Specifier catalogue: clinician review of definitions + Trance Disorder possession structure

[BigSimmo]

Tracking issue for the clinician-facing follow-ups to the DSM-5-TR specifier catalogue (#656), after the interim safety change in #691 (all generated definition text withheld from display) and a source-verification pass of the 71 previously-displayed "source-verified" definitions.

Context

The imported catalogue's auto-generated definitions proved unreliable — automated review repeatedly found clinically wrong text on rows whose source was "verified". #691 now withholds all generated definition/clinical-note text from display; the catalogue shows only structural facts (label, disorder, group, ICD-11 context), review status, provenance badge, and the hand-authored curated guidance. The nested dataset is left intact so clinician-authored definitions can be restored later.

A source cross-check of all 71 previously-displayed definitions against DSM-5-TR and WHO ICD-11 found 68/71 confirmed (the severity thresholds, durations, and subtype codes are accurate) and 3 contradicted.

1. Author clinician-reviewed definitions (the real fix)

Have a qualified clinician write/approve the specifier definitions before any generated definition text is re-displayed. The 585-item structure and labels are sound and can be kept; only the definition prose needs authoring. The full source-verification report (per-item verdicts + cited DSM-5-TR / ICD-11 URLs) is available as a starting point.

2. Trance Disorder possession structure (contradiction from the verification pass)

The catalogue models Trance Disorder with a "with/without possession" specifier. Per ICD-11 this is a structural mismatch: ICD-11 uses two separate diagnoses — 6B62 Trance disorder (without a replacing external identity) and 6B63 Possession trance disorder — not a with/without qualifier of one disorder. This needs restructuring the taxonomy node (split into two diagnoses), which is a clinician/structural decision, not a label edit.

• Note: the parallel Dissociative Identity Disorder "with/without possession form" is correct — ICD-11 6B64 genuinely covers both forms within one diagnosis. Only Trance Disorder needs the split.

Already fixed (no action needed here)

• ARFID third driver relabelled from the ICD-11 exclusion "limited availability" to the genuine driver "apparent lack of interest in eating / low appetite" (6B83) — done in fix(specifiers): withhold all generated definitions pending clinician review #691.
• Gaming online/offline, PTSD/Conduct threshold notes, AMPD provenance, BED/Hypersomnolence severity notes, possession wording — corrected during feat(specifiers): add full DSM-5-TR catalogue with verification gate #656 review.

Related: #656 (catalogue), #691 (withhold definitions).

🤖 Generated with Claude Code

[github-actions]

Summary of GitHub Issue: Specifier Catalogue - Clinician Review of Definitions + Trance Disorder Possession Structure

This issue tracks clinician-driven improvements to the DSM-5-TR specifier catalogue, following prior issues that revealed inaccuracies in auto-generated definitions. Key points discussed:

1. Issue Background:

   • Auto-generated definitions for specifiers in the imported catalogue were found unreliable, containing clinical inaccuracies.
   • As an interim safety measure, the definitions have been withheld from display (fix(specifiers): withhold all generated definitions pending clinician review #691), leaving only structural data visible (e.g., labels, categories, ICD-11 context).
   • A manual source-verification cross-check of 71 previously-displayed definitions confirmed 68 as accurate but found 3 with contradictions.

2. Actions to Address:

   • Definition Review and Authoring: A qualified clinician needs to write or approve the prose definitions for the specifiers. The structural layout of the 585 items is sound and doesn't need changes, just the definitions.

[coderabbitai]

🔗 Related PRs

#446 - Merge branch cleanup and review workflow updates [merged]
#483 - feat(differentials): interactive diagnosis detail page with honest safety snapshot [merged]
#633 - feat(specifiers): add diagnostic decision-support workspace [merged]
#656 - feat(specifiers): add full DSM-5-TR catalogue with verification gate [merged]
#661 - DSM: add diagnosis reference mode [merged]

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