The American Psychiatric Association (APA) is proposing an addition to their DSM codes that could potentially allow patients with difficult-to-diagnosis conditions – like fibromyalgia, ME/CFS (aka chronic fatigue syndrome), Gulf War Syndrome, and other chronic pain conditions – to be diagnosed as  having a psychiatric disorder.  Their deadline for accepting comments on this proposal is tomorrow, June 15, so we have to act fast if we are to have any hope of preventing this new diagnosis. 

The Diagnostic and Statistical Manual of Mental Disorders is a list of codes, referred to as DSM codes, which identify each distinct diagnosis used by psychiatrists and other mental health professionals.  The last major revision to the DSM codes was the fourth edition (DSM-IV) published in 1994.  The APA is currently working on the fifth edition (DSM-V), which is supposed to be published in May 2013. 

One of the revisions the APA is planning for DSM-V is the addition of a new diagnostic code called “Complex Somatic Symptom Disorder (CSSD).”  Somatic symptoms refer to symptoms for which there is no organic explanation. 

As you will see from the APA's description of CSSD below, anyone who is concerned because they have been experiencing chronic pain for six months or more and their doctor can't figure out what is causing their pain could be diagnosed with CSSD and forever labled as having a psychiatric disorder.  Personally, I can't imagine how someone who has had unexplained pain for six months would not be concerned. 

Complex Somatic Symptom Disorder Diagnostic Criteria

Following is the description of Complex Somatic Symptom Disorder proposed for DSM-V:

“This disorder is characterized by a combination of distressing (often multiple)
symptoms and an excessive or maladaptive response to these symptoms or associated health concerns.  The patient‟s suffering is authentic, whether or not it is medically explained. Patients typically experience distress and a high level of functional impairment. The symptoms may or may not accompany diagnosed general medical disorders or psychiatric disorders. There may be a high level of medical care utilization, which rarely alleviates the patient‟s concerns. From the clinician‟s point of view, many of these patients seem unresponsive to therapies, and new interventions or therapies may only exacerbate the presenting symptoms or lead to new side effects and complications. Some patients feel that
their medical assessment and treatment have been inadequate. 

“Patients with this diagnosis typically have multiple, current, somatic symptoms that are distressing; sometimes, they may have only one severe symptom.  The symptoms may or may not be associated with a known medical condition. Symptoms may be specific (such as localized pain) or relatively non-specific (e.g. fatigue). The symptoms sometimes represent normal bodily sensations (e.g., orthostatic dizziness), or discomfort that does not generally signify serious disease (e.g., bad taste in one's mouth). Health-related quality of life is