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

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

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.

DSM-5 controversy: Lane on “SAD”, Frances Follows the Money, Spitzer et al on Kappa reliability

DSM-5 controversy round up:

Lane on “SAD”; Frances “Follows the Money”; Spitzer et al on Kappa reliability; A Closer Look at Pending Changes to the Future of Psychiatric Diagnosis June issue The Journal of Nervous and Mental Disease

Post #178 Shortlink: http://wp.me/pKrrB-2em

Side Effects at Psychology Today

From quirky to serious, trends in psychology and psychiatry.

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

Naming an Ailment: The Case of Social Anxiety Disorder”

“Social phobia” vs. “Social anxiety disorder”: What’s in a name?

…“Using data collected from a telephone survey of residents of New York State,” the letter writers continue, “we investigated whether the disorder name affects the perceived need for treatment. Random-digit dialing was used to obtain phone numbers … In total, 806 people participated.”

“Respondents heard a brief vignette describing a person who experiences discomfort in social situations and often avoids social events. These symptoms were labeled as either social phobia or social anxiety disorder, and respondents indicated whether the person should seek mental health treatment.”

The results are dubious to say the least…

Read full commentary

Psychology Today

DSM 5 in Distress | Allen Frances

Follow The Money
APA puts publishing profits above public trust

Allen Frances MD | June 11, 2012

…APA treats DSM-5 like a valuable publishing property, not as a public trust that importantly impacts on people’s lives and public policy. It is excellent at protecting its “intellectual property” with confidentiality agreements and at protecting its trademark and copyright with bullying threats of law suits. But APA has been sadly incompetent and wildly profligate in the day-to-day work of actually producing a safe and scientifically sound DSM-5.

Dr Scully is asking us to believe ten very unbelievable things. My view – if you want to understand why an unreliable and unsafe DSM-5 is being rushed prematurely to market – is to “follow the money…”

Read full commentary at DSM-5 in Distress

Newswire

http://ajp.psychiatryonline.org/article.aspx?articleid=1109031

The American Journal of Psychiatry, VOL. 169, No. 5

Letters to the Editor | May 01, 2012

Standards for DSM-5 Reliability

Robert L. Spitzer, M.D.; Janet B.W. Williams, Ph.D.; Jean Endicott, Ph.D.
Princeton, N.J. New York City

Am J Psychiatry 2012;169:537-537. 10.1176/appi.ajp.2012.12010083

TO THE EDITOR: In the January issue of the Journal, Helena Chmura Kraemer, Ph.D., and colleagues (1) ask, in anticipation of the results of the DSM-5 field trial reliability study, how much reliability is reasonable to expect. They argue that standards for interpreting kappa reliability, which have been widely accepted by psychiatric researchers, are unrealistically high…

A Closer Look at Pending Changes to the Future of Psychiatric Diagnosis

Released: 6/7/2012 9:00 AM EDT
Source: Wolters Kluwer Health: Lippincott Williams & Wilkins

Articles Have Potential to Affect Final DSM-5 Standards as Public comment Period Ends

Newswise — New York, NY (June 7, 2012) – The June issue of The Journal of Nervous and Mental Disease (JNMD) features a special section focused on the impending release of the revised Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an update to psychiatric diagnosis standards. JNMD is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

The Journal of Nervous and Mental Disease Editor-in-Chief John A. Talbott, MD, (a past APA president and DSM-III collaborator) comments in his editorial, “The timing of this special section on DSM-5, therefore, is particularly auspicious because it provides the potential for these articles to affect the final DSM-5 decisions.” The DSM-5 manual, currently scheduled for publication in May 2013, is going through its final public comment period through June 15, 2012.

Many articles within the section present criticisms of DSM-5 proposals. Specifically, several authors worry that the new DSM-5 standards may open up more opportunities for false-positives – a doctor diagnosing a condition when it is not present, or providing medication when it is not needed.

• “Diagnostic Inflation: Causes and Suggested Cure” by Batstra and Frances displays the authors’ concern that the proposed changes to DSM-5 will result in diagnostic inflation and inappropriate use of medication. They suggest “stepped diagnosis,” which includes a watch-and-wait period before beginning medication, to combat false-positives.

• In “Recurrence of Bereavement-Related Depression: Evidence for the Validity of the DSM-IV Bereavement Exclusion From the Epidemiological Catchment Area Study,” Wakefield and Schmitz contend that the DSM-5 proposal to remove the bereavement exclusion from the definition of a major depressive episode would cause those who are experiencing normal grief after the death of a loved one to be mislabeled as clinically depressed.

Other articles respond to DSM-5 proposals to include new disorders and diagnostic constructs. For example, DSM-5 proposes to reclassify pathological gambling as a behavioral addiction, which may pave the way for other excessive behaviors to be included in this construct in the future.

• Mihordin takes a look at the potential consequences of this change in his article, “Behavioral Addiction V Quo Vadis?” in which he presents hypothetical criteria for the diagnosis of pathological model railroading disorder.

• Good and Burstein respond to the DSM-5 proposal to include a hebephilic subtype to the diagnosis of pedophilia in “Hebephilia and the Construction of a Fictitious Diagnosis”. Additionally, Wakefield examines two DSM-5 proposals on classifying pathological forms of grief as mental disorders in “Should Prolonged Grief Be Reclassified as a Mental Disorder in DSM-5? Reconsidering the Empirical and Conceptual Arguments for Complicated Grief Disorder.”

Included in the special section, “Psychotropic Marketing Practices and Problems: Implication for DSM-5” by Raven and Perry looks at how certain aspects of DSM-5 could be used by the pharmaceutical industry as marketing tools, especially with a wider customer base resulting from false-positive patients. In “A Critique of the DSM-5 Field Trials,” Jones examines problems that may have compromised the usefulness of the DSM-5 field trials.

It is important to note that the articles in the special section of JNMD were written at various points since February 2010 based on the criteria sets posted on the DSM-5 website. Many of these criteria sets have been updated since their initial posting. “Thus, the critiques of certain proposals contained in these articles may no longer be fully relevant to what is actually being proposed for DSM-5,” Dr. Talbott states in his editorial. Visit the DSM-5 website at http://www.dsm5.org/  for the most accurate information on what is being considered for inclusion in DSM-5.

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About The Journal of Nervous and Mental Disease
Founded in 1874, The Journal of Nervous and Mental Disease is the world’s oldest, continuously published independent scientific monthly in the field of human behavior. Articles cover theory, etiology, therapy, social impact of illness, and research methods

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