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Nederlog
Jun 15, 2011           

me+ME: Submission to the DSM-5 Task Force of the APA
 

This is what the title says, and for the purpose of this Nederlog and submitting it to the APA has been split up into several tables as follows:

1.  Title: ON 'THE RATIONALE' BY THE DSM-5 FOR THE CSSD AND SSSD-DIAGNOSIS
2.  Introduction by Maarten Maartensz
3.  Revealing pictures of the real subject
4.  On the formatting of this text
 
5. "Justification of Criteria-Somatic Symptoms" - APA/DSM-5 text with comments
6. References to literature by APA/DSM-5
7. Refence list to items on maartensz.org
8. Copyright of this text  



P.S.
Corrections, if any are necessary, have to be made later, and at the moment of publishing this in Nederlog the hurdle of submitting it on the APA's
DSM-5 site
- "DSM-5: The Future of Psychiatric Diagnosis", it is claimed there - still has to be taken. (It seems likely they have arranged things so as to loose
most or all of one's formatting, links and images, it is to be feared, but I'll
do the best I can, if necessary submitting it as ASCII.)


                         Maarten Maartensz (M.A. psy, B.A. phi)
        home - index - top - mail

 


    ON 'THE RATIONALE' BY THE DSM-5 FOR THE CSSD AND SSSD-DIAGNOSIS
                                           by drs. Maarten Maartensz
                                           psychologist and philosopher of science
 

 


Introduction:

I have ME/CFS since January 1, 1979, and have not been able to get the help
other ill people are legally entitled too, and that  mostly because the received medical
wisdom is and has been that "medically unexplained diseases" are a sufficient ground for
average MDs to infer that "therefore" the disease does not exist, and whatever
suffering the patient has must be produced by the patient's own deluded thinking.

I fell ill in the first year of my university studies, but succeeded nevertheless,
but with intermissions and after a long time, to obtain the best possible M.A.
in the science of psychology - which I am very sorry to say, as a philosopher
of science, is not real science, but mostly what the great physicist Richard Feynman
called 'Cargo Cult Science'
:

The same, but more so, is true of modern psychiatry - as I found out, starting late
in 2009, when I dived into the topic of ME/CFS, having a diagnosis of "ME/FM" since
1989 by several medical specialists, while being denied help by health bureaucrats,
on the ground that my disease "must be psychiatric", because that saves money,
saves efforts on the part of medical doctors, and is the cheapest for insurance companies.

What follows is my criticism of the so called "Rationale" of the DSM-5 Work Group,
incidentally so incompetent that they don't even seem to know that the "DSM-V" is not the right Trade Marked Term for their dangerous nonsense. (Fehlleistung?)

It will be on my website in the section Nederlog:

It will also be submitted to the APA, if I succeed in passing the hurdles, and if
the socalled WYSIWYG editor supplied doesn't mangle my html-text, may even
be read by the DSM-5 editors.

However, I do not expect it will make a difference, and my message to persons who
are not psychiatrists or clinical psychologists or psychotherapists is

  • that the DSM-5 is fraudulent pseudoscience;
  • that the APA should be removed from medical science as afraudulent organization
    engaging knowingly and for money in pseudoscience; and
  • that the DSM-5 should be considered, by anyone who really knows what real science is
    like, and by anyone who is interested in help ill people honestly and rationally,
    as very  dangerous totally non-scientific nonsense that courts, lawyers, and
    health-bureaucrats cannot morally trust or rely on to make fair decisions; and that
  • that the DSM-5 has been carefully crafted by fraudulent pseudo-scientists to make
    refuting psychiatric pseudoscience on objective statistical empirical grounds totally
    impossible by the trickery of making all diagnosing involve wholly subjective qualifying
    (as in "overly concerned with one's health", "too much pre-occupied with one's
    health" etc. etc.: They call it "multi-dimensional) and anyway is an
    exercise in pseudo-scientific labelling on grounds  that are nowhere given clearly,
    and always in terms unqualified vague terms (as in "Research suggests there may be
    potential evidence" - that makes the nonsense of the APA look like real science, because psychiatrists have their own medical journals in which anything goes, as long as some
    psychiatrist wrote it, taking care to speak obscurely but impressively, and with mock
    reference to "peer reviewed" nonsense by psychiatric bullshitters)

As to the strictly fair, strictly empirical and honest term "bullshit", see professor Frankfurts fine scholarly contribution "On Bullshit", Princeton University Press, 2005 also reviewed by me in The gentle art of bullshitting the public for money:

"One of the most salient features of our culture is that there is so much bullshit. Everyone knows this. Each of us contributes his share. But we tend to take the situation for granted. Most people are rather confident of their ability to recognize bullshit and to avoid being taken in by it. So the phenomenon has not aroused much deliberate concern. We have no clear understanding of what bullshit is, why there is so much of it, or what functions it serves. And we lack a conscientiously developed appreciation of what it means to us. In other words, as Harry Frankfurt writes, "we have no theory."

Frankfurt, one of the world's most influential moral philosophers, attempts to build such a theory here. With his characteristic combination of philosophical acuity, psychological insight, and wry humor, Frankfurt proceeds by exploring how bullshit and the related concept of humbug are distinct from lying. He argues that bullshitters misrepresent themselves to their audience not as liars do, that is, by deliberately making false claims about what is true. In fact, bullshit need not be untrue at all.

Rather, bullshitters seek to convey a certain impression of themselves without being concerned about whether anything at all is true. They quietly change the rules governing their end of the conversation so that claims about truth and falsity are irrelevant. Frankfurt concludes that although bullshit can take many innocent forms, excessive indulgence in it can eventually undermine the practitioner's capacity to tell the truth in a way that lying does not. Liars at least acknowledge that it matters what is true. By virtue of this, Frankfurt writes, bullshit is a greater enemy of the truth than lies are."
    (From the website for
"On Bullshit")

In brief, for me the DSM-5 is a dishonest, irrational bid for power by the APA. It should
be rejected as immoral, irrational, dishonest, unreliable and fake, and is a sufficient reason
to remove psychiatry from science, and replace psychiatrists by neurologists, neuroscientists
or medical doctors who do have a real grasp of real science and who do have a moral medical
attitude to ill people and to human rights.

The following is my take - a 61-year old psychologist and philosopher of science, ill without
help for the 33rd year, mostly because psychiatrists have intentionally poisoned the source
of real and moral medical science, and insistes that whatever medical science currently
cannot medically explain "therefore" must be "psychosomatic", "somatizing", "somatic
disorder", "between the ears", "dysfunctional belief systems", "thinking themselves ill"
and other total nonsense without any empirical validation or justification, but eminently
fit to keep psychiatrists in paid work, at the cost of patients' real interests and human
rights, and to save commercial insurance companies a lot of money: Rather than try to
help ill people, they abuse the APA's pseudoscience to classify them as mentally ill, and
therefore without right on medicines, research, or help, except by the frauds that
are sanctioned by the APA, thus saving the insurance money on real medical scientific
research and work.

It is immoral, dishonest, and pseudoscience - but it has a clear rational sufficient
explanation: This is pseudoscience for money.

Because I happened to read Freud and psychiatric texts first when I was 17 and already
then was considerably upset by the evident irrationality and clearly fraudulent claims of
much of the "science" of psychiatry, I have taken the freedom to refer to Freud as Fraud,
since that is what Freud and the DSM-5 are about: Pseudoscience for money for psychiatrists.

There is a long list of references to material on my site with links at the end.

I am quite willing and able to defend my opinions in court, and I think psychiatry and
the DSM-5 should be terminated as impostures and pseudoscience, that also has been
carefully and intentionally crafted as pseudoscience by the editors of the DSM-5.

Maarten Maartensz
   M.A. psychology
   B.A. philosophy
   Ill in the Dutch dole without help due to medical malpractice since 1984.

 

---


    A picture or two clarifies more than thousands of words:

 


 

 

 

 

 

 

 

APALogic
           (APALogic - both borrowed from The Niceguidelines.blog)

---


The "Rationale" for the DSM-5 (thus called by the APA) aka
"Justification of Criteria-Somatic Symptoms aka"
"DSM Validity Propositions 4-18-11.pdf"

The format of what follows is this:

 

 

© 2010 American Psychiatric Association. All Rights Reserved.
See Terms & Conditions of Use for more information

Justification of Criteria-Somatic Symptoms
DRAFT 4/18/11


#########

Synopsis:
 

Because the current terminology for somatoform disorders is confusing and because Somatoform Disorders, Psychological Factors Affecting Medical Condition (PFAMC), and Factitious Disorders all involve presentation of physical symptoms and/or concern about medical illness, the workgroup suggests renaming this group of disorders as "Somatic Symptom Disorders." Because of the implicit mind-body dualism and the unreliability of assessments of "medically unexplained symptoms," these symptoms are no longer emphasized as core features of many of these disorders. Because somatization disorder, hypochondriasis, undifferentiated somatoform disorder, and pain disorder share certain common features, namely somatic symptoms and cognitive distortions, these disorders are grouped under a common rubric of  "Complex Somatic Symptom Disorder."

#########

Introduction and Rationale:

      The Somatic Symptoms group was charged with viewing those DSM diagnoses where somatic issues predominate. While somatic symptoms are present in virtually every psychiatric diagnosis, they are clearest in the various somatoform disorders and in psychological factors affecting medical condition (PFAMC).

"somatic issues': meaning?
"While somatic symptoms are present in virtually every psychiatric diagnosis": Really now? Meaning what?
"virtually"?
"clearest": In what sense?
"psychological factors affecting medical condition (PFAMC)": Never heard of it - seems handy to bandy about, but clearly is a very vague omnium gatherum.

So far, not even the beginning of a remotely clear terminology.

      Contemporary criteria for somatoform disorders give heavy emphasis to the concept of "medically unexplained symptoms."

Because that is the medically honest and rational thing to do and say and admit: "We do not know", "We cannot explain this", "Science has not advanced far enough", "We can only guess", "We only have palliative treatments, alas".

That is honest rational medical science.
The APA will have none of it:

Such terminology enforces a dualism between psychiatric and medical conditions.

Postmodernistic bullshit:  It is not a matter of terminology:  It is a matter of solid medical fact  if and when one does not have the requisite factual medical knowledge to  explain something  on the basis of present medical science.

It bases a diagnosis on a negative–the absence of something, and, as such, runs the risk of misdiagnosis (Kroenke et al, 2007).

Bullshit. "As such", it does no such thing, and "as such" persons who passed medical school are "as such" supposed to be capable to deal with "a negative–the absence of something", even if it is just the absence of logic in APA's DSM-5 reasonings, "as such".

With such criteria, these disorders are very common, particularly in primary care settings where they are present in 1 out of 6 consultations (Fink, 1999).

So to reduce this to sense: In 1 out of 6 cases some medical doctor  making a diagnosis admits that he or she cannot explain something by present medical science.

These persons admit - honestly and truly, what's more - they are not omniscient.

The APA doesn't like it, and believes, or rather: pretends, it knows better:

High levels of presenting somatic symptoms that are below the diagnostic threshold of somatization disorder are quite common and disabling in primary care and medical settings and tend to be associated with both depression and anxiety disorders (Bridges and Goldberg 1985; Barsky et al 1999; Kirmayer and Robbins 1992; Escobar et al, 1998; Gureje et al, 1999).

Really now?!

Perhaps unwittingly, you are here invited, reader, to partake in a trope - a meme, if you like - pseudoscientists are fond of, and call 'evidence based science' (surely a pleonasm, but those who engage in 'evidence based science' generally are - indeed - not engaged with real science).

What is being said, is thoroughly unclear: Much is innuenco, bombast, grandiloquence, posturing, pretense, or doubletalk: "High levels", without standards; "somatic symptoms", without definition, "diagnostic treshold", without standards or metric; "somatization disorder": word magic, as the great Fraud did it; "quite common", without scale; "disabling", without saying what precisely; "tend to be": what can not be said to somehow "tend to be" something?!

APALogic!

Similarly, psychological factors which complicate underlying medical disorders constitute the essence of PFAMC and are also very common in medical settings (Levenson 2008; Dimatteo 2004).

Just as Fraud did it: Surreptitiously introduce a medicalese neologism; then suggest without real evidence or clear definition it exists and is important; then introduce an abbreviation that looks impressive; and thus APA science is done.

And what does it amount to here? "psychological factors which complicate underlying medical disorders constitute the essence" of "Psychological Factors Affecting Medical Condition (PFAMC)".

Really now? How does the APA know? They make it up.
 

-2-


      Despite their prominence in primary care settings, these diagnostic codes are rarely used.

The APApersons are already talking vaguely grandiose. and here get into semblance of contradiction: How do they know, then? Isn't this psychiatric seeing of "prominence" in spite of being "rarely used" strongly reminiscent of a Reverend Catholic Father that sees the Lord everywhere he does not see the devil at work?

In 2008, among 28 million Wellpoint/Anthem Blue Cross Blue Shield members, only 0.04% of the members had a clinical encounter for which the primary diagnosis was any of the somatoform disorders or PFAMC.

Bless non-psychiatric medical scientists! For such diagnoses are vague nonsense, and indicate a disordered dysfunctional medical mind, that indeed may be an occupational risk for psychiatrists, that are in fact not known to be the most scientific or the most intelligent of medical men (sans prejudice).

 Similarly, among patients within the Veterans Administration during the years 2002-2008, only 0.18% of inpatient encounters and 0.25% of outpatient encounters had as a primary diagnosis any of the somatoform disorders or PFAMC (Levenson, unpublished).

Well done, even if unpublished.

With the possible exception of pain disorders, these disorders are
uncommonly encountered in psychiatric practice.

Really now? Then whence the large amounts of pretended psychiatric knowledge of what they call "somatoform disorders" - but are, in fact, it emerged, medically unexplained conditions, that psychiatrists would like to make some money from, by inventing disorders that fall nominally under psychiatry.

There is considerable confusion about the criteria for the disorders and the terms themselves are intensely disliked by patients.

Apart from patients' dislikes: The "criteria for the disorders" in fact are very unclear, and it seems either intentionally so or those designing them are totally lacking in cognitive clarity and logical ability.

A 2009 survey of physicians revealed that somatoform NOS was regarded as unclear by 45%, not particularly useful by 51%, and was regarded as a useful diagnosis by only 6% of patients (Dimsdale, Sharma, & Sharpe, unpublished).

More unpublished "work" from a number of psychiatric worthies who are smart and moral enough, in my estimation, to have made it all up.

      Place of prominence in the group of somatoform disorders is given to somatization disorder, which is relatively rare, using the existing criteria (Escobar et al, 1987).

This relates to - unclarified - terminology perhaps even from  pre-DSM-IV days, as used. But lets hold on to the idea that there was research into the incidence of somatization disorder, as then defined, that found it "relatively rare".

In a systematic review of somatization disorder in population-based samples (10 studies) the median prevalence was 0.4% (range 0.03% to 0.84%) (Creed, Barsky J Psychosom Res 2004).

It is  likely - p  0.01  - that this is a pretense of mathematical exactitude that is neither based on real facts nor on precise measurements, but that is just in passing, and very often the case in psychological and psychiatric literature. (See: Feynman)

As a result, the majority of patients with somatoform disorders are given a residual category diagnosis (undifferentiated somatoform disorder, or somatoform disorder NOS) (Kumabara et al 2007). There have been very few population studies of DSM-IV somatization disorder, but the most recent in China found a prevalence of 0.03% (Phillips et al, 2009). The number of cases of somatization disorder is so small that these data cannot be used to identify the risk factors or associated features reliably.

This one must agree to: It would seem as if somatization disorder is rare, if honestly and rationally defined and sought for.

The APA-researchers are not pleased:

      Researchers therefore have largely abandoned DSM IV criteria of somatization disorder and developed their own criteria, of which abridged "4/6" and "multisomatoform" have been the most widely studied (Escobar, Kroenke).

This is to say: If it cannot be found by existing criterions, then "researchers" - note the lack of preciseness, that is a form of art in pseudoscientific prose - invent criteria which may make this appear different.

Similarly, researchers of the dominican fathers at long last found evidence based theological reasons for invasions by the devil, into the souls of nuns (See: Aldous Huxley's The devils of Loudun)

The low prevalence of somatization disorder, combined with the difficulty of measurement of all of the somatoform disorders has meant that these disorders have not even been included in most national surveys of mental health (see table below). Even liberalizing the criteria in terms of symptom count, fails to reveal a natural "cut point" in diagnosing the disorder (Creed, unpublished).

At which point a sane non-psychiatrist, who also makes otherwise no money from selling therapies to so called laymen and lay women, would infer there is 'evidence based science' that there is no somatization disorder, or if it exists it cannot be distinguished from other things.

The APA Somatisation Work Group is most displeased!

      Perhaps as a reaction to the measurement problems with somatization disorder, the low rates, and the reliance on "medically unexplained symptoms" this area of psychiatric diagnosis is understudied, and psychiatrists and health service planners have been accused of neglecting an important group of disorders associated with considerable distress and disability (Saxena 2005, Creed 2006).

Really now?! Note first the tricky "Perhaps", that is an innuendo, and the slick suggestion that "somatization disorder" is there, and only seems not to be there to non-psychiatrists and non-inquisitionists because of what the APA is pleased to call "measurement problems".

Then one sees the field of human misery that coincides with what at present cannot be medically explained is cleverly appropriated to psychiatry - or rather: the billing of the insurances of such poor patients is reserved to psychiatrists, by psychiatrists, by the phrase "this area of psychiatric diagnosis".

In the last part of this clever construction, a moral need is manufactured by dint of some unspecific accusation by unspecified persons that supposedly want psychiatrists to invade medically unexplained disease with invented imagined psychiatric disorders that can become the basic rationale for much profitable psychiatric billing.

The absence of somatoform disorders from population-based studies has been described by a German group, which did include somatoform disorders, as "astonishing considering that these disorders are the third most frequent in the general population" (Baumeister, 2007).

I say. Some Catholics complained there is not enough concern for the invasions of the devil? And whence the amazing "the third most frequent in the general population"? Meaning what precisely? In which "general population"?

      There is thus

The  APAwizards write  "thus"

a paucity of epidemiological data on somatization disorder as defined by DSM IV, and the impression is that this disorder is extremely rare.

It seems psychiatrists need the same message three times - or else the APAwizards have consulted texts how to write advertisements.

But the APA does not want "somatisation disorder" to be "extremely rare", because it sees an excellent opportunity to extend the power of psychiatry: Invade the medically unexplained diseases, and insist that one's colleagues have already found oodles of 'evidence based medical science' that would prove that it "is" a psychiatric disorder, because it is a medically unexplained disease - except don't put it thus baldly, for then it stinks like fraud:

When different criteria are adopted to assess prevalence, one finds very different prevalence estimates. In 119 primary care patients, Lynch (1999) reports that Abridged somatization (4m/6f) was present in 6%, Multisomatoform disorder in 24%, DSM IV somatization disorder <1%, and DSM IV Undifferentiated somatoform disorder in 79%.

Persons with logical minds note at this point that the mere addition of "undifferentiated" increases the incidence of "disorders" the APA hopes to profit from more than 79-fold.

-3-

      Given that (a) the reliance on medically unexplained symptoms as a key factor for such diagnoses is intensely problematic, (b) the diagnoses are not used by clinicians, (c) patients find them very objectionable, (d) clinicians find these diagnoses unclear; and (e) there are highly discrepant prevalence estimates using various criteria, the workgroup proposes a number of changes in this important area of psychiatric diagnosis.

To be honest, rational and precise:

Because the APA wants to appropriate the medically unexplained diseases as due to some psychiatric disorder, so that they can make patients with unexplained medical diseases psychiatric patients, in spite of the fact that there is no evidence somatic disorders exist other than very rarely, and patients do not like to be saddled with such euphemistic accusations that they are mad, and medical doctors who are not psychiatrists understand it is bogus...

...therefore the APA starts inventing things:


Recommendations:

      The work group proposes 4 major changes and 1 minor change to the nomenclature, as summarized below.

Well actually they list 6 "major changes" in the very paper, but then I have read and met few rational psychiatrists, and most I did read or meet had serious problems with mathematics, logic and real science.

Major change #1: Rename Somatoform disorders to Somatic Symptom Disorders and combine with PFAMC and Factitious Disorders

The workgroup suggests combining Somatoform Disorders, Psychological Factors Affecting Medical Condition (PFAMC), and Factitious Disorders into one group entitled "Somatic Symptom Disorders" because the common feature of these disorders is the central place in the clinical presentation of physical symptoms and/or concerns about medical illness.

The brief is: Mess it all up thoroughly, namely by starting to pour it into categories just invented from thin air to supply the psychiatrists' burning need for paying patients:

If you have a medically unexplained illness, and feel miserable, you claim you feel miserable. "Therefore" the APA trickily moves, what was medically unexplained illness is something characterized by "the central place in the clinical presentation of physical symptoms and/or concerns about medical illness."

The grouping of these disorders in a single section is based on clinical utility (these patients are mainly encountered in general medical settings),

I beg to observe that I think they are not quite honest: It is based on the utility for the bank accounts of psychiatrists, namely to appropriate the field of medically unexplained disease as what they claim to be able to explain as psychiatric disorders - except that they do not state so clearly, because then their personal financial interest is seen to clearly to count as ... "medical science".

rather than assumptions regarding shared etiology or mechanism.

That is to say: Down with real science! Up with APA-invention!

 Alternatively, Factitious Disorders could continue to be listed under the category "Other Disorders."

Being realistic, I see this as a bargaining trick for discusssions: OK, you disagree - we give you the Factitious Disorders, if our rules and terms apply to the rest. Deal?

Major change #2: De-emphasize medically unexplained symptoms


      Remove the language concerning medically unexplained symptoms for reasons specified above (Creed et al 2010).

Indeed, that is practical wisdom: If you want to cash in on a  field, and make profit from patients with medically unexplained diseases, it becomes very convenient to "de-emphasize" that medical science is not omiscient, since the APA fraudulent trick is to pretend that psychiatry knows where medical science has not arrived yet - and damn the patients with real diseases who get misdiagnosed: It's for a very good purpose, namely psychiatric incomes!

The reliability of such judgments is low (Rief, 2007).

Really now? That is: Medical people who say they don't know reliably have been shown to be mistaken, by Rief 2007?

In addition, it is clear that many of these patients do in fact have considerable medical co-morbidity (Creed, Ng unpublished, Escobar in press).

Really now? "considerable medical co-morbidity"?! You would expect ill people to be ill, wouldn't you, unless you are a psychiatrist who wants to turn them to people-in-need-of-psychiatry, right?!

Medically unexplained

-4-


symptoms are 3 times as common in patients with general medical illnesses, including cancer, cardiovascular and respiratory disease compared to the general population (OR=3.0 [95%CI: 2.1 to 4.2] (Harter et al 2007).

Really now?! "3 times as common" and "compared to the general population" all at "95%"? And guys and gals of your ilk and profession are widely respected for honesty, decency, rationality and scientificality?!

This de-emphasis of medically unexplained symptoms would pertain to somatization disorder, hypochondriasis, undifferentiated somatoform disorder, and pain disorder.

What the tricky writers really "would" want to "de-emphasize" is that ill people may be really ill, and that unexplained illness may merit real medical scientific research by non-psychiatrists. Perish the thought! That would only give money to non-psychiatrists!

We now focus on the extent to which such symptoms result in subjective distress, disturbance, diminished quality of life, and impaired role functioning.

Note that at this point real unexplained illness has been verbally recooked as not so much medically unexplained as psychiatrically explained, and now some further verbal APA antics are started.


Major change #3: Combine somatization disorder, hypochondriasis, undifferentiated somatoform disorder, and pain disorder into a new category entitled "Complex Somatic Symptom Disorder"– (CSSD)

Combine somatization disorder, hypochondriasis, undifferentiated somatoform disorder, and pain disorder into a new category entitled "Complex Somatic Symptom Disorder"(CSSD) which emphasizes the symptoms plus the patients' abnormal cognitions (Barsky, Lowe, Rief).

Really now? Throw the whole lot in one big basket, and insist, dishonestly, that people with unexplained diseases must be people with "abnormal cognitions". In ordinary parlance that is slander, or a quite sick sort of pretense of omniscience: 'We can't explain why you suffer - so you must be imagining you're suffering. Pay us money, and we promise we will try to cure you! Honest!'

 The term "complex"– is intended to denote that in order for this diagnosis to be made, the symptoms must be persistent and must include both somatic symptoms (criterion A) as well as cognitive distortions (criterion B).

Again, Fraud proceeded just the same tricky way: See Webster, and suddenly criterions A and B have been invented from thin air, and as suddenly whoever has an unexplained disease also has "cognitive distortions", by APA-fiat.

That's what the DSM-5 is going to say, and you better believe it if you don't want trouble with the APA!

The criteria listed in "•B" can be assessed through clinical observation or via direct inquiry of the patient.

Well, let's be rational and honest: They can be made up by the shrink as fits the shrink's interests. It's in the DSM-5, so it must be science! Trust the APA!

This is a major change in the diagnostic nomenclature, and it will likely have a major impact on diagnosis.

A rare APA pronouncement of undiluted truth: It will make many psychiatrists a whole lot better of, at the cost of many patients, but the DSM-5 permits it, so it must be morally and medically justified. APAlogic!

It clarifies that a diagnosis of CSSD is inappropriate in the presence of only unexplained medical symptoms.

That is to say: If you are not evidently mad, we from the APA will insist that you have dysfunctional belief systems - in fact, we from the APA are tricking you here, for we just invented the need for an additional defamation of ill people, whose illness non-psychiatrists can't explain, namely that such people are nuts, except the APA will concede "patients are unhappy" with such terms, and so will speak of " dysfunctional belief systems" (such as: a belief that some real disease may at present have no medical explanation - if the APA get its way, soon anybody with such a belief, even medical doctors will be mad by DSM-5 rulings!)

Similarly, in conditions such as irritable bowel syndrome, CSSD should not be coded unless the other criterion (criterion "attributions", etc) is present.

In practice, this means a shrink or GP must be found willing to say that your belief that you are ill proves - namely: by APAlogic, but who cares if it is in the DSM-5? Who can protest with authority, if it is in the DSM-5? And the APA would never put patients interests lower than psychiatrists' interests, wouldn't they? - that you are all making it up and imagining things, and therefore the APA has just the thing for you poor deluded  folks: Stiff doses of Cognitive Behavorial  Therapy, at competing prices! Cheaper than an operation too, medical insurance companies are very glad to know!

When the patients' presentation is characterized by a predominance of certain clinical features,

Such as, in the US, insufficient belief in the wisdom and honesty of the APA, or the scientific basis of the DSM-5, and in China the belief that Mao was mostly or wholly mistaken, or that the Chinese CP represses China.

optional specifiers may be employed to denote a predominance of somatic complaints (previously somatization disorder), predominant health anxiety (previously hypochondriasis), or predominant pain (previously pain disorder).

See? The APA has just magicked "somatization disorder", "hypochondriasis", and "pain disorder" away - because, you know, patients disliked these terms - and substituted something even more vague, namely "predominant" something or other, with the clever suggestion that the patience is exaggerating, and the underlying disease non-existent or not serious.

All praise the APA now!

Extensive analyses of patients with prominent health complaints

As said before: As with Fraud, as soon as the terminology has been created, there suddenly is claimed to be lots of "extensive analyses" that support it! So honest! So scientific! So credible!

suggest

A clever weasel word, that may mean absolutely anything, without specification of why, to whom, for what reason, or in whose interests, incidentally like "may", that is beloved by APA-psychiatrists for its enormous potential for innuendo.

Both terms virtually guarantee, like the above "predominant" that the clever shrinks cannot be falsified.

that what was heretofore labeled as hypochondriasis is heterogeneous. Such studies suggest that >75% of such patients would meet criteria for CSSD

Whereas that category has been freshly invented, so that this must be another case of imagining things (and note how the clever shrinks cover their asses: "studies suggest" "would meet": APALogic!)

 but that there are a sizeable minority of patients who have high illness anxiety but who have minimal somatic complaints. This condition is referred to as Illness Anxiety Disorder in DSM V.

Really now? Not even psychiatrists know that it is to be DSM -5TM, trademark and all?

It straddles both the Somatic Symptom Disorders and the OCD Spectrum group of disorders but is listed herein for convenience in making a differential diagnosis where somatic symptoms are a focus of diagnosis and treatment.

No, APA: It is not. You have just lumped everything together under one label, that you have invented because it is in the interest of your folks - psychiatrists - to be plentifully supplied with patients whose insurances pay your bills, and to do so you have decided to call everybody who has no explained disease mad, as if that is not slander and not discrimination in law, and without any basis in scientifically established fact as well.

There can be comorbidities with other psychiatric diagnoses as well as other medical diagnoses. In such cases, it is best to code all diagnoses rather than assume one is primary.

Only if you are afraid to be found out - but that is the whole purpose of the DSM-5: Make every disease in part also a psychiatric disease, so that psychiatrists can make money from ill people, and call everyone who suffers from an illness that currently has no explanation "a sufferer from somatic symptom disorder".

The presence of CSSD complicates management of all disorders and must be addressed in the treatment plan.

I'd advice medical science to oust psychiatry from medicine, and replace its practitioners with neurologists or GPs.

It is unclear how these changes would affect the base rate of disorders now recognized as somatoform disorders.

What is clear is that the APA is not going to honestly say: We psychiatrists are going to profit enormously by this, in finances and in power.

One might conclude that the rate of diagnosis of CSSD would fall, particularly if some disorders previously diagnosed as somatoform were now diagnosed

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elsewhere (such as adjustment disorder). On the other hand, there are also considerable data to suggest that physicians actively avoid using the older 6 diagnoses because they find them confusing or pejorative.

They are, and the new ones are even more so: It is all pseudo-science, and dishonest besides.

 So, with the CSSD classification, there may be an increase in diagnosis.

Hopes the APA, confidently, having seen before that the DSM has a near biblical status in courts, insurance companies, law, and bureaucracies, and very few judges, lawyers or real medical doctors will take the trouble to get into problems with the APA or write out what is wrong and mistaken and pretentious and false and phony in the DSM-5.

The B-type criteria are crucial for a diagnosis of CSSD. These criteria in essence reflect disturbance in thoughts, feelings, and/or behaviors in conjunction with long standing distressing somatic symptoms.

That is to say, not forthrightly and honestly: The APA will insist that those with unexplained diseases are making up things, and can be freely abused as malingerers, nutters, hypochondriacs and neurasthenics, except that the APA has designed a great phony show of care that these terms be not used, but only APA-approved euphemisms with the same import for patients: Act as if you're healthy or perish!

Whilst an exact threshold is perhaps arbitrary, considerable work suggests that the degree of functional impairment is associated with the number of such criteria.

As ever, the "considerable work" is unspecified or from a small gang of professional doubletalkers, and the real fact, here dishonestly touched upon in passing, is that it is all completely arbitrary and invented by APA-shrinks out to make more money for shrinks, by whatever means, as long as the people can be taken in by medicalese terminology, displays of mathematical exactitude, obscure reasonings, and many false promises and assurances.

Using a threshold of 2 or more such criteria results in prevalence estimates of XXXX in the general population, XXXX in patients with known medical illnesses, and XXXX in patients who may previously have been considered to suffer from a somatoform illness. {text in development concerning impact of different thresholds for criteria B- from Francis}

The XXXXs are in the scientific APA-text, as it was delivered to me. APAscience!

The proposal is to group together these heretofore separately recognized disorders because in fact, there are diverse sources suggesting considerable overlap among them.

Typical APA-confusion so as to create more confusion (so as to make psychiatry totally unfalsifiable, and pretend this is to make it 'evidence based medical science'): "Because" hitherto these disorders were distinct, let's now confuse them, namely "because" "there are diverse sources suggesting considerable overlap": How to make any two or three distinct things all one and the same, by APA-instructions.

A 2009 study found that 52% of physicians surveyed indicated that there was -a lot of overlap– and an additional 38% thought that there was some overlap– across these disorders. In contrast, less than 2% of physician respondents felt that these were -distinctly different disorders (Dimsdale, Sharma, & Sharpe, unpublished).

If you think this is science, you are right - provided you add: by APAlogic. (I mean "A 2009 study found": Am I reading The Sun or the Daily Mail? This is just makebelief, pretense, or ritual incantations of "some evidence" that "may suggest" that what is really profitable for psychiatrists, must be true - except they erased that phrase.

There are limited data regarding overlap in clinical settings.

Laymen expect infinite data, you see.

One primary care study, for instance, found that 20% of somatization disorder patients also had hypochondriasis (Escobar, 1998).

You ain't kidding: "One primary care study" etc. How can one possibly rationally believe that without more specifications, such as the definitions and operationalizations used? The APA doesn't tell and doesn't care, for the APA is not doing science: It is doing impression management.

In primary care patients, somatization disorder was 5 times (Fink et al 2004) to 20 times (Barsky et al 1992) more common in hypochondriasis patients as compared to primary care patients without hypochondriasis.

Really now?! And this in the time the same diseases were according to the criterions then used very rare or so vaguely defined that they could not be distinguished?!

Treatment interventions are similar in this group of disorders. Cognitive behavior therapy (CBT) and antidepressant medications appear to be the most promising therapeutic approaches for hypochondriasis,

And they certainly are prescribed by psychiatrists, so it must be really good indeed (quote from a humble honest professional organization, no member of which ever heard the terms "megalomania" or "oxymoron", as in "38,000 leaders")

APAbaloney

 somatization disorder, and pain disorder (Kroenke 2007; Sumathipala 2007). Although several variations of CBT have been employed, they share many elements in common.

Does it take an APA psychiatrist to spell out that variations on a theme have common elements?

These include the identification and modification of dysfunctional and maladaptive beliefs about symptoms and disease, and behavioral techniques to alter illness and sick role behaviors and promote more effective coping.

This is PRECISELY the same story as Chinese psychiatry under Mao and Russian psychiatry under Stalin, and indeed as outline in Orwell's "1984" and Zamyatin's "We": A caste of state sponsored engineers of the soul, ready to pounce on any "dysfunctional and maladaptive beliefs" (you want a definition? Whatever does not agree with your shrink's honest interpretation of the DSM!), while they have a plentiful array of "behavioral techniques to alter illness and sick role behaviors", such as forced labor ("graduated exercise therapy"), brainwashing, electro-shocks, and careful sectioning with personal abuse for free.

The literature on the use of antidepressants is more limited, but it too does not suggest any major distinctions in therapeutic response across these different disorders.

You don't say? This is supposed to be science?

In addition to these patient centered commonalities of treatment, all of these disorders benefit from specific interventions with the patient's non-psychiatric physician (e.g. scheduling regular appointments as opposed to prn appointments, limiting testing and procedures unless clearly indicated) (Allen 2002).

Note what this says, by implication: Your GP will be phoned by the kind APA-steered-psychiatrist, who will tell your GP to only see you when the APA approves, and your GP will be told NOT to start any real scientific research into your complaint unless the APA approves.

My advice to GPs and other medical people is to ditch the APA as an unscientific immoral organization that spread delusions on purpose so as to obtain power over patients, their incomes, their thoughts and their actions, and likewise over any GP who helps the patients against the APA, and who tries to establish any non-psychiatric cause for their suffering.

That - GPs who help patients with unexplained diseases - will be no longer allowed or much more difficult when the DSM-5 is in force, which will make many psychiatrists a lot better of, so don't you dare to protest.

A key issue is whether the guidelines for CSSD describe a valid construct and can be used reliably.

As a philosopher of science and psychologist I can be very - impolitely but truly - clear about this "key issue": It is not a valid construct; it is sheer baloney; it has been dreamt up by the editors of the DSM-5 to make psychiatrists more powerful and it is sheer bogosity and bunkum.

A recent systematic review (Lowe, submitted for publication) shows that of all diagnostic proposals, only Somatic Symptom Disorder reflects all dimensions of current biopsychosocial models of somatization (construct validity) and goes beyond somatic symptom counts by including psychological and behavioral symptoms that are specific to

Are we amazed! Isn't that bound to be honest 'evidence based medical science'?!

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somatization (descriptive validity). Predictive validity of most of the diagnostic proposals has not yet been investigated.

Which is to say, in methodological terms: There is no empirical proof and not even any empirical research in the empirical tenability of all these imagined diseases called "CSSD": The APA knows it is bunkum, flimflam and fraudulent, but it wants to put it into the DSM-5 anyway, and besides once that has arrived no psychiatry will ever be falsifiable anymore.


Major change #4: Simple or abridged somatic symptom disorder


      The diagnosis of Somatoform Disorder Not Otherwise Specified has been criticized for its vagueness (Dimsdale, Sharma, and Sharpe, 2011). On the other hand, it is readily recognized that more specific diagnoses such as those now included in CSSD, excluded patients with substantial somatic distress and who responded to psychiatric treatment.

All of this is just baloney if no good empirical percentages are given, obtained by a valid procedure, in a methodologically correct way - but one can be morally certain this will not come from the editors of the DSM-5

In an effort to be more specific about the criteria than merely "Not Otherwise Specified," DSM V introduces a new diagnosis entitled Simple Somatic Symptom Disorder. The principal differences between CSSD and SSSD are the time course and the number of B-type criteria. CSSD requires a time course of >6 months; whereas SSSD requires symptoms for >1 month.

In brief: Fake bureaucratic distinctions, without any predictive validity whatsoever, but precisely for that reason,  one surmises, included in the DSM-5, since that also makes the refutation of these fake distinctions impossible by APA-approved methods.

CSSD requires at least two B-type critieria reflecting abnormal thoughts, feelings, and behaviors; whereas SSSD requires only 1 such criterion.

In fact, this is the level of fake science the APA has stooped to: Dreaming up a number of criteria without empirical basis other than the financial interests of psychiatrists and the rich imagination of DSM-5 editors, and then pretend it is "science" by arbitrarily specifying "three out of seven" or "two out of four" criterions "must be met" to "establish" the "diagnosis".

It's all bogus; it's all pseudoscience.

 Whereas SSSD can be construed to be a more minor or acute presentation than CSSD, the symptoms can be quite protracted (viz, for instance, various pain disorders).

Which is to say in other words: Patients with unexplained diseases can be in a lot of pain, but ... the APA will make sure their GP's and other medical specialists will not do any research to help them that is not APA-approved.

      Recognizing that there can be utility in specifically coding single symptoms when they predominate, there is the option of specifying ("e.g. SSSD.pain").

Bureaucratic pseudoscience APA-style. (Remember the long and painful story of peptic ulcers: Decades a psychiatric disease, according to psychiatrists, like homosexuality and MS. Trust the APA!)

Major change #5: Illness anxiety disorder

Extensive analyses of patients with prominent health complaints suggest

WHOSE "Extensive analyses" of WHICH "patients" with WHAT "health complaints" do "suggest" FOR WHICH REASONS?

The APA doesn't tell: The APA does 'evidence based science' by innuendo, by ukaze, or by papal/APA bull.

 that what was heretofore labeled as hypochondriasis encompasses a spectrum of clinical presentations from patients in whom somatic symptoms and bodily distress predominate, to those who have very little or no somatic distress but who nonetheless (mistakenly) believe they are sick and are highly anxious about this possibility.

You are not bullshitting me here, are you, DSM-5 editors? "Extensive analyses", didn't you say? How do you know the patients are mistaken rather than your lot of bullshitters, from a long line of bullshitters, back to Fraud himself?

How can one of your ilk be honest and rational in claiming that someone with an unexplained disease - stomach ulcers, till recent, say - "nonetheless (mistakenly) believe they are sick"?! And whence the impertinence to pooh-pooh the anxiety about people who are in pain? Ah, I see: It is to make you more money, and satisfy you unconscious Schadenfreude - a term you can find in the great Fraud as well, who also went laughing to the bank, or so I assume.

Studies suggest that >75% of patients previously diagnosed with hypochondriasis would meet criteria for CSSD,

APA-style: "Studies suggest". Believe and you will go to heaven; disbelieve and we will lock you up.

but that there are a sizeable minority of patients who have high illness anxiety but who have minimal somatic symptoms or complaints.

APA-style: Innuendo that everybody who has an unexplained disease must be a hypochondriac, malingerer, neurasthenic or hysteric - but by a newly invented APA-neologism ("CSSD", "SSSD")

This condition is now referred to as Illness Anxiety Disorder in DSM V. It straddles both the Somatic Symptom Disorders and the OCD Spectrum group of disorders but is listed herein because of its close relationship to the other somatic symptom disorders in terms of clinical presentation, phenomenology, and cognitive and affective and behavioral similarities.

Or to be really honest: Because it makes psychiatry more profitable and easier for psychiatrists: You can diagnose from the DSM-5 onward by inventing anything whatsoever about anyone with an unexplained illness without money for excellent lawyers.

Major change #6: Functional Neurological Disorder (previously conversion disorder)

      We propose a new name for this disorder but acknowledge the limitations both of the proposed new name as well as the status quo. In the hopes of encouraging a fresh perspective, we are recommending a new name for this disorder. The core feature of this disorder involves its incompatibility with known neurological pathophysiology. For these reasons, we suggest an alternative name - functional neurological disorder (Stone et al, 2010).

This is - see e.g. Webster - none other than Charcot's and Fraud's hysteria, dressed up once again by psychiatric frauds for gain.

The reason the DSM-5 editors put it as they do is that their aim is to psychiatrize every disease, if possible: "somatoform disorder" for "medically unexplained disease", "functional neurological disorder" for what could be explained by real neurologists, but is better paying for psychiatrists if named as if it is within their field.

It's all quite immoral, quite fraudulent, and quite dishonest, but one must admire the impertinent cleverness of it all.

      Various other changes are made in an effort to simplify the criteria for conversion disorder.
     
First, we emphasize the importance of obtaining positive evidence of the diagnosis from appropriate neurological assessment and testing. FND is usually

Authentic Fraudian lapsus: Hardly has the disorder been invented from thin air, or there is 'evidence based science' that allows speaking of "usually", as in "There is angelic possession. Usually, it happens in and around places of religous worship."

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diagnosed after a neurologist has found the symptoms to be incongruous with disease or internally inconsistent.

Psychiatrists since Charcot and Freud have excelled in overplaying their hand and in posturing. Here the pretense is that "a neurologist" has a certain-sure way of knowing - whereas he usually hasn't: All real scientists tend to have are guesses and some empirical support for them.

 For example, functional leg weakness can be demonstrated objectively when weakness of hip extension disappears during contralateral hip flexion against resistance (Hoover's sign) (Stone 2005, Stone 2010). Functional arm tremor may be suspected when a tremor disappears during voluntary rhythmical movement of the unaffected arm.

Possibly so. Or not: What the APA and psychiatrists tend to forget or pretend is not so is that they and the rest of science has very little understanding how the brain manufactures conscious experience.

It is true this gives pseudoscientists parasiting on a (para-)medical field enormous leeway for pseudoscientific pronouncements, therapies, and assurances, that tend to serve just end: The financial interests of the pseudoscientists.

Another instance of such incongruity would be tunnel vision, a tubular visual field defect that is inconsistent with the conical field that should occur because of the laws of optics. Non-epileptic attacks are suspected when there is a seizure-like event that occurs simultaneously with a normal video EEG. The DSM-IV criteria currently require the exclusion of disease but do not refer to these useful procedures. We suggest that incorporating physical diagnostic features observed in FND into the criteria would improve confidence in the diagnosis. Misdiagnosis is rare when such practices are adopted (Stone, Smyth et al, 2005).

This seems mostly on the level: Tales to trick the laymen with, and the firm assurances - "Misdiagnosis is rare when such practices are adopted" - seems based on little else than two APA-approved "scientists" possibly saying so.

      Second, we suggest removing the requirement that the clinician has to establish that there are associated psychological stressors. This is because (a) as with feigning, it is very difficult to reliably establish that relevant psychological factors are present in all cases and (b) the research evidence suggests that psychological factors can often be found but are not specific and have only a weak association with the diagnosis (Roelofs, 2005) and (c) relevant psychological factors may be difficult to discover at the time of initial evaluation.

In other words: Do NOT investigate whether there are or may be objective reasons for patients to feel miserable: The APA is against this, on the ground that "it is very difficult to reliably establish that relevant psychological factors are present in all cases". (Which idiot would speak of "all cases" in a case like this? APA-approved "scientists"!)

The association with psychological factors has therefore been placed in accompanying text rather than remaining a clinical requirement for diagnosis.

      Third, we suggest removing the requirement that the clinician actively establish that the patient is not feigning.

This is on a pattern registered above: Making deals, as in: You allow us to falsely impute psychiatric disorders to patients - but we assure you we will not demand that you prove that patients are feigning things. Isn't the APA merciful?!

This is because (a) it is probably clinically impossible to prove that a patient is not feigning (Sharpe, 2003) and (b) there is no evidence that feigning of conversion symptoms is more common than feigning of other mental disorders. However as with other disorders, positive evidence of feigning remains an exclusion, thereby differentiating conversion from factitious disorder and malingering.

And being psychiatrists, they manage to verbally have their cake after having eaten it.

      We suggest retaining FND in the Somatic Symptom Disorders section of the DSM.

That is, in layman's talk: The APA insists it may invade the territory of neurologists - and indeed insist it may invade the territory of all medical specialisms, on the grounds that every disease has some psychiatric dimension, and therefore falls (also) under psychiatry. So clever! So profitable! So dishonest!

FND remains a condition defined by a somatic symptom that causes disability or distress

As I just said: It is neurological "therefore" it is psychiatric: APAlogic.

 and therefore sits comfortably in the new Somatic Symptom Disorders category that replaces somatoform disorders on grounds of utility.

Note the "grounds of utility": The APA doesn't care for science or facts.

The alternative placement of this diagnosis is with dissociative disorders (Brown 2007). The argument for moving FND there is that the mental mechanisms involved may be similar. However moving FNS would risk make an unjustified assumption about a mental mechanism, would lose the utility for non-psychiatric physicians of grouping it with other conditions that present with other somatic symptoms.

In other words: The APA tries to cover all eventualities, as long as it can encroach on the territory of all medical specialists: The Doctors of The Soul try to take over medicine, in the name of 'evidence based medical science', but really with an eye on the money.


Minor Changes:
Factitious Disorders:

In approaching revisions to the text concerning factitious disorder, the work group utilized input from many experts in the field, via collaboration with one of our advisors1.

Golly: "many experts in the field" - you better believe it.

__________________
1 Brenda Bursch, PhD

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In December 2008, a 4-hour meeting was held in San Diego, attended by nine participants with significant clinical, research and/or forensic experience on this topic. Additional input was solicited from an additional six experts via telephone or email.

I am sorry, but this sounds like a holiday-with-excursions for a group of housewives. What's the point of listing the duration and the time of the meeting? Were the food and swimming, the dining and the lapdancers also OK, in San Diego?

      In DSM V text,

A similar symptom: These mighty psychiatric intellects cannot remember the most simple things, such as that they are writing the DSM-5TM, rather than "DSM V"

factitious disorder has been included within the somatic symptom disorders chapter because individuals with this disorder can present with multiple somatic symptoms.

In brief: On the basis of bullshit, as is the whole category of "factitious disorder".

In addition, this diagnosis is listed in the somatic symptom disorders section to highlight the importance of distinguishing it from the other somatic symptom disorders.

      The work group proposes otherwise minor modifications to factitious disorders. The revised text eliminates the distinction between factitious disorders involving physical vs psychological symptoms.

Another example, it seems, of: Let's by all means disregard all real empirical evidence, especially such as non-psychiatrists may establish.

      Based on review of the literature and collective clinical and forensic experience, terms such as Munchausen by Proxy and Factitious Disorder by Proxy are frequently used incorrectly (Ayoub et al, 2002, Byard 2009, Stirling 2007, Shaw et al 2008). The revised text clarifies who is the patient in these circumstances; this is now termed "factitious disorder imposed on another."

In layman's talk, this means that if you see a patient every day, as a mother or sister, and know he or she is quite ill, albeit with an unexplained disease, starting 2012, saying that your brother, sister or child is quite ill, may get you sectioned, in court, or a diagnosis of insanity, by some psychiatrist whom you do not know, but who swears on the DSM-5 that family-members who have seen a family-member suffer for years on end must be lying, must be imaginging things, and must making others ill thereby, since that is what the APA and the DSM-5 say - just as in the case of the family of dissidents and resistance fighters: Their families also lied to the police, who "only did their best to maintain the laws".

      Additional minor changes in the factitious disorder descriptions were made to emphasize objective identification rather than inference about intentionality or possible underlying motivation. "Intentional production or feigning" was thus removed and replaced with "a pattern of falsification".

Just like Stalin and Mao would love to see: If you say that bacteria cause stomach ulcers in your husband, and not some unresolved tensions in your marriage, both of you are fit to be sectioned, for your husband pretends he has a physical disease, and the wife helps him in that delusion, so the APA says. Well... no longer about stomach ulcers, but about any remaining unexplained medical disease: The patients make it up, and those who help the patients are making it up too, and making the patients ill, and hence fit for sectioning, or courts. APAlogic!

 The diagnostic requirement of establishing motivation for FDs is not useful or realistic, and can lead to under-recognition and under-treatment of the disorder.

Again the APA says: DAMN the evidence: Say people are making it up, until the unexplained disease gets explained, and until then defame, denigrate, offend, disqualify, and discriminate the patients, while insisting on getting paid as well. (And the insurances, if commercial, will love it, for a tame shrink is cheaper than a surgeon saving lives. And if it is just the life of somebody a kind APA-shrink assures the court, hand on the DSM-5, that has a disease that cannot exist because it is as yet unexplained, so the patient must be making it up, and therefore merits discrimination, just as those helping him or her are fit to be locked up.

Trust the APA! It means well, for psychiatrists' incomes.

Based on research and collective clinical experience, it appears that motivations vary (for examples, see Sanders 2010; Nicol & Eccles, 1985).

This you didn't know - or the writers of the DSM-5, of course, anyway are making things up all the time.

However, in the vast majority of clinical evaluations, motivation cannot be assessed directly due to denial of having engaged in the behavior (for examples, see Ayoub, 2010; Feldman, 1994; Rogers, 2004) and/or poor insight (acknowledgement of behaviors with no understanding of motivation).

You see, laymen: You are stupid. Only psychiatrists really knows what moves you and what is good for you, and from 2012 onwards, anybody who disagrees may end up in jail or in a locked and bolted asylum. In their own best interests!

Thus, the revised text includes the wording "pattern of falsification" to emphasize that the diagnosis should follow an objective characterization of a set of behaviors, without perceived inference about the intentionality or possible underlying motivation for these behaviors.

The APA wants to have its cake after having eaten it - but it's OK, if you want it that way: When I say the whole DSM-5 is one big "pattern of falsification" (with or without quotes) I mean, by APA's own reasoning, that I perceive no inference of "intentionality or possible underlying motivation for these behaviors" (apart from fraudulence, dishonesty, lack of integrity, and a concern for money, is true, but trust me that I can explain away these plausibly as well).

"... associated with identified deception" was inserted to state that the behaviors showed evidence of deception as identified by the observer.

Where the reader should not forget that "the observer" is likely to be a psychiatrist or psychiatrist nurse, and as you may have seen these folks cannot be mistaken, never lie, never deceive, and also are omniscient: If you have a disease they can't recognize, you must be mad, as must in fact anybody who says you have been quite miserable lately. Impossible, and hence "evidence of deception as identified by the observer."

 Again, this wording emphasizes behaviors being observed, rather than inference about intent.

The APA-trained folks are such mighty minds that they can observe deception: If only they had met Uri Geller, then Martin Gardner would have been out of work. (So... what the APA must mean, deception being of the kind that as a rule is meant to be not observed, that there is "evidence of deception" if and when an APA-approved shrink says so, or says as little as 'evidence based science has been found that may suggest that there may be deception", for psychiatrists love doubletalking that way, to obscure that they are lying, by innuendo).

Finally, criterion A4 was added to clarify that factitious disorder is not diagnosed when it is accounted for by another mental disorder such as an acute psychosis.

And this is APA-science! If it is acute psychosis it cannot be make belief! AND the great minds of the APA missed it in the previous version of the DSM! Trust the APA, you dummies!

      Malingering is differentiated from factitious disorder by the intentional reporting of symptoms for personal gain such as money, time off from work and so on. In contrast, the diagnosis of factitious disorder requires demonstrating that the patient is taking surreptitious actions to cause or simulate illness in the absence of obvious rewards.

This is to say: In practice, from 2012 onwards, it will come to this: If the APA-shrink can see a way you might, conceivably, have something to gain by being ill, then you are a malingerer, and if your lovely APA-shrink can't or won't think of such a motive, it must be that you are totally imagining things.

APAlogic!

Factitious disorder with neurological symptoms is distinguished from conversion disorder by the presence of deceptive, falsification of symptoms in factitious disorder.

The logically curious may note here that if you have a real and admitted neurological disorder, from 2012 onwards you still can be blamed as a Muchhausen - someone who makes it all up: In the end, the APA-approved shrink will decide, in court, if necessary, whether you are insane or he is, and we all know we can trust the APA, and no science is as scientific as psychiatry.


Psychological Factors Affecting Medical Condition (PFAMC):

 

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      In DSM-IV, PFAMC (316) was located in isolation from other diagnoses. We have proposed moving it into the Somatic Symptom Disorders section of DSM 5 because, like the other disorders of this section, PFAMC is primarily encountered in general medical settings, and focuses on psychiatric aspects of physical symptoms and/or medical illness.

The honest reason is rather that the APA wants to psychiatrize medicine: From 2012 onwards, it may even be arranged for all lower and middle income folks in the US that you are a psychiatric case, until it has been medically proved that you are not, which you can do yourself, namely by dying. (This still does not mean that you were really ill, mind you: Since you were psychiatrically ill, the cause of your death will be known, the APA will say, and medical research will hardly be necessary. In case of clearly provable illness anyway, even so the APA will not be to blame, because we all know that science is difficult and people make mistakes. "So it goes..." - Trust the APA!)

This would be similar to the way PFAMC's corresponding diagnosis in ICD-10, Psychological and behavioural factors associated with disorders or diseases classified elsewhere (F54) is handled, as it is grouped with other somatic symptom disorders under the category of "Behavioural syndromes associated with physiological disturbances and physical factors."

Once more: Let's psychiatrize all manner of illness, for that is so convenient and helpful for psychiatrists, for repressive states, for bureaucracies, and for courts in any authoritarian state. And all commercial insurances know this is the way to save money: 'You are making it up, and you need no research. Go to your shrink, for some CBT! You are not ill! There is no illness until the APA approves!'

      DSM-IV listed several possible subtypes of PFAMC. We propose eliminating them because there is no evidence they are ever used clinically, and no publications utilizing them could be found.

A rational mind sees here evidence that the whole category of PFAMC is baloney and bullshit from the start, but not the APA.

      We have proposed no changes in criteria except to broaden B-4 to include factors other than just stress that are influencing the underlying pathophysiology of the medical disorder.

Once again: Let's psychiatrize all illness, and all medicine.

      The diagnosis should be applied only when behavioral factors persist in the face of knowledge of their maladaptive significance and when these factors are individually modifiable.

But who will be capable to pronounce upon this? Not patients: Lay people. Not GPs: Too little psychiatric knowledge. Only the APA will be able, it will say, of determining who is mad or malingering - and everybody who is ill will be, until the APA approves he or she is not, or the disease is so clearcut that it cannot be denied it is physical. Yet if you have cancer, then still the APA will be after part of your money, namely 'to teach you to cope', namely by that most amazing of psychiatric therapies, known as "Cognitive Behavorial Therapy, whether with your illness or with dying, as long as it brings in money to psychiatrists.

Body dysmorphic disorder (BDD):
 

      BDD is being considered by another workgroup (Anxiety disorders workgroup). Logically, it could be included in the framework of the Somatic Symptom Disorders but conceptually, it might also fit in the Anxiety Disorder group. Criteria and placement of this disorder remain to be determined.

Has there ever been a psychiatrist capable of clear, honest, rational thought? I suppose there has been, but from my 45 years of reading in and about psychiatry and psychology I know only a few: McCulloch, Szasz, Arieti.

And the reason is that ever since Fraud and Charcot psychiatry has been mostly fraudulent, which is the reason for its very long list of failures, and its popularity amongst people having a minimal medical education: Fraud is easier and more remunerative than honest work.

However, moving the disorder out of the Somatic Symptom Disorders section would appear to involve more of a change in the nomenclature than retaining it within the Somatic Symptom Group.

This is also known as bullshitting. Note that APA-employed editors have a great distaste for facts, and are only concerned with "nomenclature".

#########

 

Severity Metrics


      Severity metrics are readily available for somatic symptoms (viz PHQ15, Kroenke 2002) and for the cognitive distortions and misattributions associated with CSSD (viz Whiteley Index, Pilowsky. 1967, Fink 1999).

Possibly these things are "readily available", but I must fear, as someone trained in psychology, these "Severity metrics" are prone to bullshit.

The Whiteley scale may be used to assist the clinician in assessing the severity of some of the cognitions listed in Criterion B.  The mean score in primary care outpatients and community non-patient volunteers is typically <1.60. On the other hand, DSM IV hypochondriacs have typically scored >3.15, using the 14-item Whiteley with Likert scores from 1 to 5/item (Barsky et al, 1990 and 1998).

In case my readers are in doubt: This is a paragraph of pure undiluted pseudoscientific bullshit, of the best bullshit quality.

Alternate severity metrics would grade levels as "1"= mild somatic symptoms/concerns that are intermittent and not incapacitating; "2" =moderate somatic symptoms/concerns that are persistent/recurrent and minimally incapacitating; "3"= severe symptoms/concerns that are persistent/recurrent and moderately incapacitating; "4"–= very severe symptoms/concerns that are persistent/recurrent and severely incapacitating.

Alternate bullshit - and note that the whole category of "somatic symptoms/concerns" is dressed up hypochondria APA-style: For the most part pure invention without any real physical basis.

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      There are few widely employed measures of severity in factitious disorder or conversion disorder.

      For factitious disorder, one might grade severity levels as "1" when symptoms alone are reported (e.g. "bright red blood in stool"), as "2" when a lab test was modified (e.g. introducing blood into a urine sample), as "3" when patients make themselves sick or as "4" when patients" actions lead to life threatening illness.

Totally unmotivated arbitraryness, without any factual foundation. "One might grade severity levels" in Roman numerals, or German or Greek letters as well, and imagine something about it. So what?

Note that the APA obscurantists take proper dishonest care of not being found out: "might", as also illustrated below:

      For conversion disorder, the severity scoring might best be based on the persistence of the symptoms and the resulting functioning consequences. These severity scores might range for instance from 1= minor and brief impairment (non-incapacitating symptom such as aphonia lasting <2 days); 2=minor impairment and persistent/recurrent (from 3 days to 3 months); 3=moderate impairment and brief; 4= severe and persistent/recurrent ( > 3 months bedbound with contractures and/or muscle wasting).

Note that these APA-frauds do not list any reliable evidence of the incidence of a "conversion disorder" - a diagnosis psychiatrists have falsely imposed on hundreds of thousands since Charcot and Fraud started it - that leads to "> 3 months bedbound with contractures and/or muscle wasting", and do not at all discuss the possibility that people with that amount of suffering are likely or possibly suffering from a real disease - that indeed may not be known yet, for reason of which the APA finds itself morally totally justified to haunt such people to dead, and their family and helpers as well, if that is convenient.

      For PFAMC, severity scoring might range from 1 = increases risk (inconsistent adherence with anti-hypertension treatment); 2= aggravates underlying condition (e.g. anxiety aggravating asthma); 3= results in hospitalization or 4. =Results in likely severe life-threatening risk such as ignoring heart attack symptoms

A final piece of vague baloney, because the whole category of PFAMC is without any empirical justification, and so the setting up of "severity metrics" is bullshit.

But that is what all of the DSM-5 seems to be:

A fraudulent manual of pseudo-science, meant to enrich psychiatrists, to make the "science" of psychiatry totally unfalsifiable under pretense of doing this for reasons of "evidence based science", and to make psychiatry capable of any form of bureaucratic of instutional abuse, and a major tool of denying very many people real medical help, by accusing them that they are mad, malingering, feigning, and who do it by lying, namely because those who lyingly, while feigning scientific knowledge, belong to a guild of medical frauds, who are in it for the money, for themselves, and for the institutions they serve.

The DSM-5 is a sick fraudulent schema of deception, that has little or nothing to do with real science, and everything with medical fraudulence.

It is high time non-psychiatric medical specialists come to their senses and realize that the interests of their patients are very badly served by a professional group that can manufacture this manner of pseudoscientific fraudulence and deception.

 

---

 

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11

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Reference List to items on maartensz.org

The following items are on Maartensz.org and are relevant to the above discussion
of the socalled "Rationale" by the editors of the DSM-5 discussed above. They are
given in the order they were published there, preceeded by a general list of 10
items relating to ME/CFS, that rationally show - to non-psychiatrists, and to a
minority of psychiatrists who are rational, honest and scientific - that ME/CFS
is a real disease in most patients who suffer from it, and deserves help and
research rather than the offensive defamations, slander and denigrations of
ill people by the APA and APA-inspired bullshit

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As to ME/CFS (that I prefer to call ME):
 

1.  Anthony Komarof Ten discoveries about the biology of CFS (pdf)
2.  Malcolm Hooper THE MENTAL HEALTH MOVEMENT: 
PERSECUTION OF PATIENTS?
3.  Hillary Johnson The Why
4.  Consensus of M.D.s Canadian Consensus Government Report on ME (pdf)
5.   Eleanor Stein Clinical Guidelines for Psychiatrists (pdf)
6.  William Clifford The Ethics of Belief
7.  Paul Lutus

Is Psychology a Science?

8.  Malcolm Hooper Magical Medicine (pdf)
9.
 Maarten Maartensz
ME in Amsterdam - surviving in Amsterdam with ME (Dutch)
10.
 Maarten Maartensz Myalgic Encephalomyelitis

Short descriptions of the above:                

1. Ten reasons why ME/CFS is a real disease by a professor of medicine of Harvard.
2. Long essay by a professor emeritus of medical chemistry about maltreatment of ME.
3. Explanation of what's happening around ME by an investigative journalist.
4. Report to Canadian Government on ME, by many medical experts.
5. Advice to psychiatrist by a psychiatrist who understands ME is an organic disease
6. English mathematical genius on one's responsibilities in the matter of one's beliefs:

7. A space- and computer-scientist takes a look at psychology.
8. Malcolm Hooper puts things together status 2010.
9. I tell my story of surviving (so far) in Amsterdam with ME.
10. The directory on my site about ME.




See also: ME -Documentation and ME - Resources
The last has many files, all on my site to keep them accessible.
 

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About psychiatry, the DSM-5 and medical sadism:
(in the order they were published, with one or two stars prefixed to important items:)
-------------------------------------------------------------------

2009

A little more about ME and me

More about ME

Ten good modern philosophy texts

A note on good modern philosophy books

ME-disch sadisme op wereldschaal: Zeer verbitterend nieuws (Dutch)

Philosophical Essays: Why Philosophy is important

 


2010

The MEdical Sadism connection

Studies in MEdical Sadism - 3: "The evidence & the techniques"

Studies in MEdical Sadism - 4: Intermezzo - Lucian

ME: Back to the Middle Ages with professor Simon Wessely

Scientific Realism versus Postmodernism

!! Serious Health GET + CBT Warning !!

On 'exercise as therapy for ME' : The patients' evidence

 On the human predicament

 Love for logic

Resources and Documentation

ME and Human Rights

Excellent letter by professor Malcolm Hooper + ME/CFS Conference

Studies in MEdical sadism - 10: Some strong and graphic evidence

Butterflies and asses

On being human(e)

The tragi-comical human fundamental problem

Why my family was in The Dutch Resistance  in WW II a.k.a.

Having ME in Holland, Paradise of Homo Soccer Sapiens +
Radboud Ziekenhuis Nijmegen - Natural Home of the Lying ProcessTM

Get your whee-whees cuddled...

Of Bees, of Johnson, of Brain Tapping and more

On the DSM-5TM

Brit. Jn. Psychiatry: 78% of the British are not sane

Williams vs White + Feynman vs Wessely

!!HEALTH WARNING!! !!"BEWARE OF THIS SITE"!!

Sweet relief + Ayaan and me

Light relief: JC on brains and scientists, me on science

On Corporate Bodies

McCulloch vs. Wessely - MUST READ for persons with ME

On science, ME, research-funding and postmodernism

A Norwegian about LP

Morningstar shines a bright light on postmodernism

Three documents: My father's story + my story + my Human Rights

Fine skeptical diagnosis of LP + info on bogus therapies

The human (all too human) tragi-comedy

Introduction to probability

Psychiatry, psychology, CBT, GET, DSM-5 and XMRV

A realistic numerical look at human morality + 12 references

 

2011

ME + me: 33rd year of ME, summary 2010, DSM-5

Why I like Chamfort - 1

Why I like Chamfort - 2

me + ME: Causal explanation: It's malevolence, stupid!

Bagwan in Nijmegen + APA makes mockery out of medicine and morality

More on the APA's mockery of medicine and morality

More on the APA and the DSM-5

On natural philosophy, philosophy of science, and psychiatry

More on Freud and psychiatry

Excellent reply by professor Hooper - 55 points

The gentle art of bullshitting the public for money

More on bullshitting

Quite good article on ME/CFS by a psychologist

What to do + More on the DSM-5

ME: PACE-Trials and human degeneracy

Dr. Speedy clarifies NICE and PACE

Suzy Chapman clarifies the DSM-5

Body AND mind?

ME: Margaret Williams - The Media and ME

me: Logic and the Classics

On medical sadism - 1

On medical sadism - 2

Psychiatric Sadism Disorder - definition + examples

Russell Tribunal on Psychiatry

 Russell  Tribunal on Psychiatry - Verdict + DSM-5

 

 


Copyright of this text (apart from the APA's dishonest pseudoscience):

Maarten Maartensz @ maartensz.org

-- Note of June 16, 2011: Corrected some typos; added some bolding; and added some links.