One year after its initial deadline, the 5th Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, is due out in May, 2013. Published by the American Psychiatric Association, it is, in the APA’s words the:
standard classification of mental disorders used by mental health professionals in the United States. It is intended to be applicable in a wide array of contexts and used by clinicians and researchers of many different orientations. . . It can be used by a wide range of health and mental health professionals, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors.
It is commonly referred to as the ‘mental health Bible.’
With the last version the DSM-IV-TR in 2000, it was high-time for update.
I’d have thought it would be a rather sedate affair–a gathering of the great psychological minds to put together a text that better reflects the state of mental illness today.
I clearly thought wrong. The acrimony on all sides has been intense, regarding financial connections, lack of research, not enough field-testing–accusations have been flung from all corners.
For a little local color, here are some of the more–mmm, interesting statements from two sides of the fence.
- “I am increasingly uncomfortable with the whole underlying principle of rewriting the entire psychiatric taxonomy at one time. I am not aware of any other branch of medicine that does anything like this. . .There seems to be no good scientific justification for doing this, and certainly none for doing it in 2012.” (Jane Costello Resignation Letter from Child and Adolescent Disorders workgroup)
- “However, a lot of this has not been tested as well as we would like.” (Dr. Darrel Rieger, head of DSM-5 task force)
- “And that’s what the DSM is — a set of scientific hypotheses that are intended to be tested and disproved if the evidence isn’t found to support them.” (Dr. Darrel Rieger, head of DSM-5 task force)
- “If the DSM-IV criteria are taken too literally, anybody in the world could qualify for Asperger’s or PDD-NOS. ” (Catherine Lord, member of Development Neurodevelopmental Disorders Work Group)
- Already one year behind schedule, when Dr. Reiger was asked if there was time to adjust the revisions for all the disorders in the DSM-5 by the end of 2012, Regier says, “there is plenty of time (although 2 diagnoses were thrown out whole-cloth just this month, narcissistic personality disorder has been out then in, the bereavement exclusion is still up-for-grabs, Disruptive Mood Dysregulation Disorder is almost wholly untested, the autism brouhaha has not subsided. . . ).
- [But later he decided:] “We need to make some judgements now to go forward . . . Our plan is that these will be immediately tested once the DSM is official, and then one will be able to see if revisions can be made.”
- “When we began this process, we agreed that changes would only be made if there were empirical evidence to support them. Sometimes (as with Charlie’s work on preschool PTSD) this has been the case. But as time has gone by, the gap between what we need to know in order to make revisions and what we do know has grown wider and wider, while the time to fill these gaps is shrinking rapidly. More and more, changes seem to be made for reasons that have little basis in new scientific findings or organized clinical or epidemiological studies.” (Jane Costello Resignation Letter from Child and Adolescent Disorders workgroup)
- “That [requiring physicians to use DSM-IV criteria when diagnosing autism] would be a big mistake, because DSM-IV has not been very useful for women, for toddlers, for any child from 3 to 8 years of age, and also was almost useless for adolescents.” (Susan Swedo, head of committee rewriting the diagnostic criteria for autism spectrum disorders)
- Nothing. (What Dr. Fred Volkmar said about his resignation from the Committee for ‘ethical and professional reasons’). . . Months later, in a response to an e-mail from Dr. Reiger, he wrote back, “I have never attributed any bias to members of the committee (even though some of them are saying this as a spokesperson for the APA I am considering resigning from same …). Nor have I said anything to denigrate their motivation in dealing with what is probably an underfunded and inadequate process. . . .
For what it is worth I’m going to complain to the APA about [your comments]. It is of course a free country and you can say what you think but given your capacity in saying this as a spokesperson for the APA I am considering resigning from same (as a distinguished fellow or some such) in protest – this will only draw more attention to the issue sadly.”
- “We have to make sure not everybody who is a little odd gets a diagnosis of autism or Asperger disorder . . . It involves a use of treatment resources. It becomes a cost issue.” (David Kupfer, Chair of DSM-5 Task Force)
Quotes from Dr. Allen Frances, Head of Task Committee for the DSM-IV:
- “Perhaps it should occasion no surprise that a flawed process should yield a flawed product. The most fundamental problem is the poor and inconsistent writing.”
- “. . .DSM5 has been and remains in serious trouble.”
- “The leadership has established a consistent track record of proposing unrealistic plans and impossible to meet timetables―with predictably erratic course changes and repeatedly missed deadlines.”
- But poor planning and administrative foul-ups kept pushing back the field trials so that they are now at least 18 months late in completion. As time was running out, DSM-5 leadership quietly dropped the second phase of the field trials, removing any reference to it from the timeline posted on the DSM-5 Web site. Their Plan B substitute for adequate field testing appears [to be] a drastic lowering of the bar for what is “acceptable” reliability.”
- “In fact, my criticisms of DSM 5 arise precisely from its obvious failure to be an impartial, meticulous, and consensus academic endeavor. DSM 5 has suffered from a fatal combination of excessive ambition, sloppy method, and closed process. It fully deserves the concerted opposition it has generated from forty-seven professional organizations, the world press, the Society of Biological Psychiatry, the Lancet, and the general public.”
And that, I’m certain is not the end of that.
- DSM 5 Finally Begins Its Belated and Necessary Retreat (thehealthcareblog.com)
- The New Psychiatric Manual (DSM-5) Will Make You Crazy (independentsentinel.com)
- Wonderful News: DSM 5 Finally Begins Its Belated and Necessary Retreat (psychologytoday.com)
- Panel suggests DSM-5 psychiatry manual drops two disorders, keeps new autism definition (cbsnews.com)
- Op-Ed Contributor: Break Up the Psychiatric Monopoly (nytimes.com)