Alert!: the American Psychiatric Association and CFS

[Guest guest]

The American Psychiatric Association is attempting the change the rules of the

road in regard to...gulp... diagnosis- the very issue that has bedeviled ME/CFS

for so many years. The APA is not attempting to change the diagnostic criteria

for CFS...it's doing something much subtler than that; it's attempting create a

new diagnostic category for psychiatric disorders called Complex Somatic Symptom

Disorder (CSSD). A close look at the title itself is enough to give one a few

shivers...

Its 'complex' - meaning that it's not clear - meaning that there's a lot of

wiggle room and we have experience what has happened with wiggle room in the

past. Somatic symptoms generally refers to symptoms that are

unexplained.....leaving us with a new category focused on 'complex disorders

characterized by many unexplained symptoms' (Ouch). There is no specific mention

of CFS in the definition of the category (altho IBS is mentioned) but one

wonders how CFS could NOT fit into here given the lack of clear explanation of

its causes and the many symptoms that accompany it.

This APA attempt to change the DSM-5 categories it uses to categorize disease

could create a hole, a kind of black hole, in which future researchers could

attempt to tumble CFS ( and other poorly explained disorders) into.

What can you do? Submit a request that the APA not create this new category. The

hour is late - just six days remain before the deadline for submissions is

reached (June 15th) but the path is clearly laid out and the job is not

difficult. You could emphasize that

(a) the highly subjective nature of the definition - which relies on unexplained

symptoms and 'concern' about them - is too broad and could easily lead to the

inclusion of what will ultimately to be found to be non-psychiatric disorders

into a psychiatric box -as has happened in the past.

( the definition is illogical in its assumption that 'excessive concern' after

six months of unexplained symptoms is indicative of a mental disorder. This is

particularly true in the case of chronic fatigue syndrome which is accompanied

by severe fatigue associated with reductions in work, play and social

interactions. It would be hard to understand why this set of circumstances in

any person would not cause substantial concern - yet the APA asserts that such

concern is enough to fit a person into its new category of mental disorders.

( the poor efficacy of the treatment interventions (CBT) cited in this

category suggests that the creation of the category runs the risk of balkanizing

research and treatment efforts in a field with reduced upside.

It should be noted that CBT is used both in psychiatric and non-psychiatric

disorders to equal effect. CBT's efficacy in CFS - a disorder whose symptoms

would, if interpreted in one manner, appear to meet many of the CSSD criteria -

is unclear with the large PACE and FINE trials providing negligible benefit and

a recent longterm study reporting negative results.

( Given the tendency of the psychiatric profession to mislabel disorders later

found to have physiological origins and the damage that has caused to progress

in the research arena (and to the patients themselves) we suggest that it is

simply not appropriate for the APA to create large categories that rely on

'unexplained symptoms'.

Good luck!