Category Archives: DSM-5 timeline

DSM-5 publication date May 22: American Psychiatric Association to release DSM-5 between May 18-22, San Francisco

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DSM-5 publication date May 22: American Psychiatric Association to release DSM-5 between May 18-22, San Francisco

Post #235 Shortlink: http://wp.me/pKrrB-2Lq

After 14 years and with a staggering $25 million thrown at it, the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be launched during the American Psychiatric Association’s (APA) Annual Meeting in San Francisco, May 18-22, 2013.

The Bumper Book of Head Stuff has cost $25,000 a page.

“…ignore DSM 5. It is not official. It is not well done. It is not safe. Don’t buy it. Don’t use it. Don’t teach it.”

Commentary: “Does DSM 5 Have a Captive Audience?” Saving Normal, Allen Frances, MD

Further revisions and refinements to the criteria sets and disorder descriptions, following closure of the third and final stakeholder review and comment period (June 15, 2012) and the finalizing of texts in December and January, are embargoed and won’t be evident until the manual is released, next month.

Draft proposals, as they had stood on the DSM-5 Development site for the third stakeholder review, were removed from the APA’s website last November. Additional pages archiving draft proposals for DSM-5 Development internal use which remained publicly accessible were put behind a webmaster log in, around mid March.

(No drafts of the expanded texts that accompany the disorder sections and categories have been available for public scrutiny at any stage in the drafting process.)

The official publication date for DSM-5 is May 22 for the U.S. (May 31 for UK). The manual is 1000 pages and costs nearly $200 for the hardcover edition. An electronic version of the DSM-5 is understood to be in development for later this year.

According to this December 1 interview with Task Force Chair, David J Kupfer, MD, for the Washingtonian,

…While it will likely be some time before we can expect a DSM-6, it may only be a few years until a DSM-5.1 or -5.2, thanks to the expected digital version of the manual. “We don’t wait to wait another 19 to 20 years to have a new revision of the whole volume,” says Kupfer. “But if there is some unexpected consequence, which we can’t anticipate, we have an opportunity to fix something two to three years from now.”

A DSM-5 Table of Contents listing the new disorder sections and category names for DSM-5 (but not the criteria sets) can be accessed on this APA page.

Also at that URL – fact sheets, articles and videos for selected categories, which are being added to every few weeks (including justifications for some of the more controversial changes and new inclusions), and the following documents relating to the overall development process:

Insurance Implications of DSM-5 (New document)
Highlights of Changes from DSM-IV-TR to DSM-5 (updated April 5, 2013)
From Planning to Publication: Developing DSM-5
The Organization of DSM-5
The People Behind DSM-5

A number of books are publishing around the DSM-5 this April and May:

The Intelligent Clinician’s Guide to the DSM-5® by Joel Paris (Apr 17, 2013)

The Book of Woe: The DSM and the Unmaking of Psychiatry by Gary Greenberg  (May 2, 2013) (also available as an Audio Book and Audio CD)

Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life by Allen Frances (May 14, 2013)

Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 by Allen Frances MD (May 17, 2013)

Making the DSM-5: Concepts and Controversies by Joel Paris and James Phillips (May 31, 2013)

Recent press releases

December 1, 2012: APA Release No. 12-43 American Psychiatric Association Board of Trustees Approves DSM-5 (includes Attachment A: Select Decisions Made by APA Board of Trustees)

January 18, 2013: APA Release No. 13-06 DSM-5 Now Available for Preorder

February 28, 2013:  APA Release No. 13-11 APA Annual Meeting in San Francisco, May 18-22; DSM-5 to be Released

April 9, 2013: APA Release No. 13-19 APA 2013 Annual Meeting Special Track to Present DSM-5 Changes

DSM and DSM-5 are registered trademarks of the American Psychiatric Association.

Media coverage: APA Board of Trustees approves DSM-5 diagnostic criteria

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Media coverage: American Pyschiatric Association Board of Trustees approves final DSM-5 diagnostic criteria

Post #213 Shortlink: http://wp.me/pKrrB-2xF

See also Post #212 for APA News Release (12.01.12) and Message from APA President, Dilip Jeste, M.D.

Additional media coverage and commentary will be added to the top of this post as it comes to my attention.

Updates to Media coverage

Huffington Post blog

Dilip V. Jeste, M.D.
President of the American Psychiatric Association

The New DSM Reaches the Finish Line

Dilip V. Jeste, MD | December 11, 2012

Psychiatric Times

Bereavement and the DSM-5, One Last Time

Ronald W. Pies, MD | December 11, 2012

New York Times

Mind

A Tense Compromise on Defining Disorders

Benedict Carey | December 10, 2012

CanWest

Worried about work? You may need therapy: Psychiatric “bible” may classify more chronic worriers as mentally ill

Sharon Kirkey | Postmedia News |December 9, 2012

LA Times

Changes to the psychiatrists’ bible, DSM: Some reactions

Rosie Mestel | December 9, 2012

TIME

Redefining Mental Illness

Elements Behavioral Health

Binge Eating to Be Added to Mental Disorders Manual

December 8, 2012

With contribution from Sharon Kirkey

NPR

Psychiatrists To Take New Approach In Bereavement

Audio of interview with Jerome Wakefield plus transcript

December 5, 2012

New Scientist

Psychiatry is failing those with personality disorders

December 5, 2012

Psychiatric Times

APA Approves DSM-5: Final Stages Under Way

By Laurie Martin, Web Editor | December 6, 2012

SLATE

The New Temper Tantrum Disorder

Will the new diagnostic manual for psychiatrists go too far in labeling kids dysfunctional?

David Dobbs| December 7, 2012

It won’t be published until May, but the American Psychiatric Association’s Diagnostic Statistical Manual, Fifth Edition, or DSM-5—an updating of the field’s highly influential and pleasingly profitable handbook—is already in deep trouble. Every decade or so, DSM publishes a major edition, and often the changes stir controversy. But the alterations the APA announced for DSM-5 this week sparked unusually ferocious attacks from critics, many of them highly prominent psychiatrists. They say the manual fails to check a clear trend toward overdiagnosis and overmedication—and that a few new or expanded diagnoses defy both common sense and empirical evidence. This medicine is not going down well…

British Psychological Society (BPS)

DSM5 approved but controversy continues

NHS Choices

Asperger’s not in DSM-5 mental health manual

Psychology Today Blogs

The People’s Professor

Psychology 360: A brain-behavior buffet, heavy to lite, A to Z by Frank Farley, Ph.D.

Reboot Diagnosis: DSM-5 Goes Live, Nascent Movement Arises

A new open global movement emerges to re-think and re-design diagnosis

Published on December 3, 2012 by Frank Farley, Ph.D. in The People’s Professor

…Our Committee’s strategy at this point is to reboot the whole program of diagnosis, to re-examine the very fundaments of the concept of diagnosis, and to assess what might be involved in creating an alternative approach to those presently available, creating a blueprint, if you will.

Any new or evolved approach would have to meet, in my view, more rigorous scientific criteria, responding to what I call “The Seven Sins of Psychiatric/Psychological science,” (Farley, 2012), incorporate the cultural/social/relationship/humanistic side of our lives, and involve all the principal disciplinary and professional stakeholders in the U.S and internationally. Given the relentless criticisms of the DSM over several decades and the failure to take some of these serious criticisms into account, our Committee (which now consists of myself and Jon Raskin as co-chairs, and members Dean Brent Robbins, Donna Rockwell, Krishna Kumar, Sarah Kamens, and student consultant Erinn Chalene Cosby) has decided to convene with international collaboration an International Ongoing/Online Summit on Diagnosis (or similar title). Among other things we anticipate bringing together scholars and practioners globally and from across the various fields involved in diagnosis to address the Olympian task of an improved approach or approaches to what we have now. We feel the psychological health and well-being of every distressed individual requires a valid and humane approach to diagnosis, and the Zeitgeist is ready…

Medscape Medical News > Psychiatry

Experts React to DSM-5 Approval

Deborah Brauser | December 3, 2012

Experts and organizations are weighing in on this weekend’s decision by the American Psychiatric Association (APA) Board of Trustees to approve the final diagnostic criteria for the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)…

Press Connects

Psychiatrists to make vast changes to diagnosis manual

CBS News

Asperger’s syndrome dropped from American Psychiatric Association manual

CBS/AP/ December 3, 2012, 10:38 AM

Forbes

What Effect Will Changes To The DSM-5 Have On People With (And Without) Mental Health Issues?

Alice G. Walton, Contributor | December 3, 2012

Family Practice News, Practice Trends

APA Approves Final DSM-5 Criteria

Mary Ellen Schneider | Family Practice News Digital Network | December 3,  2012

Examiner

Psychiatric Group Approves New ASD Category

Autism & Asperger

Lee Wilkinson | December 3, 2012

Science Insider

Text of Divisive Psychiatric Manual Finalized

Greg Miller | December 3, 2012

Health News Review

Critic calls American Psychiatric Assoc. approval of DSM-V “a sad day for psychiatry”

Posted by Gary Schwitzer in Disease mongering, Evidence-based medicine | December 03, 2012

Psychology Today

Side Effects
From quirky to serious, trends in psychology and psychiatry

Christopher Lane, Ph.D. | December 2, 2012

A Disaster for Childhood Diagnoses

The next edition of the diagnostic manual will make a bad situation worse

The Board of Trustees of the American Psychiatric Association tried yesterday to project confidence in the next edition of its problem-plagued manual, assuring Americans that radical changes to the DSM “passed” all necessary hurdles and represented a “major milestone” for American psychiatry.

But DSM-5 is now certain to include highly controversial changes, including approval of Attenuated Psychosis Syndrome and Disruptive Mood Dysregulation Disorder—proposals that sparked widespread concern and skepticism when first circulated…

Medscape Medical News > Psychiatry

DSM-5 Gets APA’s Official Stamp of Approval

Caroline Cassels | December 2, 2012

The final diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has been approved by the leadership of the American Psychiatric Association (APA).

In an official communiqué released December 1 at 3:31 pm Eastern Time, the APA announced that its Board of Trustees approved the manual’s proposed criterial…

Boston.com

A relational view of DSM V: a care-rationing document?

Claudia M Gold | December 2, 2012

Because DSM V the newest version of the Diagnostic and Statistical manual, sometimes referred to as the “bible of psychiatry” set to come out in May 2013, makes no mention of relationships, the relational perspective is that it is a flawed instrument. The whole discussion about what categories should and should not be included is off the mark. Nonetheless, as it currently dictates who will and who will not receive treatment, it is a force to be reckoned with…

Psychology Today Blogs

DSM5 in Distress

DSM 5 Is Guide Not Bible- Ignore Its Ten Worst Changes: APA approval of DSM-5 is a sad day for psychiatry.

Allen J Frances MD | December 2, 2012

This is the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry. The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM 5 containing many changes that seem clearly unsafe and scientifically unsound. My best advice to clinicians, to the press, and to the general public – be skeptical and don’t follow DSM 5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication. Just ignore the ten changes that make no sense.

Brief background. DSM 5 got off to a bad start and was never able to establish sure footing. Its leaders initially articulated a premature and unrealizable goal- to produce a paradigm shift in psychiatry. Excessive ambition combined with disorganized execution led inevitably to many ill conceived and risky proposals.

These were vigorously opposed. More than fifty mental health professional associations petitioned for an outside review of DSM 5 to provide an independent judgment of its supporting evidence and to evaluate the balance between its risks and benefits. Professional journals, the press, and the public also weighed in- expressing widespread astonishment about decisions that sometimes seemed not only to lack scientific support but also to defy common sense.

DSM 5 has neither been able to self correct nor willing to heed the advice of outsiders. It has instead created a mostly closed shop- circling the wagons and deaf to the repeated and widespread warnings that it would lead to massive misdiagnosis. Fortunately, some of its most egregiously risky and unsupportable proposals were eventually dropped under great external pressure (most notably ‘psychosis risk’, mixed anxiety/depression, internet and sex addiction, rape as a mental disorder, ‘hebephilia’, cumbersome personality ratings, and sharply lowered thresholds for many existing disorders). But APA stubbornly refused to sponsor any independent review and has given final approval to the ten reckless and untested ideas that are summarized below.

The history of psychiatry is littered with fad diagnoses that in retrospect did far more harm than good. Yesterday’s APA approval makes it likely that DSM 5 will start a half or dozen or more new fads which will be detrimental to the misdiagnosed individuals and costly to our society.

The motives of the people working on DSM 5 have often been questioned. They have been accused of having a financial conflict of interest because some have (minimal) drug company ties and also because so many of the DSM 5 changes will enhance Pharma profits by adding to our already existing societal overdose of carelessly prescribed psychiatric medicine. But I know the people working on DSM 5 and know this charge to be both unfair and untrue. Indeed, they have made some very bad decisions, but they did so with pure hearts and not because they wanted to help the drug companies. Their’s is an intellectual, not financial, conflict of interest that results from the natural tendency of highly specialized experts to over value their pet ideas, to want to expand their own areas of research interest, and to be oblivious to the distortions that occur in translating DSM 5 to real life clinical practice (particularly in primary care where 80% of psychiatric drugs are prescribed).

The APA’s deep dependence on the publishing profits generated by the DSM 5 business enterprise creates a far less pure motivation. There is an inherent and influential conflict of interest between the DSM 5 public trust and DSM 5 as a best seller. When its deadlines were consistently missed due to poor planning and disorganized implementation, APA chose quietly to cancel the DSM 5 field testing step that was meant to provide it with a badly needed opportunity for quality control. The current draft has been approved and is now being rushed prematurely to press with incomplete field testing for one reason only- so that DSM 5 publishing profits can fill the big hole in APA’s projected budget and return dividends on the exorbitant cost of 25 million dollars that has been charged to DSM 5 preparation.

This is no way to prepare or to approve a diagnostic system. Psychiatric diagnosis has become too important in selecting treatments, determining eligibility for benefits and services, allocating resources, guiding legal judgments, creating stigma, and influencing personal expectations to be left in the hands of an APA that has proven itself incapable of producing a safe, sound, and widely accepted manual.

New diagnoses in psychiatry are more dangerous than new drugs because they influence whether or not millions of people are placed on drugs- often by primary care doctors after brief visits. Before their introduction, new diagnoses deserve the same level of attention to safety that we devote to new drugs. APA is not competent to do this.

So, here is my list of DSM 5′s ten most potentially harmful changes. I would suggest that clinicians not follow these at all (or, at the very least, use them with extreme caution and attention to their risks); that potential patients be deeply skeptical, especially if the proposed diagnosis is being used as a rationale for prescribing medication for you or for your child; and that payers question whether some of these are suitable for reimbursement. My goal is to minimize the harm that may otherwise be done by unnecessary obedience to unwise and arbitrary DSM 5 decisions.

1) Disruptive Mood Dysregulation Disorder: DSM 5 will turn temper tantrums into a mental disorder- a puzzling decision based on the work of only one research group. We have no idea whatever how this untested new diagnosis will play out in real life practice settings, but my fear is that it will exacerbate, not relieve, the already excessive and inappropriate use of medication in young children. During the past two decades, child psychiatry has already provoked three fads- a tripling of Attention Deficit Disorder, a more than twenty-times increase in Autistic Disorder, and a forty-times increase in childhood Bipolar Disorder. The field should have felt chastened by this sorry track record and should engage itself now in the crucial task of educating practitioners and the public about the difficulty of accurately diagnosing children and the risks of over- medicating them. DSM 5 should not be adding a new disorder likely to result in a new fad and even more inappropriate medication use in vulnerable children.

2) Normal grief will become Major Depressive Disorder, thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one and substituting pills and superficial medical rituals for the deep consolations of family, friends, religion, and the resiliency that comes with time and the acceptance of the limitations of life.

3) The everyday forgetting characteristic of old age will now be misdiagnosed as Minor Neurocognitive Disorder, creating a huge false positive population of people who are not at special risk for dementia. Since there is no effective treatment for this ‘condition’ (or for dementia), the label provides absolutely no benefit (while creating great anxiety) even for those at true risk for later developing dementia. It is a dead loss for the many who will be mislabeled.

4) DSM 5 will likely trigger a fad of Adult Attention Deficit Disorder leading to widespread misuse of stimulant drugs for performance enhancement and recreation and contributing to the already large illegal secondary market in diverted prescription drugs.

5) Excessive eating 12 times in 3 months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM 5 has instead turned it into a psychiatric illness called Binge Eating Disorder.

6) The changes in the DSM 5 definition of Autism will result in lowered rates- 10% according to estimates by the DSM 5 work group, perhaps 50% according to outside research groups. This reduction can be seen as beneficial in the sense that the diagnosis of Autism will be more accurate and specific- but advocates understandably fear a disruption in needed school services. Here the DSM 5 problem is not so much a bad decision, but the misleading promises that it will have no impact on rates of disorder or of service delivery. School services should be tied more to educational need, less to a controversial psychiatric diagnosis created for clinical (not educational) purposes and whose rate is so sensitive to small changes in definition and assessment.

7) First time substance abusers will be lumped in definitionally in with hard core addicts despite their very different treatment needs and prognosis and the stigma this will cause.

8) DSM 5 has created a slippery slope by introducing the concept of Behavioral Addictions that eventually can spread to make a mental disorder of everything we like to do a lot. Watch out for careless overdiagnosis of internet and sex addiction and the development of lucrative treatment programs to exploit these new markets.

9) DSM 5 obscures the already fuzzy boundary been Generalized Anxiety Disorder and the worries of everyday life. Small changes in definition can create millions of anxious new ‘patients’ and expand the already widespread practice of inappropriately prescribing addicting anti-anxiety medications.

10) DSM 5 has opened the gate even further to the already existing problem of misdiagnosis of PTSD in forensic settings.

DSM 5 has dropped its pretension to being a paradigm shift in psychiatric diagnosis and instead (in a dramatic 180 degree turn) now makes the equally misleading claim that it is a conservative document that will have minimal impact on the rates of psychiatric diagnosis and in the consequent provision of inappropriate treatment. This is an untenable claim that DSM 5 cannot possibly support because, for completely unfathomable reasons, it never took the simple and inexpensive step of actually studying the impact of DSM on rates in real world settings.

Except for autism, all the DSM 5 changes loosen diagnosis and threaten to turn our current diagnostic inflation into diagnostic hyperinflation. Painful experience with previous DSM’s teaches that if anything in the diagnostic system can be misused and turned into a fad, it will be. Many millions of people with normal grief, gluttony, distractibility, worries, reactions to stress, the temper tantrums of childhood, the forgetting of old age, and ‘behavioral addictions’ will soon be mislabeled as psychiatrically sick and given inappropriate treatment.

People with real psychiatric problems that can be reliably diagnosed and effectively treated are already badly shortchanged. DSM 5 will make this worse by diverting attention and scarce resources away from the really ill and toward people with the everyday problems of life who will be harmed, not helped, when they are mislabeled as mentally ill.

Our patients deserve better, society deserves better, and the mental health professions deserve better. Caring for the mentally ill is a noble and effective profession. But we have to know our limits and stay within them.

DSM 5 violates the most sacred (and most frequently ignored) tenet in medicine- First Do No Harm! That’s why this is such a sad moment.

UK Guardian

Asperger’s syndrome dropped from psychiatrists’ handbook the DSM

December 3, 2012

(113 comments)

DSM-5, latest revision of Diagnostic and Statistical Manual, merges Asperger’s with autism and widens dyslexia category

Asperger’s syndrome is to be dropped from the psychiatrists’ Diagnostic and Statistical Manual (DSM) of Mental Disorders, the American publication that is one of the most influential references for the profession around the world.

The term “Asperger’s disorder” will not appear in the DSM-5, the latest revision of the manual, and instead its symptoms will come under the newly added “autism spectrum disorder”, which is already used widely. That umbrella diagnosis will include children with severe autism, who often do not talk or interact, as well as those with milder forms…

The Australian

Parents fear loss of autism funding

Dan Box | December 3, 2012

THE diagnosis of Asperger’s syndrome is being dropped from the world-leading US medical manual of psychiatric conditions, in a decision that could affect the support and funding available to thousands of Australian families.

The decision is among the first major revisions to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders since 1994…

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Media coverage

Huffington Post

DSM-5: Psychiatrists OK Vast Changes To Diagnosis Manual

Lindsey Tanner | December 1, 2012

CHICAGO — For the first time in almost two decades the nation’s psychiatrists are changing the guidebook they use to diagnose mental disorders. Among the most controversial proposed changes: Dropping certain familiar terms like Asperger’s disorder and dyslexia and calling frequent, severe temper tantrums a mental illness.

The board of trustees for the American Psychiatric Association voted Saturday in suburban Washington, D.C., on scores of revisions that have been in the works for several years. Details will come next May when the group’s fifth diagnostic manual is published.

The trustees made the final decision on what proposals made the cut; recommendations came from experts in several task force groups assigned to evaluate different mental illnesses…

MedPage Today

DSM-5 Wins APA Board Approval

John Gever, Senior Editor | December 1, 2012

The American Psychiatric Association’s board of trustees has approved the fifth edition of its influential diagnostic manual, dubbed DSM-5, the group announced Saturday.

The board vote is the last step before the manual is formally released at the APA’s annual meeting next May. The association’s Diagnostic and Statistical Manual of Mental Disorders was last revised in 1994; that edition is known colloquially as DSM-IV…

Examiner
Dyslexia is out of DSM-5: Psychiatrists voted Saturday, Dec. 1, 2012

Tina Burgess | December 1, 2012

On Saturday, Dec. 1, 2012, the board of trustees of the American Psychiatric Association voted in Washington, D.C., that the term “dyslexia” will be eliminated from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

According to Saturday’s The Seattle Times report, “Board members were tightlipped about the update, but its impact will be huge, affecting millions of children and adults worldwide.”

Eliminating the term “dyslexia” from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has major implications for students with dyslexia…

CNN

Psychiatric association approves changes to diagnostic manualCNN International

Miriam Falco, CNN Medical Managing Editor | December 2, 2012

(CNN) — Starting next year, the process of diagnosing autism may see drastic changes following the revision of the official guide to classifying psychiatric illnesses.

After years of reviewing and refining criteria used by psychiatrists and other experts to diagnose mental health disorders, the American Psychiatric Association board of trustees on Saturday approved major changes to the manual, better known as DSM-5…

Dallas Morning News

Asperger’s to be removed from revised edition of American Psychiatric Association’s diagnostic manual

Associated Press The Dallas Morning News

Published: 02 December 2012 12:59 AM

CHICAGO — The now familiar term “Asperger’s disorder” is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But “dyslexia” and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation’s psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association’s new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education….

Wall Street Journal

HEALTH INDUSTRY

Psychiatric Association’s Diagnosis Revisions Seen Upending Evaluations

Melinda Beck | December 1, 2012

Asperger’s syndrome is out and hoarding is in, and starting next year, psychiatrists may diagnose some children with a new “disruptive mood dysregulation disorder” if they have severe tantrums three or more times a week for more than a year.

After more than a decade of discussion and often heated debate, the Board of Trustees of the American Psychiatric Association voted Saturday in Arlington, Va., to approve the fifth edition of the group’s “Diagnostic and Statistical Manual for Mental Disorders” or DSM-5, the official guide to classifying psychiatric illnesses.

The changes – the first major revisions since 1994 — could…

Exclusive subscriber content – sub required to view full commentary.

USA Today

Psychiatrists to make vast changes to diagnosis manual

Sharon Jayson | December 2, 212

Manual also is important for the health insurance industry in deciding what treatments to cover.

7:58 PM EST December 1. 2012 – Asperger’s is out, but binge eating and hoarding are in as official mental disorders in the latest version of the diagnostic bible published by the American Psychiatric Association, following a vote Saturday by that group’s board…

Bloomberg Businessweek – News from Business

Psychiatrists Redefine Disorders Including Autism

Elizabeth Lopatto | December 2, 2012

The vote yesterday by the American Psychiatric Association was alternately called “a disaster” by Allen Frances, who led work on the previous version, and a “conservative document” by David Kupfer, who led the panel that presented the latest edition…

Detroit Free Press ‎

Psychiatric group changing mental illness diagnoses

Lyndsey Tanner | December 2, 2012

The board of trustees for the American Psychiatric Association voted Saturday in suburban Washington, D.C., on scores of revisions that have been in the works for several years. Details will come in May, when the group’s fifth diagnostic manual is published…

Decoded Science

Diagnostic and Statistical Manual V: Small Changes with Big Implications

Gina Putt | December 1, 2012

The American Psychiatric Association’s timeline calls for the ”Final Revisions by the APA Task Force; Final Approval by APA Board of Trustees; Submission to American Psychiatric Publishing, Inc..” in December of 2012. This edition, the fifth, attempts to further…

NPR (blog)

Weekend Vote Will Bring Controversial Changes To Psychiatrists’ Bible

Alix Spiegel | ‎November 30, 2012‎

…The APA refuses to say anything about what’s in and what’s out, and they’ve also told people associated with the DSM-5 that they shouldn’t speak specifically, so it’s very hard to know. But some of the changes that were published last year on the APA website…

From Ben Carey, NYT, November 26

Thinking Clearly About Personality Disorders

Benedict Carey | November 26, 2012 | 355 Comments

This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine: personality disorders.

Personality disorders occupy a troublesome niche in psychiatry. The 10 recognized syndromes are fairly well represented on the self-help shelves of bookstores and include such well-known types as narcissistic personality disorder, avoidant personality disorder, as well as dependent and histrionic personalities.

But when full-blown, the disorders are difficult to characterize and treat, and doctors seldom do careful evaluations, missing or downplaying behavior patterns that underlie problems like depression and anxiety in millions of people.

The new proposal — part of the psychiatric association’s effort of many years to update its influential diagnostic manual — is intended to clarify these diagnoses and better integrate them into clinical practice, to extend and improve treatment. But the effort has run into so much opposition that it will probably be relegated to the back of the manual, if it’s allowed in at all…

Clinical Psychiatry News

Neuroticism and the DSM-5: What Lies Ahead?

11/27/12

By: MICHAEL BRODSKY, M.D., Clinical Psychiatry News Digital Network

If substantive changes to the DSM-5 framework do not occur before publication, clinicians will be called upon to evaluate personality using dimensional measures in addition to the personality diagnostic categories familiar to psychiatrists from the DSM-IV.

In this article, I want to consider the personality dimension of neuroticism, a construct with a long tradition of research and considerable evidence of both internal and external validity (Am. Psychol. 2009;64:241-56). Recent epidemiologic findings suggest that scores along this dimension may carry important clinical implications for mental and physical health…

American Psychiatric Association Board of Trustees approves final DSM-5 diagnostic criteria

Posted on by

American Psychiatric Association Board of Trustees approves final DSM-5 diagnostic criteria

Post #2012 Shortlink: http://wp.me/pKrrB-2xu

Yesterday, December 1, the American Psychiatric Association issued a news release – full text posted below or open PDF here: APA News Release 12.01.12

or download here: http://www.psychiatry.org/advocacy–newsroom/news-releases

There was also an alert published on Pyschiatric News here: APA Board of Trustees Approves DSM-5

A message from APA President Dilip Jeste, M.D., on DSM-5 was also published.

I’ll be compiling links to media coverage in the next post.

Contact: For Immediate Release:

Eve Herold, 703-907- 8640 December 1, 2012

press@psych.org  Release No. 12-43

Erin Connors, 703-907-8562

econnors@psych.org

Tamara Moore, 610-360-3405

tmoore@gymr.com

American Psychiatric Association Board of Trustees Approves DSM-5

Diagnostic manual passes major milestone before May 2013 publication

ARLINGTON, Va. (December 1, 2012) – The American Psychiatric Association (APA) Board of Trustees has approved the final diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The trustees’ action marks the end of the manual’s comprehensive revision process, which has spanned over a decade and included contributions from more than 1,500 experts in psychiatry, psychology, social work, psychiatric nursing, pediatrics, neurology, and other related fields from 39 countries. These final criteria will be available when DSM-5 is completed and published in spring 2013.

“The Board of Trustees approval of the criteria is a vote of confidence for DSM-5,” said Dilip Jeste, MD, president of APA. ―We developed DSM-5 by utilizing the best experts in the field and extensive reviews of the scientific literature and original research, and we have produced a manual that best represents the current science and will be useful to clinicians and the patients they serve.”

DSM-5 is the guidebook used by clinicians and researchers to diagnose and classify mental disorders. Now that the criteria have been approved, review of the criteria and text describing the disorders will continue to undergo final editing and then publication by American Psychiatric Publishing.

The manual will include approximately the same number of disorders that were included in DSM-IV. This goes against the trend from other areas of medicine that increase the number of diagnoses annually.

“We have sought to be conservative in our approach to revising DSM-5. Our work has been aimed at more accurately defining mental disorders that have a real impact on people’s lives, not expanding the scope of psychiatry,” said David J. Kupfer, MD, chair of the DSM-5 Task Force. “I’m thrilled to have the Board of Trustees’ support for the revisions and for us to move forward toward the publication.”

Organization of DSM-5

DSM-5 will be comprised of three sections:

• Section 1 will give an introduction to DSM-5 with information on how to use the updated manual;

• Section 2 will outline the categorical diagnoses according to a revised chapter organization; and

• Section 3 will include conditions that require further research before their consideration as formal disorders, as well as cultural formulations, glossary, the names of individuals involved in DSM-5’s development and other information.

Summary of Decisions for DSM-5

Key decisions made by the Board of Trustees include:*

• Overall Substantive Changes

o Chapter order

o Removal of multiaxial system

• Section 2 Disorders

o Autism spectrum disorder

o Binge eating disorder

o Disruptive mood dysregulation disorder

o Excoriation (skin-picking) disorder

o Hoarding disorder

o Pedophilic disorder

o Personality disorders

o Posttraumatic stress disorder

o Removal of bereavement exclusion

o Specific learning disorders

o Substance use disorder

• Section 3 Disorders

o Attenuated psychosis syndrome

o Internet use gaming disorder

o Non-suicidal self-injury

o Suicidal behavioral disorder

• Disorders Not Accepted for Sections 2 or 3

o Anxious depression

o Hypersexual disorder

o Parental alienation syndrome

o Sensory processing disorder

* More information on select decisions is available in Attachment A.

Collaborative Process for Development of DSM-5

Beginning in 1999, during the initial phase of this DSM revision, the APA engaged almost 400 international research investigators in 13 conferences supported by the National Institutes of Health. To invite comments from the wider research, clinical and consumer communities, the APA launched a DSM-5 Prelude website in 2004 to garner questions, comments, and research findings during the development process.

Starting in 2007 and 2008, the DSM-5 Task Force and Work Groups, made up of more than 160 world-renowned clinicians and researchers, were tasked with building on the previous seven years of scientific reviews, conducting additional focused reviews, and garnering input from a breadth of advisors as the basis for proposing draft criteria. In addition to the Work Groups in diagnostic categories, study groups were assigned to review gender, age and cross-cultural issues. The Work Groups have led the effort to review the scientific advances and research-based information that have formed the basis of the content for DSM-5.

The first draft of proposed changes was posted publicly on the website www.DSM5.org in February 2010 and the site also posted two subsequent drafts. With each draft, the site accepted feedback on proposed changes, receiving more than 13,000 comments on draft diagnostic criteria from mental health clinicians and researchers, the overall medical community, and patients, families, and advocates. Following each comment period, the DSM-5 Task Force and Work Groups reviewed and considered each response and made revisions where warranted.

The Work Groups’ proposals were evaluated by the Task Force and two panels convened specifically to evaluate the proposals—a Scientific Review Committee and a Clinical and Public Health Committee. The Scientific Review Committee looked at the supporting data for proposed changes. The Clinical and Public Health Committee was charged with assessing the potential impact of changes to clinical practice and public health. Additionally, there was a forensic review by members of the Council on Psychiatry and Law.

All of the reviews were coordinated in meetings of the Summit Group, which includes the DSM-5 Task Force co-chairs, and review committee co-chairs, consultants, and members of the Executive Committee of the Board of Trustees. The criteria were then put before the APA Assembly for review and approval. The Board of Trustees’ review was the final step in this multilevel, comprehensive process.

“At every step of development, we have worked to make the process as open and inclusive as possible. The level of transparency we have strived for is not seen in any other area of medicine,” said James H. Scully, MD, medical director and chief executive officer of APA.

###

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 .

Attachment A: Select Decisions Made by APA Board of Trustees

Overall Changes

 • Chapter order: DSM-5’s 20 chapters will be restructured based on disorders’ apparent relatedness to one another, as reflected by similarities in disorders’ underlying vulnerabilities and symptom characteristics. The changes will align DSM-5 with the World Health Organization’s (WHO) International Classification of Diseases, eleventh edition (ICD-11) and are expected to facilitate improved communication and common use of diagnoses across disorders within chapters.

 • Removal of multiaxial system: DSM-5 will move to a nonaxial documentation of diagnosis, combining the former Axes I, II, and III, with separate notations for psychosocial and contextual factors (formerly Axis IV) and disability (formerly Axis V).

Section 2 Disorders

1. Autism spectrum disorder: The criteria will incorporate several diagnoses from DSM-IV including autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder (not otherwise specified), into the diagnosis of autism spectrum disorder for DSM-5 to help more accurately and consistently diagnose children with autism.

2. Binge eating disorder will be moved from DSM-IV’s Appendix B: Criteria Sets and Axes Provided for Further Study to DSM-5 Section 2. The change is intended to better represent the symptoms and behaviors of people with this condition.

3. Disruptive mood dysregulation disorder will be included in DSM-5 to diagnose children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year. The diagnosis is intended to address concerns about potential over-diagnosis and overtreatment of bipolar disorder in children.

4. Excoriation (skin-picking) disorder is new to DSM-5 and will be included in the Obsessive-Compulsive and Related Disorders chapter.

5. Hoarding disorder is new to DSM-5. Its addition to DSM is supported by extensive scientific research on this disorder. This disorder will help characterize people with persistent difficulty discarding or parting with possessions, regardless of their actual value. The behavior usually has harmful effects—emotional, physical, social, financial and even legal—for a hoarder and family members.

6. Pedophilic disorder criteria will remain unchanged from DSM-IV, but the disorder name will be revised from pedophilia to pedophilic disorder.

7. Personality disorders: DSM-5 will maintain the categorical model and criteria for the 10 personality disorders included in DSM-IV and will include the new trait-specific methodology in a separate area of Section 3 to encourage further study how this could be used to diagnose personality disorders in clinical practice.

8. Posttraumatic stress disorder (PTSD) will be included in a new chapter in DSM-5 on Trauma- and Stressor-Related Disorders. DSM-5 pays more attention to the behavioral symptoms that accompany PTSD and proposes four distinct diagnostic clusters instead of three. PTSD will also be more developmentally sensitive for children and adolescents.

9. Removal of bereavement exclusion: the exclusion criterion in DSM-IV applied to people experiencing depressive symptoms lasting less than two months following the death of a loved one has been removed and replaced by several notes within the text delineating the differences between grief and depression. This reflects the recognition that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode beginning soon after the loss of a loved one.

10. Specific learning disorder broadens the DSM-IV criteria to represent distinct disorders which interfere with the acquisition and use of one or more of the following academic skills: oral language, reading, written language, or mathematics.

11. Substance use disorder will combine the DSM-IV categories of substance abuse and substance dependence. In this one overarching disorder, the criteria have not only been combined, but strengthened. Previous substance abuse criteria required only one symptom while the DSM-5’s mild substance use disorder requires two to three symptoms.

http://www.psychnews.org/files/DSM-message.pdf

PDF: Message from APA President on DSM-5

A Message From APA President Dilip Jeste, M.D., on DSM-5

December 1, 2012

I am pleased to announce that DSM-5 has just been approved by APA’s Board of Trustees. Getting to the finish line has taken a decade of arduous work and tens of thousands of pro-bono hours from more than 1,500 experts in psychiatry, psychology, social work, psychiatric nursing, pediatrics, neurology, and other related fields from 39 countries. We look forward to the book’s publication next May.

The goal of the DSM-5 process has been to develop a scientifically based manual of psychiatric diagnosis that is useful for clinicians and our patients. APA’s interest in developing DSM dates back to the organization’s inception in 1844, when one of its original missions was to gather statistics on the prevalence of mental illness. In 1917, the Association officially adopted the first system for uniform statistical reporting called the Statistical Manual for the Use of Hospitals for Mental Diseases, which was adopted successfully by mental hospitals throughout the country. It was expanded into the first Diagnostic and Statistical Manual (DSM) in 1952 and first revised (DSM-II) in 1968. Like the rest of the field in that era, these first two versions were substantially influenced by psychoanalytic theories.

With advances in clinical and scientific knowledge, changes in diagnostic systems are inevitable. The World Health Organization’s International Classification of Diseases (ICD)—the standard diagnostic tool for epidemiology, health management, and clinical care used around the world, which covers all medical diagnoses—has been through 10 editions since the late 1800s and is now preparing its 11th edition, due in 2015. Likewise, DSM has undergone changes to take into account progress in our understanding of mental illnesses. DSM-III, published in 1980 under the leadership of Dr. Robert Spitzer, and DSM-IV, published in 1994 under the leadership of Dr. Allen Frances, represented the state of science of psychiatry at those times and significantly advanced the field.

In the two decades since the publication of DSM-IV, we have witnessed a wealth of new studies on epidemiology, neurobiology, psychopathology, and treatment of various mental illnesses. So, it was time for APA to consider making necessary modifications in the diagnostic categories and criteria based on new scientific evidence. But there were, of course, challenges inherent in revising an established diagnostic system.

The primary criterion for any diagnostic revisions should be strictly scientific evidence. However, there are sometimes differences of opinion among scientific experts. At present, most psychiatric disorders lack validated diagnostic biomarkers, and although considerable advances are being made in the arena of neurobiology, psychiatric diagnoses are still mostly based on clinician assessment.

Also, there are unintended consequences of psychiatric diagnosis. Some arise from the unfortunate social stigma and discrimination in getting jobs or even obtaining health insurance (notwithstanding the mental health parity law) associated with a psychiatric illness. There is also the double-edged sword of underdiagnosis and overdiagnosis. Narrowing diagnostic criteria may be blamed for excluding some patients from insurance coverage and needed services, while expanded efforts to diagnose (and treat) patients in the early stages of illness to prevent its chronicity are sometimes criticized for increasing its prevalence and potentially expanding the market for the pharmaceutical industry. (It should be noted, however, that DSM is not a treatment manual and that diagnosis does not equate to a need for pharmacotherapy.)

APA has carefully sought to balance the benefits of the latest scientific evidence with the risks of changing diagnostic categories and criteria. We realize that, given conflicting views among different stakeholders, there will be inevitable disagreements about some of the proposals—whether they involve retaining the traditional DSM-IV criteria or modifying them.

The process of developing DSM-5 began in earnest in 2006, when APA appointed Dr. David Kupfer as chair and Dr. Darrel Regier as vice chair of the task force to oversee the development of DSM-5. The task force included the chairs of 13 diagnostic work groups, who scrutinized the research and literature base, analyzed the findings of field trials, reviewed public comments, and wrote the content for specific disorder categories within DSM-5. To ensure transparency and reduce industry-related conflicts of interest, APA instituted a strict policy that all task force and work group members had to make open disclosures and restrict their income from industry. In fact, the vast majority of the task force and work group members had no financial relationship with industry.

To obtain independent reviews of the work groups’ diagnostic proposals, the APA Board of Trustees appointed several review committees. These included the Scientific Review Committee (co-chaired by Drs. Ken Kendler and Robert Freeman), Clinical and Public Health Committee (co-chaired by Drs. Jack McIntyre and Joel Yager), and APA Assembly Committee (chaired by Dr. Glenn Martin). Additionally, there was a forensic review by members of the Council on Psychiatry and Law. Drs. Paul Appelbaum and Michael First were consultants on forensic issues and criteria/public comments, respectively. Reviews by all these groups were coordinated in meetings of the Summit Group, which included the task force and review committee co-chairs and consultants along with members of the Executive Committee of the Board of Trustees.

There has been much more public interest and media scrutiny of DSM-5 than any previous revisions. This reflects greater public awareness and media interest in mental illness, as well as widespread use of the Internet and social media. To facilitate this transparent process, APA created a Web site (www.dsm5.org ) where preliminary draft revisions were available for the public to examine, critique, and comment on. More than 13,000 Web site comments and 12,000 additional comments from e-mails, letters, and other forms of communication were received. Members of the DSM-5 work groups reviewed the feedback submitted to the Web site and, where appropriate, made modifications in their proposed diagnostic criteria.

We believe that DSM-5 reflects our best scientific understanding of psychiatric disorders and will optimally serve clinical and public health needs. Our hope is that the DSM-5 will lead to more accurate diagnoses, better access to mental health services, and improved patient outcomes.

Flyer: DSM-5 Core titles from American Psychiatric Publishing

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Flyer: DSM-5 Core titles from American Psychiatric Publishing

Post #211 Shortlink: http://wp.me/pKrrB-2×5

The third stakeholder review and comment period on proposals for revisions to categories and criteria for the next edition of the Diagnostic and Statistical Manual of Mental Disorders, to be known as DSM-5, was launched on May 4.

Following closure of this final public review, revisions made by the DSM-5 Work Groups to criteria and disorder descriptions subsequent to June 15 are subject to embargo.

Final criteria sets and accompanying texts won’t be released until the DSM-5 is published, next year.

The release of DSM-5 is slated for May 18-22, 2013, during the APA’s 2013 Annual Meeting in San Francisco, CA.

A couple of days ago, the third draft was removed in its entirety from the DSM-5 Development website.

In advance of release of DSM-5, the publishing arm of the American Psychiatric Association has issued a promotional flyer for its DSM-5 CORE TITLES:

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

American Psychiatric Association

Desk Reference to the Diagnostic Criteria from DSM-5

American Psychiatric Association

DSM-5 Clinical Cases

John W. Barnhill, M.D., David J. Kupfer, M.D., and Darrel A. Regier, M.D., M.P.H.

DSM-5 Guidebook

Donald W. Black, M.D., and Jon E. Grant, M.D., M.P.H., J.D.

Study Guide to DSM-5

Laura Weiss Roberts, M.D., M.A.

DSM-5 Handbook of Differential Diagnosis

Michael B. First, M.D.

DSM-5 Self-Exam Questions

Test Questions for the Diagnostic Criteria

Philip R. Muskin, M.D.

Note that the flyer states:

• New disorders include, but are not limited to, somatic symptom disorder, hoarding disorder, mild and major neurocognitive disorder, anxiety illness disorder, and premenstrual dysphoric disorder…

According to DSM-5 draft three, the proposed name for the disorder that replaces “Hypochondriasis” in DSM-IV is intended to be “J01 Illness Anxiety Disorder” not “anxiety illness disorder,” as the flyer has it. It is to be hoped that proofs of the manual will be subject to closer scrutiny than this flyer evidently underwent.

The flyer can be opened here 

   DSM-5 flyer

or download here http://dsm5.org/SiteCollectionDocuments/AH1259%20DSM-5%20flyer.pdf

+++

Related material

Further DSM-5 spin-jobs:

Psychiatric News | November 16, 2012

Volume 47 Number 22 page 1b-10

Professional News

Results of DSM Field Trials Available on AJP in Advance

Mark Moran

The field trials provide new data for the ongoing review of proposed diagnostic criteria for DSM-5

Three papers discussing the results of the DSM-5 field trials were posted October 30 by AJP in Advance. These papers describe the methods and results of the 23 diagnoses that were assessed…

and from Task Force Chair, David J. Kupfer…

Huffington Post Blog

David J. Kupfer, MD | Chair, DSM-5 Task Force | November 7, 2012

Field Trial Results Guide DSM Recommendations

Written with Helena C. Kraemer, Ph.D.

Two years ago this month, APA announced the start of field trials that would subject proposed diagnostic criteria for the future DSM-5 to rigorous, empirically sound evaluation across diverse clinical settings. And now, as the first comprehensive analyses of that effort are published, what’s clear is just how well the field trials did their job…

For comment see:

1 Boring Old Man

OMG!…

1 Boring Old Man | November 9, 2012

Side Effects

From quirky to serious, trends in psychology and psychiatry

by Christopher Lane, Ph.D.

The DSM-5 Field Trials’ Decidedly Mixed Results

Far from being a ringing endorsement, the field trials set off fresh alarm bells

Christopher Lane, Ph.D. | November 11, 2012

“What’s the chance that a second, equally expert diagnosis will agree with the first, making a particular diagnosis reliable?” asks David Kupfer, chair of the DSM-5 task force, of the decidedly mixed results of the DSM-5 field trials. First off, are you sure you really want to know?…

You Can’t Turn a Sow’s Ear Into a Silk Purse

By Allen Frances, MD | November 11, 2012

also here on Psychiatric Times (registration required):

http://www.psychiatrictimes.com/blog/frances/content/article/10168/2113993

American Psychiatric Association Annual Meeting: May 18-22, 2013, San Francisco

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American Psychiatric Association 166th Annual Meeting: May 18-22, 2013, San Francisco, CA

Post #209 Shortlink: http://wp.me/pKrrB-2wB

The American Psychiatric Association (APA) has announced its 166th Annual Meeting, scheduled for May 18-22, 2013, San Francisco, CA.

REGISTRATION DATES

EARLY BIRD REGISTRATON

Member November 1, 2012 – January 24, 2013

Nonmember November 15, 2012 – January 24, 2013

ADVANCE REGISTRATION January 25 – April 19, 2013

ONSITE REGISTRATION April 20 – May 22, 2013

Meeting website

Scientific Program

Annual Meeting Information Guide   [9MB PDF at foot of this page]

Program Highlights Preview

(Described as roughly half of the scientific program with the full program to be posted when scheduling is complete) [Click on the image at foot of page to load 9 MB PDF or download PDF from this link PREVIEW]

The DSM-5 Track starts on Page 12 of the PDF. 

 

It is planned that the DSM-5 will be released at this meeting

APA President’s Message on DSM-5  [Video 5:52 mins]

APA President Dilip Jeste, MD discusses the final stages of DSM-5 development.

Important changes to DSM-5 Development website: Draft proposals and criteria removed

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Important changes to DSM-5 Development website: Draft proposals and criteria removed

Post #208 Shortlink: http://wp.me/pKrrB-2wk

Update: November 16: Webpages on the DSM-5 Development site that were no longer accessible, yesterday, via the home page or a Proposals tab menu but were still accessible via their URLs have today been placed behind a log  in.

Following closure of the third and final DSM-5 stakeholder review, revisions made by the 13 Work Groups and Task Force to proposals and criteria for DSM-5 subsequent to June 15 are subject to embargo.

You can read the DSM-5 Permissions Policy here  (Updated: 5/30/2012).

The DSM-5 Development site Terms and Conditions of Use can be read here (Effective Date: June 21, 20120).

The Terms and Conditions of Use page has not been updated to reflect very recent changes to the website.

+++

Removal of proposals for DSM-5 categories and criteria

I have a webpage change detection service set up for the home page and selected pages of the DSM-5 Development site.

Today, November 15, I was notified that the DSM-5 Development home page text has been recently edited.

The home page text has been revised and the 20 links towards the foot of the home page text to Proposed Revisions have been removed, as has the drop-down tab menu for Proposed Revisions, Rationales, Severity Specifiers for the 20 DSM-5 category sections.

The revised home text can be read here.

The home page text as it had stood prior to recent editing can be reviewed (for a while) on this Google cache page.

[...Google's cache of http://www.dsm5.org/ . It is a snapshot of the page as it appeared on 4 Nov 2012 21:50:47 GMT...]

The DSM manual and its clinical and research criteria sets are a major cash cow for the publishing arm of the APA.

APA is protecting its intellectual property rights by removing draft criteria as they had stood at June 15, 2012 and in placing an embargo on interim revisions to the texts, prior to publication of the final categories, criteria sets and associated textual content, next year.

Consequently, draft proposals, criteria, rationales, severity specifiers and for some categories, PDF files expanding on proposals and rationales, as they had stood at the time of the third draft, are no longer available for review or for comparison with earlier iterations of the draft directly from links on the site’s home page text or from links in a Proposals tab drop-down menu along the top of the home page.

According to the DSM-5 Development home page and recent commentary from Task Force Chair, David J Kupfer, MD, DSM-5 remains on target for release in May 2013.

No recent projections for the date by which an online version of the DSM-5 is expected to be available, post publication of the print edition, have come to my attention but it is anticipated that access to any online version of the manual would be available via subscription – not as a freely accessible public domain version, as ICD-10-CM and ICD-11 will be when they are published and implemented.

Changes to content on DSM-5 Development site (1)

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Changes to content on DSM-5 Development site (1)

Post #189 Shortlink: http://wp.me/pKrrB-2jn

 

Content embargo

According to American Psychiatric Association’s recently published, highly restrictive DSM-5 Permissions Policy – following closure of the third and final public review, the content of DSM-5 will be under strict embargo until the manual is published.

DSM-5 is expected to be finalized by December 31 for publication in May 2013.

APA closed its third stakeholder review of draft proposals for DSM-5 categories and criteria on June 15 and issued a Press Release on June 26 – write-up from Deborah Brauser for Medscape Medical News, below.

Between closure of the final review and Wednesday, June 27, the DSM-5 Development site stated that although comments on proposals could no longer be submitted through the website the site would remain viewable with the draft proposals until DSM-5′s publication.

That line of text was deleted from the DSM-5 Development site home page yesterday, Thursday, June 28.

It remains unconfirmed whether it is now APA’s intention to remove the draft as it stood at the third review from the DSM-5 Development site at some point between now and the slated publication date.

 

Categories and criteria text frozen during final revisions

According to DSM-5 Development home page text, revisions to categories and criteria will continue to be made between now and the end of 2012 in response to stakeholder feedback; continued analysis of DSM-5 Field Trial results; scrutiny by the DSM-5 Scientific Review Committee which will review scientific validating evidence for revisions; an extensive peer review process; review by an Assembly DSM-5 committee and an overall final review by the DSM-5 Task Force.

Disorder categories and criteria texts as they currently stand on the website are now frozen and the site content will not be updated to reflect any further revisions and edits made between June 15 and submission of final texts, later this year, for approval by APA Board of Trustees.

None of the manual’s extensive textual content that will accompany the new categories has been out on public review.

The remainder of the development process is set out on the Home Page under “Next Steps” and in the APA Board Materials Packet – December 10-11, 2011. This document sets out the DSM-5 Development program from December 2011 until May 2013:

Open here: Item 11.A – DSM Task Force Report

 

From Medscape Medical News > Psychiatry

Last DSM-5 Public Review Period Ends With 2000 Comments

Deborah Brauser | June 26, 2012

June 26, 2012 — The latest and final public comment period for the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) ended on June 15 — but not before logging 2298 responses from around the world, the American Psychiatric Association (APA) reports.

This was the third public comment period that has been opened for online feedback regarding the manual’s proposed criteria changes. To date, there have been a total of 15,000 public comments posted…

Read full report

Ed: Free registration required for access to most parts of Medscape site.

 

Comment on closure of third and final draft review from 1 Boring Old Man

1 Boring Old Man

missed opportunity…

Wednesday, June 27, 2012

 

Related material

1] APA News Release June 26, 2012

2] DSM-5 Development Timeline

3] DSM-5 Development Permissions Policy

4] DSM-5 Terms and Conditions of Use

APA closes third and final comment period: fails to publish field trial results

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APA closes third and final comment period: fails to publish field trial results

Post #184 Shortlink: http://wp.me/pKrrB-2gs

So that’s it.

The third and final review of draft proposals for DSM-5 categories and criteria wrapped up last night.

APA closed the DSM-5 Development site for feedback around midnight without publishing its promised report on the DSM-5 field trial results.

Stakeholders have been obliged to submit feedback without the benefit of scrutinizing reliability data or any other information about the field trials APA had intended/may still intend/does not intend publishing.

James H. Scully, Jr., M.D., American Psychiatric Association CEO and Medical Director, blogs at Huffington Post.

I’ve asked Dr Scully why the report has been withheld; whether the Task Force still intends to publish field trial data and when that report might be anticipated.

If APA is so confidence about its field trial results, why the reluctance to place this data in the public domain?

In his Huff Po commentary of May 31, Dr Scully claimed:

“…DSM-5, unlike DSM-IV, invited comments from the world, and the work groups and task force considered every one of the more than 25,000 comments received and conducted further research where indicated.”

Following the first posting of draft proposals, out on review for ten weeks in spring 2010, APA reported receiving around 8,600 submissions; for the second review, around 2,120. I’m curious about this figure of “25,000 comments.”

I’ve asked Dr Scully, will he account for that figure of a total of 25,000 comments so far? I’ll update if Dr Scully responds.

According to Task Force Vice-Chair, Darrel Regier, M.D., the specific diagnostic categories that received the most comments during the second public review and feedback exercise had been the sexual and gender identity disorders, followed closely by somatic symptom disorders and anxiety disorders.

Following closure of the two previous public reviews, APA issued statements and articles. I will update with any statements that are released.

 

What now?

Content on the DSM-5 Development site (proposals for changes to categories, criteria, rationales, severity specifiers etc) is now frozen.

The site will not be updated to reflect any revisions and edits made between June 15 and submission of final texts, later this year, for approval by APA Board of Trustees.

The remainder of the development process is set out on the Home Page under “Next Steps” and in the APA Board Materials Packet – December 10-11, 2011. This document sets out the DSM-5 Development program from December 2011 until May 2013:

Open here: Item 11.A – DSM Task Force Report

According to APA’s newly published and highly restrictive DSM-5 Permissions Policy – following closure of this third and final public review and comment period, content of DSM-5 will be under strict embargo until the manual is published.

Final text is expected to be presented to APPI, the APA’s publishing arm, by December 31 for May 2013 publication.

I shall continue to update this site with any developments and with media coverage and commentary.

 

DSM-5 Round up

At DSM 5 in Distress, Allen Frances challenges “APA Newspeak”:

DSM5 in Distress
The DSM’s impact on mental health practice and research.

Top 10 Indicators Of DSM-5 Openness
Challenging APA newspeak.

Allen Frances, M.D. | June 15, 2012

In ’1984′, George Orwell introduced the term ‘Newspeak’ – the abuse of language by totalitarian bureaucracies to create an upside down, looking glass world of misinformation. He was probably inspired by ‘Pravda,’ the Soviet Union’s propaganda paper that literally means ‘truth’ in Russian but was famous for publishing everything but.

This brings us to the American Psychiatric Association. Its medical director recently justified the astounding $25 million APA has already spent on DSM 5 (5 times the cost of DSM IV) with a curious claim- DSM 5 was so exorbitantly expensive because it was so unprecedentedly open. This classic Newspeak kills two truth birds with one stone — DSM 5 didn’t waste a huge amount of money and DSM 5 didn’t fail because it was a closed shop. The futile hope is that black will become white if only you say it enough times.

In fact, it is very cheap to run an open process — and very expensive to run a PR disinformation campaign. It cost me nothing but an hour’s time to write this blog. How much, I wonder, will it cost APA to pay off GYMR (its high powered public relations producer of newspeak pravda) to defend its indefensible claims that DSM 5 is an open process and that it can meet its unrealistic timetable with a reliable manual?

Here is a top 10 list of great moments in the history of APA ‘openness’.

1) APA forces work group members to sign confidentiality agreements to protect DSM 5 ‘intellectual property’.

2) DSM 5 does a confidential and super-secret ‘scientific’ review of itself- real science is never secret.

3) APA rebuffs calls from 51 mental health associations for an open and independent scientific review.

4) APA’s legal office tries to stifle criticism and censor the internet using inappropriate and bullying threats of trademark litigation.

5) APA plans to steeply jack up licensing costs for use of DSM criteria sets in order to recoup its unaccountably huge investment on its ‘intellectual property’.

6) DSM 5 only reluctantly engages on the issues and instead stonewalls criticism with offensive and defensive tactics.

7) The original DSM 5 plan for field trials included no prior public viewing of criteria sets and no period for public comment. These are added only under heavy outside pressure.

8) DSM 5 publishes no aggregations of key areas of concern identified during public reviews; doesn’t respond publicly to them and there is no indication that public input has had any impact whatever on DSM 5.

9) The APA ‘charitable’ foundation (meant to provide open public education) is named by a watchdog group as the 7th worst charity in all of the US.

10) APA promises to post a complete set of DSM 5 reliability data in time to allow comments during the final period of public review- but fails to do so.

And this is just a taster. At least a dozen reporters have spontaneously mentioned to me that never in their careers have they encountered anything so byzantine as the APA press office. And dozens of APA members have emailed their frustration at not being able to get a straight (or any) answer from a staff whose salaries are paid by their membership dues.

It requires lots of time, money, and brain power to create ‘pravda.’ Perhaps this explains why everything connected with DSM 5 is always so late and so expensive and why a high flying hired gun like GYMR is needed to run its interference. The real truth is fast, cheap, and very simple to explain.

Additional research is available at Suzy Chapman’s website. She monitors DSM-5 development at http://dxrevisionwatch.wordpress.com

 

On June 13, the American Counseling Association, representing 50,000 US counselors, published its submission to DSM-5:

ACA provides final comments on the DSM-5

ACA President Don W. Locke has sent the American Psychiatric Association a letter providing final comments for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Based on comments from ACA members and the ACA DSM Task Force, the letter acknowledges useful changes that had been made to previous drafts of the DSM-5: the development of the Cultural Formulation Outline, reversing the pathologizing of normal bereavement, and limiting the expansion of personality disorder types. ACA also calls for addressing the one-dimensional nature of the new Substance Use Disorder category and rejects the proposed dimensional assessments. Click here to view letter.

This is the third letter ACA has sent to the American Psychiatric Association providing feedback for the DSM-5. Click the links below to read the previous letters and a response from APA:

 
 
 

The DSM-5 Open Letter Committee of the Society for Humanistic Psychology, Division 32 of the American Psychological Association is publishing its response to the third draft :

To the DSM-5 Task Force and the American Psychiatric Association

As you know, the Open Letter Committee of the Society for Humanistic Psychology and the Coalition for DSM-5 Reform have been following the development of DSM-5 closely.

We appreciate the opportunity for public commentary on the most recent version of the DSM-5 draft proposals. We intend to submit this brief letter via the dsm5.org feedback portal and to post it for public viewing on our website at http://dsm5-reform.com/

Since its posting in October 2011, the Open Letter to the DSM-5, which was written in response to the second version of the draft proposals, has garnered support from almost 50 mental health organizations and over 13,500 individual mental health professionals and others.

Our three primary concerns in the letter were as follows: the DSM-5 proposals appear to lower diagnostic thresholds, expanding the purview of mental disorder to include normative reactions to life events; some new proposals (e.g., “Disruptive Mood Dysregulation Disorder” and “Attenuated Psychosis Syndrome”) seem to lack the empirical grounding necessary for inclusion in a scientific taxonomy; newly proposed disorders are particularly likely to be diagnosed in vulnerable populations, such as children and the elderly, for whom the over-prescription of powerful psychiatric drugs is already a growing nationwide problem; and the increased emphasis on medico-biological theories for mental disorder despite the fact that recent research strongly points to multifactorial etiologies.

We appreciate some of the changes made in this third version of the draft proposals, in particular the relegation of Attenuated Psychosis Syndrome and Mixed Anxiety-Depression to the Appendix for further research. We believe these disorders had insufficient empirical backing for inclusion in the manual itself. In addition, given the continuing elusiveness of biomarkers, we are relieved to find that you have proposed a modified definition of mental disorder that does not include the phrase “underlying psychobiological dysfunction.”

Despite these positive changes, we remain concerned about a number of the DSM-5 proposals, as well as the apparent setbacks in the development process.

Our continuing concerns are:

• The proposal to include new disorders with relatively little empirical support and/or research literature that is relatively recent (e.g., Disruptive Mood Dysregulation Disorder)

• The lowering of diagnostic thresholds, which may result in diagnostic expansion and various iatrogenic hazards, such as inappropriate treatment and stigmatization of normative life processes. Examples include the newly proposed Minor Neurocognitive Disorder, as well as proposed changes to Generalized Anxiety Disorder, Attention Deficit/Hyperactivity Disorder, Pedophilia, and the new behavioral addictions.

• The perplexing Personality Disorders overhaul, which is an unnecessarily complex and idiosyncratic system that is likely to have little clinical utility in everyday practice.

• The development of novel scales (e.g., severity scales) with little psychometric testing rather than utilizing established standards.

In addition, we are increasingly concerned about several aspects of the development process. These are:

• Continuing delays, particularly in the drafting and field testing of the proposals.

• The substandard results of the first set of field trials, which revealed kappas below accepted reliability standards.

• The cancelation of the second set of field trials.

• The lack of formal forensic review.

• Ad hominem responses to critics.

• The hiring of a PR firm to influence the interpretation and dissemination of information about DSM-5, which is not standard scientific practice.

We understand that there have been recent attempts to locate a “middle ground” between the DSM-5 proposals and DSM-5 criticism. We believe that, given the extremity and idiosyncrasy of some of the proposed changes to the manual, this claim of a “middle ground” is more rhetorical and polemic than empirical or measured. A true middle ground, we believe, would draw on medical ethics and scientific standards to revise the proposals in a careful way that prioritizes patient safety, especially protection against unnecessary treatment, above institutional needs.

Therefore, we would like to reiterate our call for an independent scientific review of the manual by professionals whose relationship to the DSM-5 Task Force and/or American Psychiatric Association does not constitute a conflict of interest.

As the deadline for the future manual approaches, we urge the DSM-5 Task Force and all concerned mental health professionals to examine the proposed manual with scientific and expert scrutiny.

It is not only our professional standards, but also –and most importantly– patient care that is at stake. We thank you for your time and serious consideration of our concerns, and we hope that you will continue to engage in dialogue with those calling for reform of DSM-5.

Sincerely,

The DSM-5 Open Letter Committee of the Society for Humanistic Society, Division 32 of the American Psychological Association

American Psychiatric Association (APA) Assembly Notes and Full Treasurer’s Report

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American Psychiatric Association (APA) Assembly Notes and Full Treasurer’s Report

Post #174 Shortlink: http://wp.me/pKrrB-2bX

Update @ June 1, 2012

James H. Scully, Jr., M.D., CEO and Medical Director of the American Psychiatric Association, has published a response to Allen Frances’ Huff Po blog of May 30:

DSM-5 Inaccuracies: Setting the Record Straight

Update @ May 30, 2012

1 Boring Old Man

reform, or accept your fate…

1 Boring Old Man | May, 30 2012

Huffington Post Blogs Allen Frances, MD

DSM-5 Costs $25 Million, Putting APA in a Financial Hole

Allen Frances | May 30, 2012

The American Psychiatric Association just reported a surprisingly large yearly deficit of $350,000. This was caused by reduced publishing profits, poor attendance at its annual meeting, rapidly declining membership, and wasteful spending on DSM-5. APA reserves are now below “the recommended amount for a non-profit (reserves equal to a year’s operating expenses).”

APA has already spent an astounding $25 million on DSM-5. I can’t imagine where all that money went. As I recall it, DSM-IV cost about $5 million, and more than half of this came from outside research grants. Even if the DSM-5 product were made of gold instead of lead, $25 million would be wildly out of proportion. The rampant disorganization of DSM-5 must have caused colossal waste. One obvious example is the $3 million spent on the useless DSM-5 field trial, with its irrelevant question, poorly conceived design, and embarrassing results…

Full commentary

On May 8, in an article for Medscape Medical News, Deborah Brauser reported:

     …Members of the task force said they hope to publish the full results [of the DSM-5 field trials] “within a month.” However, the third and final public comment period for the manual opened last week and ends on June 15. Although the entire period is 6 weeks long, the public may only have 2 weeks to comment after the publication of the field trials’ findings. DSM-5 Field Trials Generate Mixed Results

With less than three weeks to go before the stakeholder and public comment period closes, there is still no sign of a report on the DSM-5 field trials.

If the Task Force does not get a report out soon, stakeholders will be obliged to submit feedback without the benefit of data from the trials to inform their comments. Once again, this third and final stakeholder review smacks of a purely tokenistic exercise.

For the two previous draft reviews, some disorders were accompanied by PDF documents expanding on new and revised disorder descriptions and work group rationales.

For the Somatic Symptom Disorders, no updated “Disorder Descriptions” or “Rationale/Validity” documents have been published that reflect substantial revisions made to proposals and criteria between the second and third drafts. The documents as published for the second review have been taken down from the DSM-5 Development site but have not been revised and reissued.

I have twice contacted APA Media and Communications for clarification of whether the Work Group intends to publish revised documents before the end of the comment period. Evidently APA Media and Communications don’t wish to provide me with a response.

 

I will update if and when a report on the field trials emerges from the Task Force.

In the meantime, here are two public domain documents that may be of interest to APA watchers:

APA Assembly Notes Spring 2012

or download here:

http://alabamapsych.org/wp-content/uploads/2012/02/apa_assembly_notes_may_2012.pdf

APA Treasurer’s Report May 2012  [.ppt compatible PowerPoint reader required]

or view here:

https://docs.google.com/file/d/0BzWdENl1wkVSYk5aXzRZelFYUjA/edit?pli=1

Make Yourself Heard! says DSM-5′s Kupfer – but are they listening?

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Make Yourself Heard! says DSM-5′s Kupfer – but are they listening?

Post #166: Shortlink: http://wp.me/pKrrB-26L

Four further commentaries from 1 boring old man on DSM-5 field trial results and Kappa values:

major depressive disorder κ=0.30?…

May 6, 2012

a fork in the road…

May 7, 2012

Village Consumed by Deadly Storm…

May 8, 2012

box scores and kappa…

May 8, 2012

MedPage Today

Most DSM-5 Revisions Pass Field Trials

John Gever, Senior Editor | May 07, 2012

“…Darrel Regier, MD, the APA’s research director, explained that the trials were intended primarily to establish reliability – that different clinicians using the diagnostic criteria set forth in the proposed revisions would reach the same diagnosis for a given patient. The key reliability measure used in the academic center trials was the so-called intraclass kappa statistic, based on concordance of the “test-retest” results for each patient. It’s calculated from a complicated formula, but the essence is that a kappa value of 0.6 to 0.8 is considered excellent, 0.4 to 0.6 is good, and 0.2 to o.4 “may be acceptable.” Scores below 0.2 are flatly unacceptable.

Kappa values for the dozens of new and revised diagnoses tested ranged from near zero to 0.78. For most common disorders, kappa values from tests conducted in the academic centers were in the “good” range:

Bipolar disorder type I: 0.54
Schizophrenia: 0.46
Schizoaffective disorder: 0.50
Mild traumatic brain injury: 0.46
Borderline personality disorder: 0.58

In the “excellent” range were autism spectrum disorder [0.69], PTSD [0.67], ADHD [0.61], and the top prizewinner, major neurocognitive disorder [better known as dementia], at 0.78. But some fared less well. Criteria for generalized anxiety disorder, for example, came in with a kappa of 0.20. Major depressive disorder in children had a kappa value of 0.29. A major surprise was the 0.32 kappa value for major depressive disorder. The criteria were virtually unchanged from the version in DSM-IV, the current version, which also underwent field trials before they were published in 1994. The kappa value in those trials was 0.59.

But a comparison is not valid, Regier told MedPage Today…”

Read full report

DSM5 in Distress
The DSM’s impact on mental health practice and research.

Newsflash From APA Meeting: DSM 5 Has Flunked its Reliability Tests
Needs To Be Kept Back For Another Year

Allen J. Frances, M.D. | May 6, 2012

“…The results of the DSM 5 field trials are a disgrace to the field. For context, in previous DSM’s, a diagnosis had to have a kappa reliability of about 0.6 or above to be considered acceptable. A reliability of .2-4 has always been considered completely unacceptable, not much above chance agreement…”

Reconstructed from data published by A Frances, DSM 5 in Distress, Psychology Today, 05.06.12

“…No predetermined publication date justifies business as usual in the face of these terrible Field Trial results (which are even more striking since they were obtained in academic settings with trained and skilled interviewers, highly selected patients, and no time pressure. The results in real world settings would be much lower). Reliability this low for so many diagnoses gravely undermines the credibility of DSM 5 as a basis for administrative coding, treatment selection, and clinical research…”

Read full commentary

Scientific American

Field Tests for Revised Psychiatric Guide Reveal Reliability Problems for Two Major Diagnoses

Ferris Jabr | May 6, 2012

“…The kappa for generalized anxiety disorder was about 0.2 and the kappa for major depressive disorder was about 0.3.

“…These numbers are way too low according to the APA’s own scales—and they are much lower than kappas for the disorders in previous versions of the DSM. Regier and other members of the APA emphasized that field trial methodology for the latest edition is far more rigorous than in the past and that kappas for many diagnoses in earlier editions of the DSM were likely inflated. But that doesn’t change the fact that the APA has a problem on its hands: its own data suggests that some of the updated definitions are so flawed that only a minority of psychiatrists reach the same conclusions when using them on the same patient. And the APA has limited time to do something about it…”

“…Until the APA officially publishes the results of the field trials, nobody outside the association can complete a proper analysis. What I have seen so far has convinced me that the association should anticipate even stronger criticism than it has already weathered. In fairness, the APA has made changes to the drafts of the DSM-5 based on earlier critiques. But the drafts are only open to comment for another six weeks. And so far no one outside the APA has had access to the field trial data, which I have no doubt many researchers will seize and scour. I only hope that the flaws they uncover will make the APA look again—and look closer…”

Read full report

Psychiatric News | May 04, 2012
Volume 47 Number 9 page 1a-28
American Psychiatric Association
Professional News

DSM Field Trials Providing Ample Critical Data

David J. Kupfer, M.D.

This article is part a series of commentaries by the chair of the DSM-5 Task Force, which is overseeing the manual’s development. The series will continue until the release of DSM-5 in May 2013.

As of this month, the 12-month countdown to the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) officially begins. While the developers of DSM-5 will continue to face several deadlines over the coming year, the progress that has been made since APA’s 2011 annual meeting has been nothing short of remarkable.

One of the most notable and talked-about recent activities of the DSM revision concerns the implementation and conclusion of the DSM-5 Field Trials, which were designed to study proposed changes to the manual…

Read on

From the same article and note that

“After the comment period closes, visitors will no longer be able to submit feedback through the site, and the site will not reflect any further revisions to the draft manual in anticipation of its publication in May 2013. However, the site will remain live and viewable.”

Make Yourself Heard!

The DSM-5 Web site (www.dsm5.org) is open to a third and final round of feedback. For six weeks, patients and their loved ones, members of the profession, and the general public can submit questions and comments via the Web site. All will be read by members of the appropriate DSM-5 work groups.

A summary of changes made to the draft diagnostic criteria since the last comment period (May-July 2011) will help guide readers to important areas for review, but visitors are encouraged to comment on any aspect of DSM-5. After the comment period closes, visitors will no longer be able to submit feedback through the site, and the site will not reflect any further revisions to the draft manual in anticipation of its publication in May 2013. However, the site will remain live and viewable.

Psychiatrists can use this important opportunity to express their opinions about proposed changes and how they may impact patient care. Since http://www.dsm5.org was first launched in February 2010, the work groups have discussed— and in many cases, implemented draft changes in response to—the feedback received from the site. This final comment period presents a historic opportunity for APA members to take part in the DSM-5 revision process and help impact the way in which psychiatric disorders are diagnosed and classified in the future.

David J. Kupfer, M.D., is chair of the DSM-5 Task Force and a professor of psychiatry at the University of Pittsburgh Medical Center and Western Psychiatric Institute and Clinic.

Commentary on Dr Kupfer’s report from 1 boring old man

self-evident…

I boring old man | May 6,  2012

Further commentary from 1 boring old man on DSM-5 controversy

not a good time…

1 boring old man | May 5, 2012