Deadline: November 15

In what follows here, I am forced to dip my toe into a very complex process that involves a lot of details.  I  beg pardon for any confusions this may create.  My purpose is to invite readers to contribute objections to the oversight committee for the International Classification of Diseases, in its publication process for classification codes for fictitious psychosomatic disorders. icd10

There seems to be a general consensus here at the Global Summit for Diagnostic Alternatives, that the DSM-5 can appropriately be characterized as a “Little Shop of Horrors.”  In my own view, this may be particularly true of the category of diagnoses called “psychosomatic”, which I see as a frequent source of harms to chronic pain patients.  The so-called “Somatic Symptom Disorder” in the DSM-5 has greatly broadened and loosened previous DSM-IV criteria for applying mental health diagnoses to people who are upset and anxious about their medical symptoms  — whether or not they have a recognized medical problem. There is reason to be concerned that this diagnostic label may capture millions of people in the early stages of common medical problems like cardiac disease, Non-Hodgkins Lymphoma, Diabetes or Fibromyalgia. The diagnosis may kill some patients by getting them written off as head cases, denying them further medical investigation as their underlying diseases develop further.

Now the American Psychiatric Association seems to be trying to slip the same camel’s nose under a related tent — the International Classification of Diseases (ICD). During the September 18-19, 2013 meeting of the ICD-9-CM Coordination and Maintenance Committee, a proposal was submitted by an unspecified requester for the insertion of “Somatic symptom disorder” and “Illness anxiety disorder” into Chapter 5 of the forthcoming US specific ICD-10-CM.

The following extract edited from Suzy Chapman’s excellent “DxRevisionWatch” website expands on the nature of the APA proposal.

================Begin Extract
See page 45 of Diagnosis Agenda: Additional Tabular List Inclusion Terms for ICD-10-CM:

http://www.cdc.gov/nchs/data/icd9/icd9cm_proposals_91819.pdf

F45 Somatoform disorders
F45.1 Undifferentiated somatoform disorder

Add Somatic symptom disorder

F45.2 Hypochondriacal disorders
F45.21 Hypochondriasis

Add Illness anxiety disorder

These two DSM-5 categories did not form part of Dr Darrel Regier’s presentation on Day Two of the meeting, during which he presented a number of other proposals on behalf of APA, for insertion as inclusion terms to existing ICD-10-CM codes.

Illness anxiety disorder is already proposed to be added to the ICD-11 Beta draft, dual parented under “Obsessive-compulsive and related disorders” and “Bodily distress disorders, and psychological and behavioral factors associated with disorders or diseases classified elsewhere.”

Several of the new DSM-5 disorders presented by Dr Regier, on behalf of APA, which are proposed for addition to the ICD-10-CM are already proposed for inclusion in the ICD-11 Beta draft.

Binge eating disorder (BED;
Hoarding disorder;
Excoriation (skin picking) disorder;
Premenstrual dysphoric disorder (PMDD) [dual parents under Chapter 5 Mental and behavioral disorders and Chapter 15 Diseases of the genitourinary system].

[Note: ICD-11 permits categories to be assigned to more than one parent term.]
====================== End Extract.
An expanded discussion of Somatic Symptom Disorder and the ICD process can be found at http://wp.me/pKrrB-3vK

DxSummit participants include several professional practitioners in psychiatry and psychology.  If you believe as I do that somatoform and hypochondrial disorders deserve a far more open and publicly transparent discussion before they are confirmed as recognized disease classifications with billable treatment codes, then now is the time to write in protest and objection to their being slipped into the ICD “under the radar”.
The deadline for receipt of public comment and objections to any proposals contained within the ICD-9-CM C & M meeting Diagnosis Agenda is November 15. Comments by email to: Donna Pickett, CDC: nchsicd9CM@cdc.gov

Richard Lawhern

About Richard Lawhern

Richard A. Lawhern, Ph.D. is a technically trained medical layman who volunteers time and research in support of chronic face pain patients. His doctoral degree is in Engineering Systems (UCLA 1977) and much of his professional career was devoted to experimental design, technical writing and analysis of emerging technologies. He is a past webmaster and member of the Board of the US Trigeminal Neuralgia Association. He presently moderates and writes for "Living With TN", a patient mutual support website among the 35 online communities of "Ben's Friends". During 18 years at Internet social networking websites, Dr. Lawhern has interacted with and assisted over 4,000 chronic pain patients, family members and physicians.