DSM-V and ME/CFS -Submission to APA

Compiled by Professor Malcolm Hooper and Margaret Williams for submission by The 25% ME Group
20th March 2010

Introduction

The 25% ME Group for the Severely Affected is a registered UK charity repre-senting people who are profoundly disabled by Myalgic Encephalomye-litis/Chronic Fatigue Syndrome (ME/CFS).

Myalgic Encephalomyelitis (ME) has been classified by the World Health Or-ganisation (WHO) as a neurological disorder since 1969. Currently it is listed in the International Classification of Diseases (ICD), chapter 6, under Disorders of Brain at ICD-10 G 93.3. In the 1992 revision of the ICD, the WHO approved the term “Chronic Fatigue Syndrome” (CFS) as a term by which ME may be known. The term CFS is coded only to ME at ICD-10 G93.3, hence the composite term “ME/CFS” is often used to denote the disorder. A synonymous term also sanc-tioned by the WHO is “postviral fatigue syndrome”.

This submission is a public record of the charity’s concern relating to the forth-coming revision of the American Psychiatric Association (APA)’s Diagnostic and Statistical Manual for Mental Disorders (DSM) and the intention to create a new diagnostic category of “Complex Somatic Symptom Disorder” (CSSD) which would combine existing categories of somatisation disorder, undifferentiated somatoform disorder, hypochondriasis and pain disorder (APA; Justification of Criteria – Somatic Symptoms, 1/29/10).

An influential group of American and European psychiatrists, including British psychiatrists Professors Michael Sharpe, Peter White and Simon Wessely (often referred to as the “Wessely School”: Hansard; Lords, 9th December 1998:1013), together with Francis Creed (since 1997, Professor of Psychological Medicine in the Psychiatry Research Group in the Manchester University School of Medicine; European Editor of the Journal of Psychosomatic Research and a member of the Medical Research Council Advisory Board) does not accept the WHO classifica-tion of ME/CFS as a neurological disorder but assert that it is a functional somatic syndrome (ie. a mental disorder).

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Dr Alan Gurwitt, a US psychiatrist who does not subscribe to the Wessely School beliefs about ME/CFS, has repeatedly expressed his dismay and frustration; for example on 23rd January 2003 he noted about these psy-chiatrists: “They often fail to distinguish between ‘chronic fatigue’ and ‘chronic fatigue syndrome’. The former is a fairly common symptom in medical clinics that does have a high linkage to already-present psychological problems. The latter is a specific medical condition. Their sloppiness has led to all kinds of trouble and misunderstandings‛ (http://www.masscfids.org/resource-library/3-research/162-on-the-morbid-fascination-with-psychiatric-morbidity).