Incorporation changes from DSM-IV in CSSD

Another major aspect of the new CSSD criteria is its departure from the various qualifying distinctions contained within the several previous diagnostic categories it replaces.

These previous diagnoses, to be obliterated and incorporated within the more diffuse CSSD, are:

• Somatization disorder
• Undifferentiated Somatoform disorder
• Hypochondriasis
• Pain Disorder Associated with Both Psychological Factors and a General Medical Condition
• Pain Disorder Associated with Psychological Factors.

A major question is: what is lost, if anything, in the "lumping" of the older conditions? Moreover, what, if anything, that is lost provided more rigorous procedures for making more accurate diagnoses—or at least less inaccurate?

Somatization disorder requires a history of many physical complaints before the age of 30. The new CSSD throws this qualification overboard. Why the change? Has the historical finding, which has counted as a distinct marker, evaporated?

A second major change is that fatigue, a symptom highlighted in the statement about CSSD, is specifically stated as not a symptom found in somatization disorder. This issue of fatigue directly impacts the differential diagnosis between the proposed CSSD definition and the physiological, multi-systemic illness of CFS—also known in Europe as myalgic encephalopathy or myalgic encephalomyelitis. Somatization disorder would be hard to confuse with CFS, for instance sleep disorder and decreased concentration are not physical symptoms included in the diagnosis of somatization disorder. Also in somatization disorder, head, joint and possible muscle pain are the only stated symptoms in common with those of CFS/ME. Yet the CSSD criteria, with a psychological not a medical interpretation will provide a diagnosis of CFS/ME.

Eliminating distinctions of somatization disorder negates distinctions that must have taken years to discriminate.

A second diagnostic criteria transformed/lumped into CSSM is Undifferentiated Somatoform Disorder. This diagnosis instead of simply relying upon multiple somatic symptoms (CSSD) actually group specific symptoms necessary for diagnostic fulfillment.

These include: "One or more physical complaints (e.g., fatigue, loss of appetite, gastrointestinal or urinary complaints) which either 1) the symptoms cannot be fully explained by a known general medical condition, or 2) when there is a medical condition are excessive in relation to the condition." In this condition, as in CSSD, much of the differential diagnosis depends on the interpretation of the individual physician—whether medical or psychological or both.

Yet the new CSSD definition simply widens further the amount of undifferentiated territory. Is negation of diagnostic detail supportable, and again what are the practical consequences?