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Susanna Argady comments on the DSM-5
Monday 20 June 2011
From Susanna Argady (via email):
COMMENTS ON DSM -5 SOMATIC SYMPTOM DISORDERS, CSSD
My submission to the DSM-5 Work Party,
As an individual who is severely affected by Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and one who observes events surrounding this condition I offer my comments on the proposed CSSD criteria.
The description of CSSD strongly reflects the spirit of the Wessely school in relation to ME/CFS and appears to be aimed at any medical condition which has not quite attained medical legitimacy in the eyes of many practitioners. Unfortunately, ME/CFS falls into this category and is being placed at risk by these criteria of being further entrenched in this position.
The proposed criteria rely on the prejudice of the practitioner for a diagnosis of CSSD and for the conclusion that the patient’s reaction to symptoms is unreasonable. The criteria are equivocal and pathologise patient beliefs and behaviours which are rational in their context and may serve the survival of patients. For example:
As the Work Party would be aware, diagnosis of SSD or CSSD can itself lead to further distress. This can happen firstly, because the diagnosis is inappropriate, replacing a biomedical one and can result in the patient being deprived of the opportunity to receive a more precise diagnosis and treatment. Secondly, its manner of application too often invalidates the patient. Thirdly, it carries stigma even in medical settings and is a short step from accusations of malingering which can lead to maltreatment.
It is difficult to see how expansion of the coverage of CSSD and using it as an add-on diagnosis would advance the welfare of patients. Why is the Working Party so enthusiastic to capture a wider range of conditions under the classification when there is no effective treatment for these conditions? On the other hand, patients sometimes improve, without psychiatric intervention. Their distress is alleviated too. In the meantime, of course, patients need proper support and need to avoid harmful treatment.
The proposed CSSD criteria are so wide and the report so imprecise that reading this document is not unlike trying to carry jelly in a string bag. The dedication to eliminating dualism seems to create only confusion. The description is unscientific and in circular fashion confirms its own assumption that there is no disease state involved. Diagnosing the symptoms listed as pathological would not make sense without this assumption. When a biomedical condition is present the use of such criteria pose a hazard to patients.
The criteria lend themselves to arbitrary and capricious use. There is already a history of these types of criteria being wrongly applied to ME/CFS and these misdiagnoses continue even in the face of the growing evidence of biomedical conditions. ME/CFS patients have already experienced the harm that such descriptions can do.
Who benefits from this proposal? Not the patients.
The CSSD proposal should be withdrawn.
Submissions and comments to the DSM-5:
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