Category Archives: David Kupfer

DSM-5 released: Media, professional and advocacy reaction: Round up #4

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For earlier responses to the release of DSM-5 see Posts #253, #252, #251 and #249

The colour of money

If you want to view the WHO’s ICD-10 “Blue Book” or the “Green Book”, the ICD-10 Tabular List Version: 2010 or the forthcoming US ICD-10-CM you can do so for free, online.

If you want to view the “Purple Book” it’s going to set you back $199 in hardcover and $149 in paperback.

American Psychiatric Association has never given free access to the DSM. According to Task Force chair, David J Kupfer, no change is planned to that policy. An online version is in the pipeline but it won’t be free.

“A digital version is promised within a few months through a secure website and also as mobile device applications. Revisions will be more frequent and most likely would be distributed only electronically…” (APA Leaders Defend New Diagnostic Guide John Gever, Medscape Today, May 18, 2013)

The finalized criteria sets and the texts that accompany the disorder sections are nailed down with copyright permissions and restrictions.

What resources are available for free?

On this page of the American Psychiatric Association’s website, you can view the DSM-5 Table of Contents, a document titled Insurance Implications for DSM-5, Psychiatric News articles, disorder descriptions and rationales fact sheets, videos and a document called Highlights of Changes from DSM-IV to DSM-5. New documents are being added to this page every few weeks.

The DSM-5 Development site, from which the third draft was removed, last November, will remain online. Currently undergoing reorganization, APA says the platform will serve as a resource for clinicians, researchers, insurers, and patients.

There is now a tab page Ask Questions or Provide Feedback with a form for submitting questions and feedback. The page states that as frequent questions are received the answers will be continually added to the FAQ pages.

Down the right hand side of the DSM-5 Development Home Page are links for disorder description and rationale documents for some new and existing disorders. (Note that at the time of writing, not all the links are live links, so you may need to hop to this page, in order to open some of the PDFs.)

At the top of the list of links, there is a new document, Important Coding Corrections and an Insurance Implications FAQ.

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No position statement issued yet from the American Psychological Association, but a Practice Central Update around DSM-5, ICD-10-CM and the cross-walk has been published: Nine frequently asked questions about DSM-5 and ICD-10-CM Practice Research and Policy staff, May 16.

Quick primer on cross-walk from a coding industry site, here: For Mental Health, how do DSM-5, CPT and ICD-10 Codes Interact?

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Medscape Medical News – A Guide to DSM-5

Today, Medscape Medical News has published a 15 section guide highlighting the major additions and revisions in the new DSM-5.

Medscape Medical News from The American Psychiatric Association’s 2013 Annual Meeting

This coverage is not sanctioned by, nor a part of, the American Psychiatric Association.

Medscape Psychiatry: A Guide to DSM-5 Bret S. Stetka, MD, Christoph U. Correll, MD, May 21, 2013

Psychiatric Times > APA Annual Meeting Conference reports

Experts Discuss Changes, Updates in DSM-5

Heidi Anne Duerr, MPH | 22 May 2013

Includes summary of revision of DSM-IV’s Somatoform Disorders to Somatic Symptom and Related Disorders for DSM-5.

“One thing that has not completely changed is the inherent ambiguity in these diagnoses…It will be up to each clinician to determine what “excessive” or “disproportionate” means in terms of pathological response.”

Registration for access to this article may be required.

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Other coverage

Jeffrey A Lieberman gets a little hot under the collar over “misguided and misleading ideologues and self-promoters…spreading scientific anarchy” in a guest blog for Scientific American:

Scientific American Guest Blog | Jeffrey A Lieberman, May 20, 2013

DSM-5: Caught between Mental Illness Stigma and Anti-Psychiatry Prejudice

Dr. Lieberman was installed as President-elect of the American Psychiatric Association (APA); he will serve as APA President from May 2013 to May 2014.

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Three radio and TV broadcasts

PBS Newshour | ANALYSIS AIR DATE: May 20, 2013 | Presenter Judy Woodruff

What DSM-5, Updated Mental Health ‘Bible,’ Means for Diagnosing Patients

Transcript plus Listen again on mp3

SUMMARY

The American Psychiatric Association released a new edition of the DSM, which doctors use to diagnose and treat mental disorders. Judy Woodruff discusses the changes and implications for both patients and professionals with Dr. Michael First of Columbia University and Dr. Steven Hyman of the Broad Institute.

World News Australia Radio | May 22, 2013, 9:00 am – Source: Kerri Worthington, SBS

Controversy over ‘psychiatry bible’

Transcript plus Listen again on mp3

Quotes from Associate Profressor Tim Carey, also Professors Helen Christensen, executive director of the Black Dog Institute, Perminder Sachder and Gordon Parker

An update to a highly influential mental health manual, the so-called bible of psychiatry, has been unveiled to criticism from both within and without the profession.

ABC Australian Broadcasting Corporation | May 20, 2013 | Reporter: Emma Alberici

Normal behaviour defined as mental illness

Transcript plus 15.58 mins Video available to watch again

Allen Frances, MD, talks to Emma Alberici on DSM-5 and diagnostic inflation.

For earlier responses to the release of DSM-5 see Posts #253, #252, #251 and #249

DSM-5 released: Media, professional and advocacy reaction: Round up #3

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Post #253 Shortlink:
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For earlier responses to release of DSM-5 see Posts #252, #251 and #249

The Conversation

Two visions for understanding illness: DSM and the International Classification of Diseases
James Bradley, Lecturer in History of Medicine/Life Science at University of Melbourne, May 22, 2013

DSM-5 tells us more about psychiatry than psychiatrists
Prof, Sir Simon Wessely, Professor of Psychological Medicine at King’s College London, May 20, 2013

Under new psychiatric guidebook we might all be labelled mad
Allen Frances, Professor Emeritus of Psychiatry at Duke University, May 20, 2013

Explainer: What is the DSM?
Peter Kinderman, Professor of Clinical Psychology at University of Liverpool, May 20, 2013

Mental disorders: debunking some myths of the DSM-5
Perminder Sachdev, Scientia Professor of Neuropsychiatry, Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry at University of New South Wales, April 18, 2013

Five new mental disorders you could have under DSM-5, May 20, 2013
Authors: Christopher Fairburn, Professor of Psychiatry at University of Oxford; Christopher Lane, Professor of English at Northwestern University; David Mataix-Cols, Professor and Honorary Consultant Clinical Psychologist at King’s College London; Jon Grant; Professor of Psychiatry and Behavioral Neuroscience at University of Chicago; Karen M. von Deneen, Associate Professor at Xidian University

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The Dana Foundation: Psychiatric Drug Development: Diagnosing a Crisis Steven E Hyman, MD, April 02, 2013

Steven E Hyman, MD, resigned from the DSM-5 Task Force in 2012. Dr Hyman remains listed as Chair of the APA-WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders

Update: Commentary by Bernard Carroll at Health Care Renewal, April 6, 2013

Blogs Psych Central: Video NIMH’s Thomas Insel on a New Understanding of the Brain Sandra Kiume, April 2013

Video: 13:04 mins

NIMH’s Thomas Insel on a New Understanding of the Brain By Sandra Kiume

Director of the National Institute for Mental Health Thomas Insel gives a TED Talk on the new domain criteria research direction, and how an important first step is to reframe mental illness as brain disorders.

By doing so, diverse fields like psychology, cognitive science, molecular neuroscience, genetics, psychiatry, and more can work together toward a new understanding of the mind.

NIMH: Mental Disorders as Brain Disorders: Thomas Insel at TEDxCaltech, April 23, 2013

Video 15:05 mins

Psycritic: What If the NIMH Succeeds? What Then? May 11, 2013

A child psychiatrist takes a critical look at psychiatry, the news, culture, etc

Jonathan Turley: From DSM-I to DSM-5 in the Legal System: Mental Illness Issues in the Courtroom Charlton Stanley (Otteray Scribe), guest blogger, May 19

Canada.com: Infighting, boycotts, resignations: Psychiatry faces another crisis of confidence Sharon Kirkey, Postmedia News, May 17

Includes Allen Frances video

Radio New Zealand: New reference manual issued by Psychiatric Assn May 19

Healio Psychiatric Annals: APA President-Elect: ‘Our time is now’ May 19

Los Angeles Times Review of Books: Andrew Scull on The Book of Woe: The DSM and the Unmaking of Psychiatry and Hippocrates Cried : The Decline of American Psychiatry Andrew Scull, May 19

Delusions of Progress: Psychiatry’s Diagnostic Manual

Essay length article that includes reference to the legal threats issued on behalf of American Psychiatric Publishing against Dx Revision Watch site, in December 2011.

Truth Dig: British Psychologists Find Fault With DSM-V Alexander Reed Kelly, May 16

England’s Division of Clinical Psychology, which represents more than 10,000 practitioners, has criticized the latest edition of the field’s leading diagnostic manual for its categorizing of normal behaviors—such as shyness in children and depression after the death of a loved one—as medical problems treatable with drugs…

New York Post: We’re all mad here, New psychiatry manual turns ordinary American life into mental disorders Allen Frances, MD, May 18

Millions of people who went to sleep last night thinking they were normal woke up this morning with a new mental disorder…

Medscape Medical News, Psychiatry: Use DSM-5 ‘Cautiously, If at All,’ DSM-IV Chair Advises Pam Harrison, May 17

“I believe that the American Psychiatric Association (APA)’s financial conflict of interest, generated by DSM publishing profits needed to fill its budget deficit, led to premature publication of an incompletely tested and poorly edited product,” Dr. Frances states.

“The problems associated with the DSM-5 prove that the APA should no longer hold a monopoly on psychiatric diagnosis…. The codes needed for reimbursement are available for free on the Internet.”

Spiked Online, UK: Our brains aren’t moulded by abuse Ken McLaughlin. May 16

So, is mental distress caused by faulty genes or by past experiences of childhood abuse? Maybe it’s neither.

For earlier responses to release of DSM-5 see Posts #252, #251 and #249

DSM-5 released: Media, professional and advocacy reaction: Round up #2

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Post #252 Shortlink:
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For earlier responses to release of DSM-5 see Posts #251 and #249

Medpage Today, US: APA Leaders Defend New Diagnostic Guide John Gever, Deputy Managing Editor,  May 18

…DSM-5 is now on sale for $199 in hardcover and $149 in paperback. The APA has never made the DSM freely available (it is an important source of revenue) and no change in that policy is planned…A digital version is promised within a few months through a secure website and also as mobile device applications. Revisions will be more frequent and most likely would be distributed only electronically, Kupfer said.

Wall Street Journal, US: Revised Psychiatric Manual Faces Mixed Reviews Shirley Wang, May 18

The widely criticized new version of the U.S. psychiatric diagnostic manual due out faces a potentially diminished role in research, which would mark a shift for what has been considered the bible of American psychiatry for 30 years.

…Dr. Kupfer, the DSM leader, said researchers should look at the DSM as “a guide but not necessarily the only framework they should use to carry out basic science.”

“For the DSM to be considered primarily a guide for clinicians is a “dramatic backtracking from their prior position as putting themselves out there as the best basis for research,” said Geoffrey Reed, senior project officer at the World Health Organization…Most of the research funded by the NIMH and published in psychiatry journals in the past 20-plus years had to use DSM diagnostic criteria; otherwise, scientists had no hope of publishing, said Dr. Reed.

The Guardian, UK: New US manual for diagnosing mental disorders published Ian Sample, science correspondent, May 18

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, has divided medical opinion

[Ed: Note according to a WPA-WHO 2011 Survey, around 11% of practising UK psychiatrists and around 23% of practising psychiatrists surveyed globally reported using DSM-IV more than ICD-10.]

…Though not used in the UK, where doctors turn to the World Health Organisation’s International Statistical Classification of Diseases (ICD), the US manual has global influence. It defines groups of patients, and introduces new names for disorders. Those names can spread, and become the norm elsewhere. More importantly, the categories redefine the populations that are targeted by drugs companies.

The Pharmaletter, US: Europe adopting US strategies to diagnose and treat ADHD Industry article, May 16

…Although Europe trails behind the USA in terms of market revenue, ADHD therapeutics markets are expected to show strong growth, with Spain predicted to witness a compound annual growth rate (CAGR) of 8% over 2012-2018, beating the USA’s CAGR of 6% during the same future period. European markets have not yet neared the saturation point that ADHD therapeutics are facing in the USA, and there is an optimistic view for ambitious growth in this region.

Medpage Today, US: DSM-IV Boss Presses Attack on New Revision John Gever, Deputy Managing Editor, May 17

Includes Complimentary Source PDF:
http://annals.org/article.aspx?articleid=1688399

…Ironically, DSM-5 has come under attack from the autism community for rewriting the autism spectrum classification in ways that autism advocates have feared will disqualify many children from receiving autism diagnoses — a controversy that Frances did not address…But he did suggest that the DSM in general has become too important after a very modest beginning in the 1950s.

“The DSM … has since acquired perhaps too much real-world influence as the arbiter of who gets what treatment and whether it will be reimbursed; who is eligible for disability benefits, Veterans Affairs benefits, and school and mental health services; and who qualifies to receive life insurance, adopt a child, fly an airplane, or buy a gun,” Frances observed.

Biomedcentral: Patient advocacy and dsm-5 Dan J Stein and Katharine A Phillips, May 17

BMC Medicine 2013, 11:133 doi:10.1186/1741-7015-11-133

Published: 17 May 2013 Abstract (provisional). Complete article is available as free, provisional PDF here

Abstract (provisional)

The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a useful opportunity to revisit debates about the nature of psychiatric classification. An important debate concerns the involvement of mental health consumers in revisions of the classification. One perspective argues that psychiatric classification is a scientific process undertaken by scientific experts and that including consumers in the revision process is merely pandering to political correctness. A contrasting perspective is that psychiatric classification is a process driven by a range of different values and that the involvement of patients and patient advocates would enhance this process. Here we draw on our experiences with input from the public during the deliberations of the Obsessive Compulsive-Spectrum Disorders subworkgroup of DSM-5, to help make the argument that psychiatric classification does require reasoned debate on a range of different facts and values, and that it is appropriate for scientist experts to review their nosological recommendations in the light of rigorous consideration of patient experience and feedback.

Herald Online, PR Newswire: New Social Media Campaign Features Stories Of Individuals Who Rejected Psychiatric Association’s DSM-5

Campaign timed to coincide with rollout of American Psychiatric Association’s DSM-5, Open Paradigm Project

SAN FRANCISCO, May 18, 2013 — /PRNewswire-USNewswire/ — The Open Paradigm Project, in collaboration with MadinAmerica.com, Occupy Psychiatry, and leading organizations in the movement to reform mental health care, announces a social media campaign showcasing video testimonials by individuals negatively impacted by the traditional psychiatric model, which focuses on pathology and illness rather than wellness and recovery. The launch coincides with the American Psychiatric Association’s (APA) rollout of its latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), taking place at the APA’s annual meeting in San Francisco this weekend. In light of National Institute of Mental Health (NIMH) director Thomas Insel’s move away from the DSM (“lack of validity… patients deserve better”) and DSM-5 task force chair David Kupfer’s admission of an absence of biological markers of mental illness (“we’re still waiting”), these stories starkly unveil the failure of, and harm done by, the prevailing model of mental health care…

Vox, Gibraltar: Western Psychiatry in Crisis Vox Editor, May 17

DSM 5 and exclusively biological psychiatry must be completely rethought

The following is an extract of the Mental Health Europe article:

Western psychiatry is in crisis. The direction taken by the new Diagnostic and Statistical Manual of Mental Disorders (DSM 5), due to be published later this week, has received ample criticism. Moreover, in disagreement with the American Psychiatric Association, the United States National Institute of Mental Health (NIMH), the world’s largest research institute, has announced they will no longer fund projects based exclusively on DSM categories. Unfortunately, while Mental Health Europe considers the NIMH decision to be the right one, by focusing almost entirely on neuroscience and on so-called disorders of the brain, the NIMH is missing out on the critical importance of user experiences to psychiatric research and to the practice of psychiatry…

…For more information, please contact MHE Information and Communications Manager Silvana Enculescu at silvana.enculescu@mhe-sme.org. MHE Senior Policy Adviser Bob Grove and MHE Policy Officer Yves Brand will be available for interviews.

    Click link for PDF document   More harm than good – DSM 5 and exclusively biological psychiatry must be completely rethought

BBC: Mental health ‘bible’ update due May 18

Psych Central, US: DSM-5 Released: The Big Changes John M Grohol, Psy.D., May 18

Wired Science, US: A Case That Tells the Weird Tale of DSM – and Other Recommended Reading David Dobbs, May 18

For a single post that shows how weirdly and unevenly psychiatric diagnosis actually works (and fails to work) in this country, and what that means for the new DSM, get over to Maia Svalavitz’s clear-eyed account of her own five diagnoses (and the one she never got)…

Independent, UK: Comment: Despite what the DSM implies, medical intervention is not always the answer to mental health issues Frank Furedi, May 18

You don’t need to be a mental health professional to take an interest in the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders

…Recently, the British Psychological Society’s division of clinical psychology has attacked the psychiatric profession for offering a biomedical model for understanding mental distress. But its criticism was not directed at the ethos of medicalisation as such, but only at the tendency to associate mental illness with biological causes. What it offered was an alternative model of medicalisation – one where mental illness was represented as the outcome of social and psychological cause. It seems that medicalization has become so deeply entrenched that even critics of the DSM accept its premise.

OUP Blog (Oxford University Press): Clinician’s guide to DSM-5 Joel Paris, MD, May 18

…The DSM system can be described as flawed but necessary. Clinicians need to communicate to each other, and even a wrong diagnosis allows them to do so.

For earlier responses to release of DSM-5 see Posts #251 and #249

DSM-5 released: Media, professional and advocacy reaction: Round up #1

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Eureka Alert: American Psychiatric Association Press Release: American Psychiatric Association releases DSM-5 May 17

Science Media Centre, UK: Press briefing: Has psychiatry gone too far? May 17

Speakers:

Prof Elizabeth Kuipers, Professor of Clinical Psychology, Head of Department of Psychology, King’s College London’s Institute of Psychiatry;
Prof David Clark, Professor of Experimental Psychology, University of Oxford and Honorary Fellow of the British Psychological Society;
Prof Nick Craddock, Professor of Psychiatry, University of Cardiff and Director of the National Centre for Mental Health, Wales;
Prof David Taylor, Royal Pharmaceutical Society expert and spokesperson on mental health medicines and Editor of the Maudsley Prescribing Guidelines;
Andy Bell, Deputy Chief Executive, The Centre for Mental Health

Medscape Medical News from The American Psychiatric Association’s 2013 Annual Meeting: DSM-5: Setting the Record Straight Jeffrey A Lieberman, MD

…The NIMH’s position on the DSM and need for scientific progress in understanding the genetic and neurobiologic basis of mental disorders has not changed. The DSM is an essential guide to clinicians to facilitate accurate diagnosis and treatment. At the same time, biomedical research cannot be confined by traditional diagnostic constructs and their boundaries. Tom and I, and the APA and NIMH, are in complete agreement on this. The DSM is a valuable guide that helps clinicians in the evaluation of patients to establish an accurate diagnosis and facilitate the most effective treatment. It is designed to reflect the latest scientific knowledge and translate this into a “user-friendly” instrument for clinicians and patients…

Medscape Medical News from The American Psychiatric Association’s 2013 Annual Meeting: DSM-5 Officially Launched, But Controversy Persists Caroline Cassels, May 18

…diagnostic categories represented in the DSM-IV and the International Classification of Diseases-10 (ICD-10, containing virtually identical disorder codes) remain the contemporary consensus standard for how mental disorders are diagnosed and treated.

American Psychological Association: Practice Central Update: Nine frequently asked questions about DSM-5 and ICD-10-CM Practice Research and Policy staff, May 16

APA Practice staff answer questions about billing, determining diagnoses and more related to the two diagnostic classification systems.

Market Place, Health Care, US: How much is the DSM-5 worth? Dan Gorenstein, May 17

It’s 19 years old and it still brings in about $4-5 million a year…with 150,000 pre-orders the DSM-5 is a hot seller. We may do a second printing more quickly than we originally thought,” says Scully. At $199 dollars for the hardcover, $149 for paperback — that’s more than $20 million in sales right there.

BBC Radio 5 live: Friday 10:00, 120 mins


http://www.bbc.co.uk/programmes/b01sf42v

One of the country’s leading psychologists tells this programme that the way mental health conditions are diagnosed in the UK is “deeply flawed” and too many people are being labelled with specific syndromes like post traumatic stress disorder, attention deficit hyperactivity disorder and personality disorders. Dr Lucy Johnstone, from the division of clinical psychology, says we shouldn’t be labelling behaviour as illnesses when in most cases people are just reacting in understandable ways to life experiences. Victoria speaks to Dr Johnstone and to listeners who have been diagnosed with mental health problems.

Clip 14:52: Are we too quick to diagnose mental health illnesses?


http://www.bbc.co.uk/programmes/p0195g8k

RCPSYCH, UK: Troubled waters Blog of the President of the Royal College of Psychiatrists, Prof Sue Bailey

The Monthly, Australia: DSM-5 and the Mental Illness Make-over Prof Nick Haslam, May 2013

ABC News, Australia: Psychiatry bible receives a makeover Sophie Scott, Michelle Brown, Gillian Bennett, May 19

Daily Telegraph, Australia: New psychiatry manual, DSM5, reclassifies previously normal behaviours as illnesses Sue Dunlevy, May 18

Toronto Star, Canada: DSM-5: Controversial changes to psychiatry’s bible Nancy White, May 17

El Confidential, Madrid: El DSM-5, la nueva biblia de los psiquiatras, atacada por los psicólogos May 14

Sinc habla en exclusive con David J. Kupfer

Psychiatric News, US: Ink Meets Paper as DSM-5 Goes to Press Aaron Levin, May 17

Slate, US: The DSM-5 Is Not Crazy, Psychiatry’s new diagnoses of picking, bingeing, and tantrums sound silly, but they’re useful for me and my patients, Marla W Deibler, May 17

Ottowa Citizen, Canada: Infighting, boycotts, resignations: Psychiatry faces another crisis of confidence Sharon Kirkey, Postmedia News, May 17

Independent, UK: Doctors in dispute: What exactly is normal human behaviour? Jeremy Laurance, May 17

Japan Times: Psychiatrists under fire in mental health battle Jamie Doward, May 18

Reuters: Psychiatrists unveil their long-awaited diagnostic “bible” Sharon Begley, May 17

NIMH Director issues joint statement with APA President-elect on DSM’s validity as diagnostic tool

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NIMH Director issues joint statement with APA President-elect on DSM’s validity as a diagnostic tool

Post #248 Shortlink:
http://wp.me/pKrrB-308

180degrees

Less than two weeks after throwing DSM under the bus, NIMH’s Director, Thomas Insel, has issued a joint statement with APA President-elect, Jeffrey Lieberman.

This week, DSM…

…represents the best information currently available for clinical diagnosis of mental disorders

In a Pharmalot report titled NIMH Director Says The Bible Of Psychiatry Is Valid, After All, Ed Silverman writes:

‘Just 10 short days after trashing the widely regarded bible of psychiatry for lacking validity, National Institutes of Mental Health director Tom Insel has had a change of heart. Along with American Psychiatric Association president-elect Jeff Lieberman, he has now issued a statement saying the forthcoming version…is a valuable diagnostic tool. Their missive amounts to a combination of face saving and damage control…’

Report, here, from Sharon Jayson, for USA Today:

NIH official clarifies criticism of diagnostic manual

‘The groups also make it clear that DSM-5 isn’t going away.

‘DSM-5 and RDoC represent complementary, not competing, frameworks…As research findings begin to emerge from the RDoC effort, these findings may be incorporated into future DSM revisions and clinical practice guidelines,” the statement says. “But this is a long-term undertaking. It will take years to fulfill the promise that this research effort represents for transforming the diagnosis and treatment of mental disorders.”‘

1 Boring Old Man’s take here: a long and winding road…

Gary Greenberg at the New Yorker: The Rats of N.I.M.H.

Tuesday’s joint statement from Thomas Insel and Jeffrey Lieberman, here:

 Click link for PDF document   Joint APA and NIMH Statement

Or here on NIMH site: DSM-5 and RDoC: Shared Interests

Full text APA Release No. 13-37

For Information Contact:
Eve Herold, 703-907-8640 May 14, 2013
press@psych.org Release No. 13-37
Erin Connors, 703-907-8562
econnors@psych.org
DSM-5 and RDoC: Shared Interests
Thomas R. Insel, M.D., director, NIMH
Jeffrey A. Lieberman, M.D., president-elect, APA

NIMH and APA have a shared interest in ensuring that patients and health providers have the best available tools and information today to identify and treat mental health issues, while we continue to invest in improving and advancing mental disorder diagnostics for the future.

Today, the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), along with the International Classification of Diseases (ICD) represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5. As NIMH’s Research Domain Criteria (RDoC) project website states, “The diagnostic categories represented in the DSM-IV and the International Classification of Diseases-10 (ICD-10, containing virtually identical disorder codes) remain the contemporary consensus standard for how mental disorders are diagnosed and treated.”

Yet, what may be realistically feasible today for practitioners is no longer sufficient for researchers. Looking forward, laying the groundwork for a future diagnostic system that more directly reflects modern brain science will require openness to rethinking traditional categories. It is increasingly evident that mental illness will be best understood as disorders of brain structure and function that implicate specific domains of cognition, emotion, and behavior. This is the focus of the NIMH’s Research Domain Criteria (RDoC) project. RDoC is an attempt to create a new kind of taxonomy for mental disorders by bringing the power of modern research approaches in genetics, neuroscience, and behavioral science to the problem of mental illness.

The evolution of diagnosis does not mean that mental disorders are any less real and serious than other illnesses. Indeed, the science of diagnosis has been evolving throughout medicine. For example, subtypes of cancers once defined by where they occurred in the body are now classified on the basis of their underlying genetic and molecular causes.

All medical disciplines advance through research progress in characterizing diseases and disorders. DSM-5 and RDoC represent complementary, not competing, frameworks for this goal. DSM-5, which will be released May 18, reflects the scientific progress seen since the manual’s last edition was published in 1994. RDoC is a new, comprehensive effort to redefine the research agenda for mental illness. As research findings begin to emerge from the RDoC effort, these findings may be incorporated into future DSM revisions and clinical practice guidelines. But this is a long-term undertaking. It will take years to fulfill the promise that this research effort represents for transforming the diagnosis and treatment of mental disorders.

By continuing to work together, our two organizations are committed to improving outcomes for people with some of the most disabling disorders in all of medicine.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in diagnosis, treatment, prevention, and research of mental illnesses including substance use disorders.

Visit the APA at www.psychiatry.org
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More on the RDoC from the NIMH website

Research Domain Criteria

The National Institute of Mental Health Strategic Plan Released August 2008

DSM-5 Round up: May #1

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More reports on last week’s announcement by NIMH Director, Thomas Insel

BMJ News [Full report behind paywall]

Director of top research organization for mental health criticizes DSM for lack of validity

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2954 (Published 8 May 2013)

Michael McCarthy, Seattle | May 8, 2013

New Scientist print edition No 2196 May 11, 2013

[The first of these two print edition articles is behind a subscription]

How a scientific DSM will transform psychiatry

Peter Aldhous, Andy Coghlan, additional reporting by Sara Reardon

This article appears in the print edition THIS WEEK section under the headline

A revolution in mental health, Patients deserve better than an unscientific manual, says leading health institute

…don’t expect the landscape of mental illness to change any time soon. Insel accepts that it will take at least a decade to conduct the research necessary to devise a new approach to diagnosis. In the meantime, patients’ illnesses will continue to be diagnosed using the DSM’s symptom-based categories…

…Even the transition in research will be gradual – the NIMH isn’t going to stop funding projects based around DSM diagnoses overnight. But it is clear that new approaches will get priority in future, and with a budget of almost $1.5 billion per year, the NIMH is in a position to call the shots…

This week’s Editorial in the print edition is an edited version of the Allen Frances opinion piece published by New Scientist earlier this week:

Print edition Editorial > Opinion

Don’t count on this manual, The future of psychiatric research lies in simpler questions, by Allen Frances

UK Independent

The Diagnostic and Statistical Manual of Mental Disorders has been updated but should we beware this manual’s diagnosis?

The book which gives doctors a checklist for mental illnesses – as made famous by The Psychopath Test – has been updated. But does it really work?

…An alternative – and free – publication, International Statistical Classification of Diseases (ICD), issued by the World Health Organisation, provides an official international classification system of mental illness that the DSM sometimes borrows. The ICD is used in Europe for clinical treatment in preference to the DSM and without the lurid headlines. The DSM, though, is increasingly influential on our way of thinking about mental health…

Mark Piesing | May 8, 2013

Comment to article from Dx Revision Watch

For global usage of DSM v ICD by practising psychiatrists and country by country breakdown see
Slide 17 Global use of DSM-5 and ICD-10; Slide 18 Use by country breakdown
http://www.aaidd.org/media/3192013.pdf
Data from The WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification Free full paper

UK Radio

BBC R4 Today programme

Discussion on DSM-5 | Today programme, Thurs, May 9


http://www.bbc.co.uk/iplayer/episode/b01s8qx7/Today_09_05_2013/

1 hr.50 mins in from start |  7 minutes

With James Davies, Lecturer and author of “Cracked” (has also had two articles around his book published in the Times)

Does your child really have a behavioural problem? James Davies, May 6 2013

and Prof Nick Craddock

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BBC R4 All in the Mind [One year left to listen again]


http://www.bbc.co.uk/programmes/p018qfjm

Presenter Claudia Hammond

The new edition of the American Diagnostic and Statistical Manual of Mental Disorders will be launched later this month, Professor Simon Wessely discusses its potential impact in the UK.

Duration: 9 mins at start of 28 min broadcast| Tuesday 07 May 2013 21:00 | Repeated Wed 8 May 2013 15:30

Discussion omitted any reference to, and implications for the WHO/APA International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders commitment to strive as far as possible for harmonization between the mental health chapter of the forthcoming ICD-11 (Chapter 5) and DSM-5.

The Scientist

NIMH to Steer Away from New Manual

The agency will no longer use the newly revised guide to mental disorders to categorize its funding priorities.

Kate Yandell | May 9, 2013

…To better classify mental disease, the NIMH has started the Research Domain Criteria (RDoC) project, which Insel said will “transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.” However, biological biomarkers for mental disease are few, so Insel said that RDoC is more of a framework for future knowledge to fit into than a completed classification system…

…In order to better fill in the gaps, he said that NIMH grant applicants will be asked to think of research projects that cut across diagnoses…

…NIMH is not “ditching” the DSM completely, Insel told Time. DSM diagnostic criteria will continue to be important in the clinic, just not as guides for research.

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Not specific to recent announcement by NIMH’s, Thomas Insel

Huffington Post [Also at Psychiatric Times, Psychology Today]

Hippocratic Humility in the Face of ‘Unexplained’ Medical Problems

Allen Frances, MD | May 7, 2013

With contribution from Dr Diane O’Leary

National Pain Report

Could Fibromyalgia Be Labeled as a Psychiatric Illness?

Celeste Cooper, RN | May 5, 2013

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Related material

National Institute of Mental Health (NIMH) announcement Transforming Diagnosis
Published by Thomas Insel, Director, NIMH, April 29, 2013

Full text of rebuttal statement from David J Kupfer, Chair, DSM-5 Task Force, press released by APA on May 6, 2013
Dx Revision Watch Post #242:
http://wp.me/pKrrB-2VO

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DSM-5 and the NIMH Research Domain Criteria Project Psychiatric Times, James Phillips, MD, April 13, 2011

NIMH Research Domain Criteria (RDoC) Draft 3.1: June, 2011

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International media Round up #1: National Institute of Mental Health to re-orientate research away from DSM categories

Posted on by

International media Round up #1: National Institute of Mental Health to re-orientate research away from DSM categories

Post #243 Shortlink:
http://wp.me/pKrrB-2VZ

Update: Additional media coverage on NIMH added (Matthew Herper, Forbes; Deborah Brauser, Medscape Medical News; Ferris Jabr, Scientific America; John M Grohol, PsychCentral; TIME; 1 Boring Old Man), plus details of DSM-5 on BBC R4 radio

BBC R4′s All in the Mind this evening will be discussing the impact of the DSM on UK mental health and asking whether or not we in the UK pay any attention to what it contains. No other details about whom Claudia Hammond will be interviewing:


http://www.bbc.co.uk/programmes/b01s8cpf

BBC Radio 4 | Duration: 28 minutes | Tuesday 07 May 2013 21:00 | Wed 8 May 2013 15:30

Yesterday, American Psychiatric Association press released a rebuttal from DSM-5 Task Force Chair, David J Kupfer, to the announcement, last week, that the world’s largest federal mental health funding agency will be re-orientating research away from DSM categories.

Read Kupfer’s statement here:

Statement, David Kupfer, MD, May 3, 2013 [press@psych.org Release No. 13-33]

Chair of DSM-5 Task Force Discusses Future of Mental Health Research

Click link for PDF document American Psychiatric Association Press Release

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The story is trickling into mainstream media and being picked up internationally. For earlier media and blogger coverage, see Dx Revision Watch post: National Institute of Mental Health (NIMH) to ditch the DSM (May 3).

There has been mixed reaction to this announcement by NIMH’s Director, Thomas Insel, with many welcoming a shift from DSM dominance but scepticism, also, over whether NIMH might realistically achieve its objectives, as set out a couple of years ago.

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Media Round up #1

Forbes

Pharma & Healthcare

Why Psychiatry’s Seismic Shift Will Happen Slowly

Matthew Herper Forbes Staff | May 8, 2013

…I called the NIMH, and was put on the phone with Bruce Cuthbert, the director of the division of adult translational research. I had a pretty simple question. If the NIMH were really rejecting or abandoning the DSM, that would mean the agency wouldn’t accept studies that use DSM-5 criteria. For instance, if you wanted to test a new schizophrenia drug in schizophrenics, you’d have to find some new RDoC way of describing the disease.

Cuthbert said repeatedly that would not be the case. It’s not so much that studies that use the DSM-5 will be excluded and abandoned, but that researchers would now be allowed to apply for grants that would not use the manual’s diagnostic criteria, or subdivided them in new, creative ways…

Medscape Medical News > Psychiatry

NIMH, APA Clash Over Upcoming DSM-5

‘Patients Deserve Better,’ NIMH Director Says

Deborah Brauser | May 7, 2013

Scientific America

No One Is Abandoning the DSM, But It Is Almost Time to Transform It

Ferris Jabr | May 7, 2013

PsychCentral

Did the NIMH Withdraw Support for the DSM-5? No

John M. Grohol, Psy.D. | May 7, 2013

…Will this replace the DSM-5? No, because as Dr. Insel notes, “This is a decade-long project that is just beginning.” If the NIMH effort ever replaces the DSM, it will be a long time from now…

“I also should point out that these comments reflect [only] our translational research portfolios. Our Division of Services and Intervention Research mostly supports research conducted in clinical settings that is relevant to current clinical practice and services delivery. Thus, [...] grants in these areas will continue to be predominantly funded with DSM categories for some time.” [according to Dr. Bruce Cuthbert, director of the Division of Adult Translational Research at the National Institute of Mental Health]

1 Boring Old Man

…groundhog day

1 Boring Old Man | May 7, 2013

TIME

Mental Illness

Mental Health Researchers Reject Psychiatry’s New Diagnostic ‘Bible’

Maia Szalavitz | May 7, 2013

Just weeks before psychiatry’s new diagnostic “bible”—the DSM 5— is set to be released, the world’s major funder of mental health research has announced that it will not use the new diagnostic system to guide its scientific program, a change some observers have called “a cataclysm” and “potentially seismic.” Dr. Thomas Insel, the director of the National Institute on Mental Health, said in a blog post last week that “NIMH will be re-orienting its research away from DSM categories.”

The change will not immediately affect patients. But in the long run, it could completely redefine mental health conditions and developmental disorders. All of the current categories — from autism to schizophrenia — could be replaced by genetic, biochemical or brain-network labeled classifications. Psychiatrists, who are already reeling from the conflict-filled birth of the fifth edition of the Diagnostical and Statistical Manual of Mental Disorders, are feeling whipsawed…

…The NIMH has outlined a new diagnostic system — called Research Domain Criteria (RDoC) — that could ultimately replace the DSM, but it’s not yet ready for prime time. For the time being, NIMH and the psychiatrists who use the manual will continue to abide by existing classifications for diagnosing patients and getting treatment reimbursed. “Some people have the idea that we’re trying to ditch or diss the DSM and that’s not a fair assessment,” says Insel…

New York Times

Psychiatry’s Guide Is Out of Touch With Science, Experts Say

Pam Belluck and Benedict Carey | May 6, 2013

…“As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”

…Dr. Insel said in the interview that his motivation was not to disparage the D.S.M. as a clinical tool, but to encourage researchers and especially outside reviewers who screen proposals for financing from his agency to disregard its categories and investigate the biological underpinnings of disorders instead. He said he had heard from scientists whose proposals to study processes common to depression, schizophrenia and psychosis were rejected by grant reviewers because they cut across D.S.M. disease categories.

“They didn’t get it,” Dr. Insel said of the reviewers. “What we’re trying to do with RDoC is say actually this is a fresh way to think about it.”

He added that he hoped researchers would also participate in projects funded through the Obama administration’s new brain initiative.

Dr. Michael First, a psychiatry professor at Columbia who edited the last edition of the manual, said, “RDoC is clearly the way of the future,” although it would take years to get results that could apply to patients. In the meantime, he said, “RDoC can’t do what the D.S.M. does. The D.S.M. is what clinicians use. Patients will always come into offices with symptoms.”

For at least a decade, Dr. First and others said, patients will continue to be diagnosed with D.S.M. categories as a guide, and insurance companies will reimburse with such diagnoses in mind…

Science Insider

NIMH Won’t Follow Psychiatry ‘Bible’ Anymore

Emily Underwood | May 6, 2013

…Helena Kraemer, a biostatistician at Stanford University in Palo Alto, California, who was responsible for field trials of diagnostic categories proposed for DSM-5, says that Insel is right that the NIMH’s new program, called Research Domain Criteria (RDoC) is “the direction we have to go.” However, she says, “he’s wrong in saying that DSM-5 is to be set aside.” When it comes to validity, there now is no gold standard, she says. “The DSM is a series of successive approximations.” Kraemer’s vision is that future versions of the manual will not have to wait 10 to 15 years for revision, but incorporate new scientific data from RDoC as it emerges. She says that a meeting is scheduled in June to discuss the possibility of converting the DSM into an electronic document that could incorporate those changes. “Everybody I’ve talked to about it thinks that’s a good idea.”

…Implementing RDoC will present some practical challenges, [William] Carpenter acknowledges. “This does shift the paradigm.” Rather than excluding all study subjects who do not fit a DSM diagnosis, such as major depression, for example, the new approach might include a range of participants with different diagnoses who all demonstrate anhedonia, the impaired ability to experience pleasure, and might look for underlying brain abnormalities that they share in common. “I bet that the rough spots are overcome pretty quickly,” Carpenter says, “but of course we have to see how well that actually works out…”

The Globe and Mail [Canada]

American Psychiatric Association rebuked over new diagnostic manual

Wency Leung | May 6, 2013

…[Gary] Greenberg says that while he believes that this change in the institute’s research direction will generate a huge amount of science on mental health, he is skeptical that researchers will be able to boil down the extraordinarily complex workings of the brain into sound and specific diagnostic criteria.

In response to Insel, the APA issued a statement on Saturday by David Kupfer, chair of the DSM-5 task force, noting that it has been waiting for decades for reliable biological and genetic markers on which to base precise diagnoses. “We are still waiting,” Kupfer said.

In the meantime, the DSM is the “strongest system currently available for classifying disorders,” he said.

“Efforts like the National Institute of Mental Health’s Research Domain Criteria (RDoC) are vital to the continued progress of our collective understanding of mental disorders,” Kupfer said. “But they cannot serve us in the here and now, and they cannot supplant DSM-5…”

Psychology Today Blog Mood Swings

NIMH: A Requiem for DSM – and its Critics
A new generation will reject DSM, and the anti-biological critics of DSM too

Dr. Nassir Ghaemi in Mood Swings | May 5, 2013

Update: Response from Gary Greenberg and further comment from Bernard Carroll, MD

Wetenschap 24 News [Netherlands]

Psychiaters verwerpen psychiatriebijbel

Door: Nadine Böke | mei 03, 2013

De grootste onderzoeksinstelling voor geestelijke gezondheidszorg ter wereld, het Amerikaanse NIMH (National Institute for Mental Health) verwerpt ‘psychiatriebijbel’ DSM.

LaPresse [French Canadian]

Le blogue santé

DSM-5: une bible controversée

Valérie Simard | 6 mai 2013

Agence Science-Presse [French Canadian]

Recherche: désaveu de la bible des psychiatres

Agence Science-Presse |  le 6 mai 2013

(Agence Science-Presse) L’ouvrage qu’on décrit sans cesse comme la «bible» des maladies mentales, et dont la nouvelle édition, après des années d’attente, doit paraître ce mois-ci, vient d’être écarté par rien de moins que le plus gros organisme subventionnaire de la recherche sur les maladies mentales au monde.

De Morgen [Belgium]

Something rotten in de psychiatrie

OPINIE − 07/05/13

De labelingmachine van de DSM 5 is mensonwaardig.
Wat doet de overheid, vraagt Marc Calmeyn. Calmeyn is psychiater en psychoanalyticus. Hij werkt in Brugge.

For earlier media and blogger coverage, see Dx Revision Watch post: National Institute of Mental Health (NIMH) to ditch the DSM.

Kupfer (APA) statement on National Institute of Mental Health (NIMH) announcement

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Kupfer (APA) statement on National Institute of Mental Health (NIMH) announcement

Post #242 Shortlink:
http://wp.me/pKrrB-2VO

David J Kupfer, Chair, DSM-5 Task Force, has issued a statement in response to the April 29 announcement by NIMH’s Thomas Insel:

 Click link for PDF document   American Psychiatric Association Press Release

Text:

For Information Contact:

Eve Herold, 703-907-8640 May 3, 2013

press@psych.org Release No. 13-33

Erin Connors, 703-907-8562

econnors@psych.org

Statement by David Kupfer, MD

Chair of DSM-5 Task Force Discusses Future of Mental Health Research

The promise of the science of mental disorders is great. In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting. In the absence of such major discoveries, it is clinical experience and evidence, as well as growing empirical research, that have advanced our understanding of disorders such as autism spectrum disorder, bipolar disorder, and schizophrenia.

This progress will soon be recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The new manual, due for release later this month, represents the strongest system currently available for classifying disorders. It reflects the progress that we have made in several important areas.

• A revised chapter organization signals how disorders may relate to each other based on underlying vulnerabilities or symptom characteristics.

• Disorders are framed in the context of age, gender, and cultural expectations, in addition to being organized along a valuable developmental lifespan within each chapter.

• Key disorders were combined or reorganized because the relationships among categories clearly placed them along a single continuum, such as substance use disorder and autism spectrum disorder.

• A new section introduces emerging measures, models and cultural guidance to assist clinicians in their evaluation of patients. For the first time, self-assessment tools are included to directly engage patients in their diagnosis and care.

DSM, at its core, is a guidebook to help clinicians describe and diagnose the behaviors and symptoms of their patients. It provides clinicians with a common language to deliver the best patient care possible. And through content such as the new Section III, the next manual also aims to encourage future directions in research.

Efforts like the National Institute of Mental Health’s Research Domain Criteria (RDoC) are vital to the continued progress of our collective understanding of mental disorders. But they cannot serve us in the here and now, and they cannot supplant DSM-5. RDoC is a complementary endeavor to move us forward, and its results may someday culminate in the genetic and neuroscience breakthroughs that will revolutionize our field. In the meantime, should we merely hand patients another promissory note that something may happen sometime? Every day, we are dealing with impairment or tangible suffering, and we must respond. Our patients deserve no less.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org

ENDS

National Institute of Mental Health (NIMH) to ditch the DSM

Posted on by

National Institute of Mental Health (NIMH) to ditch the DSM

Post #241 Shortlink:
http://wp.me/pKrrB-2UL

An edited version of the post published on May 3

DSM5NIMH to ditch DSM

Earlier this week, in a blog dated April 29, Thomas Insel, National Institute of Mental Health’s Director, quietly drove another nail into the coffin of DSM-5.

NIMH, part funders of the 13 DSM-5 Research Planning Conferences held between 2004 and 2008 and the monographs that resulted out of them, announced that NIMH “will be re-orienting its research away from DSM categories.”

I don’t have figures for how much funding NIMH has sunk into the development of DSM-5.

This announcement comes just three weeks before the American Psychiatric Association launches its next edition of the Diagnostic and Statistical Manual of Mental Disorders, with a clutch of spin off publications scheduled for release in May and September.

APA has yet to issue a statement or comment in the press.

At the end of this post are links to the NIMH Research Domain Criteria (RDoC) posted in 2011, and a commentary by James Phillips, MD, for Psychiatric Times, from April 2011: “DSM-5 and the NIMH Research Domain Criteria Project.”

You can read Thomas Insel’s announcement in full, below, followed by a round up of media coverage.

Additional coverage and commentary is being added, as it comes in, below the NIMH announcement in the pale blue box.

Most recently added: Dr Tad; Neurocritic BlogSpot

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On April 24, in Mental health: On the spectrum, Nature had reported:

“Research suggests that mental illnesses lie along a spectrum — but the field’s latest diagnostic manual still splits them apart…

“…The APA claims that the final version of DSM-5 is a significant advance on the previous edition and that it uses a combination of category and dimensional diagnoses. The previously separate categories of substance abuse and substance dependence are merged into the new diagnosis of substance-use disorder. Asperger’s syndrome is bundled together with a handful of related conditions into the new category called autism-spectrum disorder; and OCD, compulsive hair-pulling and other similar disorders are grouped together in an obsessive–compulsive and related disorders category. These last two changes, Regier says, should help research scientists who want to look at links between conditions. “That probably won’t make much difference to treatment but it should facilitate research into common vulnerabilities,” he says.

“The Research Domain Criteria project is the biggest of these research efforts. Last year, the NIMH approved seven studies, worth a combined US$5 million, for inclusion in the project — and, Cuthbert says, the initiative “will represent an increasing proportion of the NIMH’s translational-research portfolio in years to come”. The goal is to find new dimensional variables and assess their clinical value, information that could feed into a future DSM.

“One of the NIMH-funded projects, led by Jerzy Bodurka at the Laureate Institute for Brain Research in Tulsa, Oklahoma, is examining anhedonia, the inability to take pleasure from activities such as exercise, sex or socializing. It is found in many mental illnesses, including depression and schizophrenia.

“Bodurka’s group is studying the idea that dysfunctional brain circuits trigger the release of inflammatory cytokines and that these drive anhedonia by suppressing motivation and pleasure. The scientists plan to probe these links using analyses of gene expression and brain scans. In theory, if this or other mechanisms of anhedonia could be identified, patients could be tested for them and treated, whether they have a DSM diagnosis or not.

“One of the big challenges, Cuthbert says, is to get the drug regulators on board with the idea that the DSM categories are not the only way to prove the efficacy of a medicine. Early talks about the principle have been positive, he says. And there are precedents: “Pain is not a disorder and yet the FDA gives licences for anti-pain drugs,” Cuthbert says.

“Going back to the drawing board makes sense for the scientists, but where does it leave DSM-5? On the question of dimensionality, most outsiders see it as largely the same as DSM-IV. Kupfer and Regier say that much of the work on dimensionality that did not make the final cut is included in the section of the manual intended to provoke further discussion and research. DSM-5 is intended to be a “living document” that can be updated online much more frequently than in the past, Kupfer adds. That’s the reason for the suffix switch from V to 5; what comes out next month is really DSM-5.0. Once the evidence base strengthens, he says, perhaps as a direct result of the NIMH project, dimensional approaches can be included in a DSM-5.1 or DSM-5.2…”

National Institute of Mental Health (NIMH) announcement

Transforming Diagnosis

By Thomas Insel on April 29, 2013

Thomas R. Insel, M.D., is Director of the National Institute of Mental Health (NIMH).

“…Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system…”

“…That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system….”

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Dr Tad Blog

Paradigms lost: NIMH, McGorry & DSM-5’s failure

Dr Tad | May 4, 2013

Neurocritic Blogspot

RDoC Dimensional Approach for Research vs. DSM-5 for Diagnosis

Neurocritic | May 5, 2013

Article in Romanian

DESCOPERĂ

Cea mai importantă ştiinţă a minţii umane, psihiatria, se transformă în urma unei decizii importante

Article in French

Psychomédia

Le National Institute of Mental Health (NIMH) américain se distance du DSM-5 de l’American Psychiatric Association

Soumis par Gestion le 3 mai 2013

“Le National Institute of Mental Health (NIMH) américain réoriente ses recherches en se distançant du DSM, le Diagnostic and Statistical Manual of Mental Disorders, dont la cinquième édition sera lancée par l’American Psychiatric Association le 22 mai, explique son directeur, Thomas Insel, dans un billet publié le 29 avril…”

Article in Turkish

Psikiyatristler DSM tanı kriterlerini terk ediyor!

Dünyadaki en büyük ruh sağlığı araştırma kurumlarından ABD Ulusal Sağlık Kurumu (NIMH), psikiyatrik rahatsızlıkların semptomlara bağlı olarak belirlenmesine dayanan tanı yöntemini terk ediyor.

Pazar, 05 Mayıs 2013

Scientific American John Horgan Blog

Psychiatry in Crisis! Mental Health Director Rejects Psychiatric “Bible” and Replaces With… Nothing

“NIMH director Insel doesn’t mention it, but I bet his DSM decision is related to the big new Brain Initiative, to which Obama has pledged $100 million next year.”

John Horgan | May 4, 2013

Psychology Today
Side Effects | Christopher Lane Ph.D.

The NIMH Withdraws Support for DSM-5
The latest development is a humiliating blow to the APA.

Christopher Lane, Ph.D. | May 4, 2013

Government Health IT

NIMH moving beyond DSM

Anthony Brino, Associate Editor | May 3, 2013

1 Boring Old Man

old news…

1 Boring Old Man | May 3, 2013

Previously posted

Mindhacks blog

National Institute of Mental Health abandoning the DSM

“In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.

In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.

This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.

As a result the NIMH will now be preferentially funding research that does not stick to DSM categories…”

New Scientist

Psychiatry divided as mental health ‘bible’ denounced

Andy Coghlan and Sara Reardon | May 3, 2013

“The world’s biggest mental health research institute is abandoning the new version of psychiatry’s “bible” – the Diagnostic and Statistical Manual of Mental Disorders, questioning its validity and stating that “patients with mental disorders deserve better”. This bombshell comes just weeks before the publication of the fifth revision of the manual, called DSM-5…”

“…We cannot succeed if we use DSM categories as the gold standard,” says Insel. “That is why NIMH will be reorienting its research away from DSM categories,” says Insel. Prominent psychiatrists contacted by New Scientist broadly support Insel’s bold initiative. However, they say that given the time it will take to realise Insel’s vision, diagnosis and treatment will continue to be based on symptoms.

“Insel is aware that what he is suggesting will take time – probably at least a decade, but sees it as the first step towards delivering the “precision medicine” that he says has transformed cancer diagnosis and treatment. “It’s potentially game-changing, but needs to be based on underlying science that is reliable,” says Simon Wessely of the Institute of Psychiatry at King’s College London. “It’s for the future, rather than for now, but anything that improves understanding of the etiology and genetics of disease is going to be better [than symptom-based diagnosis].”

New Scientist opinion piece

One manual shouldn’t dictate US mental health research

“The new edition of the DSM “bible” is so flawed that the US National Institute of Mental Health is right to abandon it, says Allen Frances”

Allen Frances, MD | May 3, 2013

@AllenFrancesMD on Twitter

@AllenFrancesMD: @dxrevisionwatch Hype alert. The NIMH dx approach is a necessary, but guarantees nothing in the future and offers nothing in the present.

The Verge

Federal institute for mental health abandons controversial ‘bible’ of psychiatry

Katie Drummond | May 3, 2013

“In a surprising move, the US government institute responsible for overseeing mental health research is distancing itself from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The DSM has, for several decades, been perceived as the “bible” that delegates how psychiatric illnesses are defined, diagnosed, and treated.”

“The National Institute of Mental Health (NIMH) — which funds more research into mental illness than any other agency in the world — this week announced a plan to re-orient its investigations “away from DSM categories.” The move comes mere weeks before the publication of the DSM-5, an update to the manual that’s been mired in controversy because of several contentious changes to existing diagnostic criteria…”

CBS News

National Institute of Mental Health no longer will use DSM diagnoses in studies

Stephanie Pappas | Livescience.com | May 3, 2013

Pharmalive

NIMH Director Says The Bible Of Psychiatry Lacks Validity

Ed Silverman | May 3, 2013

MIT Technology Review

NIMH Will Drop Widely Used Psychiatry Manual

Susan Young | May 3, 2013

Science 2.0

NIMH Delivers A Kill Shot To DSM-5

By Hank Campbell | May 3, 2013

Pacific Standard [Not on NIMH announcement]

Psychiatry’s Contested Bible: How the New DSM Treats Addiction

The 1,000-page psychiatrists’ Big Book will redefine addiction. Critics are already demanding a boycott.

Michael Dhar | May 3, 2013

Drug Rehab [Not on NIMH announcement]

Somatic Symptom Disorder

drugrehab in Mental Health | April 30, 2013

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Related material

DSM-5 and the NIMH Research Domain Criteria Project  Psychiatric Times, James Phillips, MD, April 13, 2011

NIMH Research Domain Criteria (RDoC)  Draft 3.1: June, 2011

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DSM-5 Round up: April #3

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DSM-5 Round up: April #3

Post #240 Shortlink:
http://wp.me/pKrrB-2T2

…Psychiatry has already reached far into our daily lives, and it’s not by virtue of the particulars of any given D.S.M. It’s because the A.P.A., a private guild, one with extensive ties to the drug industry, owns the naming rights to our pain. That so significant a public trust is in private hands, and on such questionable grounds, is what we ought to worry about.

The New Yorker, April 9, 2013

The Book of Woe

Gary Greenberg is a Connecticut psychotherapist, author of four books and cultivator of an impressive braid.

Greenberg’s new book The Book of Woe: The DSM and the Unmaking of Psychiatry on the politics and controversies surrounding the making of DSM is published by Blue Rider Press on May 2. Read an excerpt here.

Extracts from “Manufacturing Depression” (Harpers, May 2007), essays, articles and other writings can be read here. Media interviews and podcasts here.

Gary Greenberg blogs here.

Interview with Gary Greenberg:

The Atlantic

The Real Problems With Psychiatry

A psychotherapist contends that the DSM, psychiatry’s “bible” that defines all mental illness, is not scientific but a product of unscrupulous politics and bureaucracy.

“…take the damn thing away from them.”

Hope Reese | May 2, 2013

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DSM-5 Media Round up: April #3

Nature | News Feature

Nature Volume: 496, Pages: 416–418 Date published: (25 April 2013) DOI:doi:10.1038/496416a

Mental health: On the spectrum

Research suggests that mental illnesses lie along a spectrum — but the field’s latest diagnostic manual still splits them apart.

David Adam | April 24, 2013

p. 397 Editorial

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Globe and Mail (Canada)

When did life itself become a treatable mental disorder?

Patricia Pearson | Special to The Globe and Mail | April 27, 2013

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Plos Open Access

Perspective doi:10.1371/journal.pbio.1001544

Subgrouping the Autism “Spectrum”: Reflections on DSM-5

Meng-Chuan Lai, Michael V. Lombardo, Bhismadev Chakrabarti, Simon Baron-Cohen

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Monitor on Psychology (Organ of the American Psychological Association)

The Next DSM

A look at the major revisions of the Diagnostic and Statistical Manual of Mental Disorders, due out next month.

Rebecca A Clay | April 2013

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Psychology Today

Saving Normal

The International Reaction to DSM-5

Allen Frances, MD | April 23, 2013

For WPA/WHO survey of global usage of ICD-10 v DSM-5 see Presentation slides: Slides 17 and 18:
Revising the ICD Definition of Intellectual Disability: Implications and Recommendations March 19, 2013
Data from World Psychiatry. 2011 Jun;10(2):118-31.
The WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification.
Reed GM, Mendonça Correia J, Esparza P, Saxena S, Maj M. Free full paper

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Huffington Post Allen Frances MD
Allen Frances MD, Professor Emeritus, Duke University | April 21, 2013

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Slide presentation David J Kupfer

Psychiatry Update – American College of Physicians | March 2, 2013

www.acponline.org/about_acp/chapters/va/13mtg/kupfer_psychiatryupdate.pptx

File Format: Microsoft Powerpoint .pptx

(Emerging options for DSM-5 Primary Care Version from Slide 18)

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Psychiatric News | April 19, 2013
Volume 48 Number 8 page 5-5
10.1176/appi.pn.2013.4b14
American Psychiatric Association

Professional News

Gambling Disorder to Be Included in Addictions Chapter

Mark Moran | April 19, 2013

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Full paper PDF:

www.luc.edu/law/media/law/students/publications/llj/pdfs/hass.pdf

Could the American Psychiatric Association Cause You Headaches? The Dangerous Interaction between the DSM-5 and Employment Law

Douglas A. Hass | March 9, 2013

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Scientific American

New DSM-5 Ignores Biology of Mental Illness

The latest edition of psychiatry’s standard guidebook neglects the biology of mental illness. New research may change that

Ferris Jabr | April 2013

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UK Times

First, the good news: you’re not having a nervous breakdown

John Naish | April 16, 2013

Behind a paywall

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