Letter to Editors, J of Evaluation in Clinical Practice re Peter D White paper

-------- Forwarded Message --------
Subject: Re: Errors in J Eval Clin Pract. Original Paper: White PD. A perspective on causation of the chronic fatigue syndrome by considering its nosology
Date: Sun, 4 Aug 2019 09:55:54 +0100
From: Suzy Chapman
To: Lia Curtin, Editorial Assistant; Professor Andrew Miles
CC: Dr Geoffrey Reed; Dr Robert Jakob; Dr Christopher Chute; Suzy Chapman

To: Lia Curtin, Editorial Assistant; Professor Andrew Miles, Regional Editor, UK & Europe

CC: Peter Denton White, Emeritus Professor of Psychological Medicine, Wolfson Institute of Preventive Medicine, Queen Mary University of London

Dr Christopher Chute, John Hopkins, Chair, ICD-11 Medical Scientific Advisory Committee (MSAC);
Dr Robert Jakob, World Health Organization, Team Leader Classifications and Terminologies (ICD, ICF, ICHI);
Dr Geoffrey Reed, Columbia University, Senior Project Officer for development of ICD-11 Mental and Behavioural Disorders, Dept of Mental Health and Substance Abuse, World Health Organization

Dear Ms Curtin and Professor Miles,

Re: Journal of Evaluation in Clinical Practice, Version of Record online: 01 August 2019: Original Paper: White PD. A perspective on causation of the chronic fatigue syndrome by considering its nosology [1].

I write to bring to your attention errors within Professor White's paper, specifically in relation to classification and coding in ICD-10 and ICD-11.

I am taking the liberty of copying in three key members of the World Health Organization's ICD-11 development team, Drs Jakob, Reed and Chute, whom you may wish to consult.

1: The author states:

'Turning to established diagnostic classification systems, how are CFS and ME considered? There are arguably seven different ways to classify the illness within the International Classification of Diseases, 10th edition (ICD‐10).24 . . . Finally, the miscellaneous chapter includes “R53.82 Chronic fatigue, unspecified,” which includes “chronic fatigue syndrome NOS,” and if a patient is of a certain age, one might even consider “R54 Senile asthenia”!'

24. World Health Organisation. International Classification of Diseases, 10th edition. 2016. Retrieved from: https://www.who.int/classifications/icd/icdonlineversions/en/

This statement is incorrect.

There is no code "R53.82 Chronic fatigue, unspecified" or inclusion, "chronic fatigue syndrome NOS" within the International Classification of Diseases, 10th edition. 2016.

"R53.82 Chronic fatigue, unspecified" and its inclusion, "chronic fatigue syndrome NOS" are specific to the U.S.'s clinical modification, ICD-10-CM, which is developed and maintained by NCHS/CDC [2].

These two terms were added by NCHS to ICD-10-CM's Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) during the ICD-10-CM development and adaptation process. Neither term is coded for or indexed within the WHO's ICD-10 (which has no Tabular List four or five character codes between R53 and R54), or within ICD-11.

2: The author states:

'The 11th edition of the ICD still holds ME in the neurology chapter, classified under post‐viral fatigue syndrome, whereas there has been a radical change to somatoform disorders within the mental and behavioural disorders chapter, which now considers these as examples of “body [sic] distress disorder.” Neurasthenia has been omitted.2'

which is correct, but the author goes on to state:

'This clustering of functional somatic syndromes has been reported many times and needs to be considered in any study of the aetiology of CFS. Fink's concept of body [sic] distress syndrome recently incorporated into ICD‐11 is an alternative way of considering this finding.29'

29. Fink P, Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res. 2010;68(5): 415‐426.

This statement is incorrect.

The Fink P, Schröder A. (2010) diagnostic construct, "Bodily distress syndrome (BDS)" has not been incorporated into ICD-11 MMS (Mortality and Morbidity Statistics).

For the core ICD-11, WHO has approved the differently conceptualized, "Bodily distress disorder (BDD)" with three coded for severity specifiers [3][4].

Creed & Gurege [5], Gurege & Reed [6] and Per Fink [7] clarify that as defined for ICD-11, BDD is a conceptually different diagnosis: ICD-11's BDD and the Fink P, Schröder A. (2010) BDS are differently characterized, have very different disorder descriptions/criteria, and are inclusive of different patient sets.

Rather than provide clarity around ICD classification, misconceptions within this paper will add further confusion between these divergent diagnostic constructs.

I should be pleased if these errors can be discussed with the paper's author and with the WHO and addressed either in the version of the paper currently online or via corrigenda.


Susan E Chapman


1 White PD. A perspective on causation of the chronic fatigue syndrome by considering its nosology.
J Eval Clin Pract. 2019;1–6. https://doi.org/10.1111/jep.13240

2 Centers for Disease Control, Clinical Modification (ICD-10-CM) 2020 release:
https://www.cdc.gov/nchs/icd/icd10cm.htm#FY 2020 release of ICD-10-CM

3 ICD-11 for Mortality and Morbidity Statistics (Version: 04/2019), 6C20 Bodily distress disorder:

4 Fuss J, Lemay K, Stein DJ, Briken P, Jakob R, Reed GM and Kogan CS. (2019). Public stakeholders’ comments on ICD‐11 chapters related to mental and sexual health. World Psychiatry, 18: 233-235. https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20635

5 Creed F, Gureje O. Emerging themes in the revision of the classification of somatoform disorders. Int Rev Psychiatry. 2012 Dec;24(6):556-67. doi: 10.3109/09540261.2012.741063

6 Gureje O, Reed GM. Bodily distress disorder in ICD-11: problems and prospects. World Psychiatry. 2016 Oct;15(3):291-292. doi: 10.1002/wps.20353

7 Syndromes of bodily distress or functional somatic syndromes - Where are we heading. Lecture on the occasion of receiving the Alison Creed award 2017, Fink, Per. Journal of Psychosomatic Research, Volume 97, 127 - 130 https://www.jpsychores.com/article/S0022-3999(17)30445-2/fulltext Lecture slides: http://www.eapm2017.com/images/site/abstracts/PLENARY_Prof_FINK.pdf

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