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ME Association submission to the DSM-5

Friday 17 June 2011

From the UK's ME Association:


WritingME Association submission to the consultation on the revision of the American Diagnostic and Statistical Manual of Mental Disorders

By tonybritton on June 13, 2011

The ME Association has submitted the following comments to the consultation on the proposed, new American Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the “DSM-5”. Our contribution was officially acknowledged on Sunday (June 12) at 10.52am.

The ME Association is a UK based medical charity that provides information and support for people with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome).

The concerns we express below refer to the proposal to create a new and wide-ranging psychiatric category – Complex Somatic Symptom Disorder (CSSD) – in the next edition of the American Diagnostic and Statistical Manual of Mental Disorders (ie DSM V) and the widespread belief that people with ME and CFS may become included in this new medical terminology.

ME is recognised by the World Health Organisation (in section G93:3 of ICD 10) and by the UK Department of Health as a complex neurological disorder – a fact that is now supported by numerous published research studies.

CFS, which includes a wider group of clinical presentations, is indexed to the WHO neurological classification.

It is not therefore appropriate to use the proposed terminology of CSSD – either by intention or mistake – to describe or classify people with ME or CFS as having somatic presentations of mental health disorders in any other system of disease classification or explanation such as the DSM.

This proposal itself has a number of major flaws, including:

  • A very limited and partial scientific rationale with too much reliance on subjective judgements.
  • An implied acceptance that diagnoses are always correct.
  • An assumption that all that is important in psychological medicine is already known and what remains uncertain can be summarised in one new clinical entity.

Psychological Medicine already attracts a lot of negative criticism and this proposal will only make matters worse.

The APA therefore needs to reflect on its full responsibilities when reviewing a subject area as complex and uncertain as this.

We therefore suggest that you drop CSSD and instead refer to ‘chronic distress that may be related to psychological or physical events or a combination’. This is a term that should lead to empathetic, focused management.


The above originally appeared here.

Submissions and comments to the DSM-5:

www 13 June 2011:  Open letter: Submission about the creation of a new category
www 15 June 2011:  Mary Schweitzer letter to APA on CSSD proposal for DSM-5
www 16 June 2011:  Fred Friedberg's comments to the DSM-5 Work Group on Somatic Symptom Disorders
www 17 June 2011:  ME Association submission to the DSM-5
www 18 June 2011:  European ME Alliance submission to DSM-5 draft proposals
www 19 June 2011:  Comment by Dr John L Whiting to the DSM-5
www 20 June 2011:  Susanna Argady comments on the DSM-5
www 21 June 2011:  DSM-5 web site period for comments extended



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