how the very wide range of DSM-5 using clinicians and practitioners in the field would differentiate B (3) criteria-meeting patients from patients with chronic health conditions who are using health care strategies to improve their symptoms and level of functioning; and whether these strategies might also be viewed negatively rather than as a positive response to the management of a chronic health condition.
JD: "...I think you're asking me a couple of different questions, let me parse them apart...we all have things that go wrong with us, we all have pains, problems with or without a diagnosis and they come and go and what we are talking about is really persistent...let me operationalize that in a couple of ways; we all have patients who have dreadful, dreadful disorders of one form or another and the issue is how much they let their lives be subsumed or dominated by it.
"So is this a person who is spending all of his or her life searching the internet looking for new data, are they able to go and still have some satisfaction, some involvement, some enjoyment with their spouse and family or is their life in a shadow, dominated, absorbed with those issues. That's what we're trying to get at and it's tricky...if you have some suggestions..."
The question raiser then expresses concern that practitioners who are not doctors or psychiatric practitioners might have some difficulty interpreting the wording of the criteria to differentiate between negative and positive coping strategies.
JD: "...we have struggled with this a lot and I wish I could say that this was gospel now...it's not. I think it is a step in the right direction.
"Also the issue is that the criteria aren't the same as the text. Criteria by definition are a succinct, condensation of what we try to portray in the text. The text will go on for five or six pages for this disorder group and we'll try to make it crystal clear. I take your point, I'll look at that section very carefully."
Session Chair, Darrel Regier, then steps in to expand on the differences between the DSM manual text and the criteria "check lists" and that clinical training and experience in the use of the manual text are needed in order to apply the criteria.
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As I've mentioned above, for the DSM-5's third draft, rather than revise in favour of less inclusive criteria, Dimsdale's SSD work group (which had included Profs Michael Sharpe and Francis Creed) lowered the threshold for a diagnosis of SSD, despite the considerable concerns expressed in the previous two stakeholder comment periods.
