Coalition for DSM-5 Reform

Looking for media coverage on the Coalition for DSM-5 Reform Petition?  Go to Page 2

American Psychiatric Association should not be confused with
American Psychological Association – both use the acronym – APA.

Dx Revision Watch has no connection with the Coalition for DSM-5 Reform, its Open Letter initiative or associated petition. All enquiries relating to the Coalition for DSM-5 Reform should be addressed directly to Dr David Elkins, Ph.D., Chair, Coalition for DSM-5 Reform committee.

Coalition for DSM-5 Reform

The Coalition for DSM-5 Reform is calling for the American Psychiatric Association to submit its draft proposals for new categories and criteria for DSM-5 to independent scientific review or drop its most controversial proposals.

An Open Letter and Petition sponsored by the Society for Humanistic Psychology (Division 32 of the American Psychological Association), in alliance with several other American Psychological Association divisions, attracted nearly 7000 signatures in its first three weeks.

You can view the Open Letter and iPetition here.

The Petition was launched quietly, on 22 October, by three committee members of Division 32: David N. Elkins, Brent Dean Robbins and Sarah Kamens, Doctoral Candidate in Clinical Psychology, Fordham University and Division 32 Student Representative.

Coalition for DSM-5 Reform Committee

David N. Elkins, Ph.D.      Email:  David Elkins
President, Society for Humanistic Psychology, Division 32 of the American Psychological Association

Brent Dean Robbins, Ph.D.      Email:  Brent Dean Robbins
Secretary, Society for Humanistic Psychology, Division 32, American Psychological Association

The committee has co-opted

Jonathan D. Raskin, Ph.D.     Email:  Jonathan D. Raskin
Fellow, Society for Humanistic Psychology, Division 32, American Psychological Association;
Fellow, Society for Theoretical and Philosophical Psychology, Division 24, American Psychological Association; Member, American Counseling Association

Donna Rockwell, Ph.D.

Frank Farley, Ph.D.

Media enquiries

Media enquiries and enquiries from organizations wishing to discuss endorsement of the Coalition for DSM-5 Reform’s Open Letter should be addressed to David Elkins and Brent Dean Robbins

More than 45 mental health professional bodies are endorsing the Open Letter which is highly critical of many of the draft criteria and categories being proposed for the revision of DSM-IV by 13 American Psychiatric Association DSM-5 Work Groups. See the Coalition for DSM-5 Reform website for a list of organizations that are endorsing the Petition.

The American Psychiatric Association has scheduled a third and final stakeholder review for spring 2012 with the next version of the Diagnostic and Statistical Manual of Mental Disorders slated for publication in May 2013.

Alarmed by the potential dangers they see in many of the most recent proposals, released in May 2011, the Petition sponsors are inviting mental health professionals and mental health organizations to sign up in support of their Open Letter to the American Psychiatric Association’s DSM-5 Development Task Force.

Of particular concern to the Sponsors are:

(1) The lowering of diagnostic thresholds, which may artificially inflate the prevalence of numerous disorders. By increasing the number of people who qualify for a diagnosis, DSM-5 may lead to the excessive medicalization and stigmatization of normative or transient distress.

(2) The potential consequences of lowered thresholds and new disorder categories on vulnerable populations such as children and the elderly. These populations are already at risk for excessive and inappropriate treatment with medications that have dangerous side effects. We are particularly concerned about the overuse of medications for “Attenuated Psychosis Syndrome,” “Disruptive Mood Dysregulation Disorder,” “Mild Neurocognitive Disorder,” Attention Deficit/Hyperactivity Disorder, and Generalized Anxiety Disorder.

(3) The lack of scientific evidence substantiating many of these new proposals.

The Coalition for DSM-5 Reform has opened a number of platforms


Uploaded: 11.24.11 http://www.ipetitions.com/petition/dsm5/

“Sign the Open Letter to the DSM-5 Committee and the American Psychiatric Association to change DSM-5. David Elkins, PhD, President, Division 32, Society for Humanistic Psychology, APA voices concern that the DSM-5, if not changed, may harm vulnerable populations and the field of psychology itself.”

Open Letter and iPetition

Coalition for DSM-5 Reform on Twitter    @dsm5reform

Coalition for DSM-5 Reform on Facebook

Coalition for DSM-5 Reform website

This initiative is also being covered on

The Society for Humanistic Psychology Blog

The Society for Humanistic Psychology on Twitter  @HumanisticPsych

The Society for Humanistic Psychology on Facebook


Developments (most recent first)


June 20, 2012: Coalition for DSM-5 Reform Open Letter Petition reaches 13,714 signatures


June, 2012: Coalition for DSM-5 Reform submits response in third DSM-5 stakeholder review

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


January 30, 2012: Coalition for DSM-5 Reform Open Letter Petition reaches 11,000 signatures


January 27, 2012: APA responds to Coalition for DSM-5 Reform letter to DSM-5 Task Force and APA trustees calling for independent review of controversial proposals, dated January 09, 2012

      APA Response on 01.27.12 to Coalition for DSM-5 Reform letter of 01.09.12

Read text of letter January 09, 2012 letter here: Psychologists call for independent review of DSM-5


January 12, 2012: Association for Contextural Behavioral Science (ACBS) voices serious concern about DSM-5

ACBS voices serious concern about DSM-5

Douglas Long

The ACBS Board of Directors has expressed serious concern regarding the content of the future Diagnostic and Statistical Manual, Fifth Edition, (DSM-5), which is currently under development. The DSM serves as an important component of the research, education, and practice of most licensed psychologists in the United States.

“We find that many of the proposed changes to the DSM are inconsistent with Contextual Behavioral Science and practice,” explains Patty Bach, ACBS President. “The proposed version minimizes the role of non-medical (i.e., environmental) variables in the etiology and course of psychopathology. What’s more, the new diagnoses and revisions to existing ones serve to pathologize normal human experiences such as bereavement.”

Following a vote by the Board of Directors, ACBS has signed on to an open letter addressed to the DSM-5 Task Force and the American Psychiatric Association. The letter can be found here. It outlines many specific concerns, and offers suggestions for change.

By signing this letter, ACBS has joined with many sections of the American Psychological Association, the British Psychological Society, the Association for Women in Psychology, as well as many other notable organizations.

Learn more about this issue, and co-sign the letter here.


January 09, 2012: Coalition for DSM-5 Reform submits another letter to DSM-5 Task Force and APA trustees calling for independent review of controversial proposals.

Read text of letter here: Psychologists call for independent review of DSM-5


January 04, 2012: Coalition for DSM-5 Reform Open Letter Petition reaches 10,000 signatures


December 16, 2011: Editor of Psychiatric Times invites its readership to submit views on DSM-5 for potential publication

In a brief Editorial entitled The Debate Over DSM-5: We Invite Your Views, James L. Knoll IV, MD, Editor, Psychiatric Times, clarifies Psychiatric Times’s position with regard to the journal’s intent behind posting the many blogs about DSM-5 that appear on its web site.

Dr Knoll encourages and invites readers to submit their viewpoints on DSM-5 “in the spirit of collegial and scientific investigation.” Dr Knoll writes that manuscripts and letters sent to editor@PsychiatricTimes.com will be reviewed for possible publication either in print or on www.PsychiatricTimes.com.

Read Editorial here


December 16, 2011: Coalition for DSM-5 Reform Open Letter Petition reaches 9000 signatures


December 13, 2011: British Psychological Society issues statement in response to DSM-5 encouraging its members to sign Coalition for DSM-5 Reform petition for mental health professionals

Society issues statement in response to DSM-5

The Society has today (13 December 2011) released a statement expressing concerns regarding the proposed revisions of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, which is one the main internationally-used classification systems for diagnosis of people with mental health problems in clinical settings and for research trials.

The Society for Humanistic Psychology (Division 32) of the American Psychological Association (APA) has recently published an open letter to the DSM-5 taskforce raising a number of concerns about the draft revisions proposed for DSM-5 and citing a number of issues raised previously by the BPS.

In its statement today, the Society shares the concerns expressed in the open letter from the Society of Humanistic Psychology (Division 32) of the APA and encourages members of the Society to read the letter themselves and consider signing the petition.

David Murphy, Chair of the Society’s Professional Practice Board said:

“The Society recognises that a range of views exist amongst psychologists, and other mental health professionals, regarding the validity and usefulness of diagnostic frameworks in general and the Diagnostic and Statistical Manual of the American Psychiatric Association, in particular.

“However, there is a widespread consensus amongst our members that some of the changes proposed for the new framework could lead to potentially stigmatizing medical labels being inappropriately applied to normal experiences and also to the unnecessary use of potentially harmful interventions.

“We therefore urge the DSM 5 taskforce to consider seriously all the issues that have been raised and we would echo the American Psychological Association’s call for the taskforce to adhere to an open transparent process based on the best available science and in the best interest of the public”.

You can read the Society statement in full online.

Open PDF on the BPS site here: BPS Statement on DSM-5 12.12.11

Or open PDF here, on Dx Revision Watch: BPS statement on DSM-5 12-12-2011

Text version in this Dx Revision Watch post


December 2, 2011: American Psychological Association publishes statement

APA Press Releases

December 2, 2011

Statement of the American Psychological Association on the DSM-5 Development Process

WASHINGTON—Diagnostic classification systems of disorders and diseases are an integral part of health care delivery. Any such system, including the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association and the pending revision of the International Classification of Diseases (ICD-11) of the World Health Organization, must be based on the best available science and serve the public interest.

The American Psychological Association has members with significant expertise in the scientific areas relevant to the DSM, and we have urged them to take part in the DSM revision efforts. We are encouraged that many psychologists are making meaningful contributions to the process as individuals, as members of the DSM-5 Task Force and work groups, and through the divisions of the American Psychological Association. This involvement includes offering comments on draft provisions and participating in field trials.

We applaud the Society for Humanistic Psychology (Division 32 of our association) for its leadership role in generating dialogue and information-sharing within the broader mental health community concerning the revisions process. The Society also has prepared, disseminated, and garnered wide support for an “open letter” to the DSM-5 Task Force and the American Psychiatric Association, which expresses specific concerns related to the DSM-5 development process.

We share their belief that the purpose of any diagnostic classification system should be to improve treatment outcomes. Thus it is essential to consider the impact of any new diagnostic system or category on vulnerable individuals, groups and populations, particularly children, older adults, and ethnic minorities. By appropriately identifying individuals in need of treatment, it is possible to both safeguard the welfare of individuals and to direct treatment resources where they are most needed. Concerns also have been raised that over-identification or misidentification of individuals as being in need of treatment could lead to the use of unnecessary and potentially harmful interventions.

The American Psychological Association recognizes that there is a diversity of opinion concerning the ongoing DSM-5 development process. Our association has not adopted an official position on the proposed revision; rather, we have called upon the DSM-5 Task Force to adhere to an open, transparent process based on the best available science and in the best interest of the public. In this regard, we appreciate the Task Force’s expressed commitment to seriously consider the issues and concerns raised by experts in the mental health field in their deliberations.

We call upon our members (either as individuals or groups) to continue to add their perspectives to enhance the validity and clinical utility of the DSM-5. The American Psychological Association will continue to monitor the revision process and be a strong voice for its transparency.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 154,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.


November 23, 2011: American Psychiatric Association posts statement “Update on the Status of DSM-5″ (November 11.22.11) on its main website

Open PDF here:      APA Update on the Status of DSM-5 11.22.11

or open on the APA’s website here

A text version can be read in this Dx Revision Watch post:

Psychiatric Manual Revision Pushes Ahead Amid Continued Concerns (APA issues update on status of DSM-5)


November, 22, 2011: American Psychiatric Association releases response (dated 11.21.11) to American Counseling Association letter of 11.17.11 

      APA letter to ACA 11.21.11  or on the APAs DSM-5 Development site here

A text version of this 7 page letter can be read in this DX Revision Watch post:

American Psychiatric Association response to ACA, 11.21.11

or on Psychiatric Times here:

ACA Expresses DSM-5 Concerns to the American Psychiatric Association


November 17, 2011: American Counseling Association releases letter calling for external review of DSM-5

ACA In The News | Press Release 11.17.11

ACA Expresses DSM-5 Concerns to the American Psychiatric Association

Yesterday, November 17, the American Counseling Association (ACA) released a letter from ACA President Don W. Locke to the American Psychiatric Association on behalf of professional counselors expressing current concerns about the DSM-5 revision process. The letter focuses on the need for better empirical evidence, the lack of information about proposed dimensional and cross cutting assessments, problems with the ongoing field trials, concerns about the biological emphasis of the revised definition of mental disorders, and the need for greater transparency.

To view the ACA letter sent to American Psychiatric Association President John Oldham, open here in PDF format:

     ACA letter to DSM-5 Task Force November 17, 2011


November 17, 2011: Allen Frances, MD, who had chaired the DSM-IV Task Force, publishes brief commentary on ACA letter

Psychology Today | DSM-5 Blog

Counselor’s Turn Against DSM-5: Can APA Ignore 120,000 Users?


November 11, 2011: Allen Frances, MD, who had chaired the DSM-IV Task Force, publishes a commentary on Dr Regier’s inteview for Medscape News, as part of series of commentaries on DSM-5

Psychology Today | DSM5 in Distress

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

DSM 5- ‘Living Document’ or ‘Dead on Arrival: ‘untested ‘scientific hypotheses’ must be dropped

News flash From Medscape Medical News—“APA Answers DSM-5 Critics”—a defense of DSM-5 offered by Darrel A. Regier, MD, vice-chair of the DSM-5 Task Force. Wonderful news that the American Psychiatric Association (APA) is attempting to address the fact that DSM-5 alarms many of its potential users—it is long past time for an open dialog.

Unfortunately, however, Dr Regier dodges the concerns that must be addressed if DSM-5 is to become a safe and credible document. Five simple questions were previously posed to APA with a request for straight answers. Read on here

Comment from Suzy Chapman: In his interview for Medscape, Darrel Regier, MD, APA Director of Research and Task Force Vice-chair, made some chilling statements.

According to Dr Regier:

“Our plan is that these [judgements] will be immediately tested once the DSM is official, and then one will be able to see if revisions can be made…”

“Our workgroups are struggling with this balance…for what might be the most appropriate fix. Some of these fixes are not as well studied as others and we recognize that. But we can’t move forward without some of these put into practice. So we think this is a much more testable set of scientific hypotheses…”

“And that’s what the DSM is — a set of scientific hypotheses that are intended to be tested and disproved if the evidence isn’t found to support them….”

“We’re thinking of having a DSM-5.1, DSM-5.2, etc, in much the same way is done with software updates…”

So come May 2013, the APA plans to publish an unvalidated beta version, as though it were the next release of Firefox, test out its pet theories on vulnerable patients and use children as guinea pigs, then release post publication “patches” to fix a flawed and potentially damaging product.


November 9, 2011: Dr Melba T. Vasquez, Ph.D., President of the American Psychological Association, responds in a letter to the DSM-5 Task Force

     Response from Melba T Vasquez to DSM-5 Task Force 11.09.11


November 9, 2011: Darrel Regier, MD, DSM-5 Task Force Chair, responds to Coalition for DSM-5 Reform’s Open Letter in an interview with journalist, Deborah Brauser, for Medscape Medical News

(Free registration is required in order to view this Medscape article.)

Medscape Medical News > Psychiatry

APA Answers DSM-5 Critics

Deborah Brauser | November 9, 2011


November 8, 2011: Coalition for DSM-5 Reform issues press release

Scientists and Clinicians Warn about Dangerous Implications of DSM-5

For Immediate Release: November 8, 2011 – It started as a small committee of three persons from the Society for Humanistic Psychology (SHP) who were alarmed about the potential dangers they saw in the proposed DSM-5. Of particular concern were increased risks to vulnerable populations of children and the elderly, possible increases in the number of people who will be diagnosed with a mental disorder, and the lack of scientific basis behind some of the proposals. But what could three people do?

So far, they have generated almost 5000 signatures from mental health professionals from around the world, supporting an Open Letter to the DSM-5 Task Force and the American Psychiatric Association, posted in an online petition

(http://www.ipetitions.com/petition/dsm5/).

Additionally, to date 10 Divisions of the American Psychological Association and 7 other psychology organizations have also endorsed the letter and signed the petition.

The DSM-5 Task Force responded to the Open Letter, but the SHP committee was not satisfied with explanations offered by the Task Force. Thus, the committee has written a response (see below and attached). The letter (goo.gl/gusMy) explains why the response of the task force was not adequate, reiterates the potential dangers of the DSM-5, and requests that the DSM-5 proposals be submitted for independent review by scholars and scientists not selected by, nor affiliated with, the DSM-5 Task Force and the American Psychiatric Association which publishes the manual.

The SHP committee hopes that an independent review will result in revisions to the proposed DSM-5 that will more accurately reflect the scientific literature and help ensure that vulnerable populations are not inappropriately diagnosed with mental disorders and treated with psychiatric drugs that have dangerous side effects.

David N. Elkins, President of the Society of Humanistic Psychology and Chair of the Open Letter Committee stated, “If the proposed DSM-5 is not changed, I am concerned that hundreds of thousands of normal individuals – including children and the elderly – will be diagnosed with a mental disorder and inappropriately treated with powerful psychiatric drugs. I hope the leaders of the DSM-5 Task Force listen to our concerns and insist that changes be made. Mental health professionals, who are the major purchasers and users of the DSM, have a right to know that the manual is credible and safe to use.”

LETTER AND LINK TO BLOG: goo.gl/gusMy

CONTACT INFO:
Email: Brent Dean Robbins
Phone: 716-982-8594


November 7, 2011: Coalition for DSM-5 Reform responds to Task Force letter

Open the letter here in PDF format:

    Response to DSM-5 Task Force 11.07.11

Text version follows:

Response to Letter from DSM-5 Task Force and the American Psychiatric Association:

Society of Humanistic Psychology

November 7, 2011

ATTENTION:
David J. Kupfer, M.D., Chair of DSM-5 Task Force
Darrel A. Ragier [sic], M.D., M.P.H., Vice Chair of DSM-5 Task Force
John M. Oldham, M.D., President of the American Psychiatric Association
Dilip V. Jeste, M.D., President-Elect of the American Psychiatric Association
Roger Peele, M.D., Secretary of the American Psychiatric Association

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

Thank you for your response to the Open Letter that was composed by the Society for Humanistic Psychology (Division 32 of the American Psychological Association) and endorsed by over 4,600 individuals and 17 organizations, including nine other divisions of the American Psychological Association. In this context, it should be noted that the American Psychological Association itself has not taken a position on this matter other than to encourage its members to participate in the DSM-5 development process. It is our understanding that President Melba Vasquez will be responding to your letter separately on behalf of the American Psychological Association. We are writing on behalf of the Society for Humanistic Psychology Open Letter Committee to express our gratitude that the Task Force has opened a public dialogue about these issues and to let you know that we are happy to share your letter with our membership. We are pleased that the Task Force will consider the issues we described in our Open Letter as well as those raised by others in the mental health field.

However, we remain deeply concerned about the issues we raised and find that your response did not adequately address them. Our main concerns include:

(1) The lowering of diagnostic thresholds, which may artificially inflate the prevalence of numerous disorders. By increasing the number of people who qualify for a diagnosis, DSM-5 may lead to the excessive medicalization and stigmatization of normative or transient distress.

(2) The potential consequences of lowered thresholds and new disorder categories on vulnerable populations such as children and the elderly. These populations are already at risk for excessive and inappropriate treatment with medications that have dangerous side effects. We are particularly concerned about the overuse of medications for “Attenuated Psychosis Syndrome,” “Disruptive Mood Dysregulation Disorder,” “Mild Neurocognitive Disorder,” Attention Deficit/Hyperactivity Disorder, and Generalized Anxiety Disorder.

(3) The lack of scientific evidence substantiating many of these new proposals.

Our rationale for these concerns can be found in our open letter, which is available at http://www.ipetitions.com/petition/dsm5/ for all interested mental health professionals to sign.

Although we appreciate your explanations of the Task Force’s activities, we did not find them sufficient to address our concerns for the following reasons:

A single set of field trials, no matter how large and diverse the sample size, is not an adequate replacement for a body of scientific literature that is built over time through the contributions of multiple and independent researchers. Many of the newly proposed disorder categories lack this important and critically necessary body of scientific support.

Though reliability and utility are important, we are also concerned about validity and potential social consequences. As you know, increasing the number of people who qualify for a psychiatric diagnosis may lead to epidemiological inflation and, as a consequence, the inappropriate medication and stigmatization of individuals with normative conditions. It also leads to ethical and moral concerns about our professions.

Though we are pleased to learn you are not considering the inclusion of several conditions proposed by outside sources (such as Parental Alienation Disorder), it would help to avoid confusion if you removed these conditions from the list of DSM-5 considerations at your website (where they still appear as of 11/7/11):

http://www.dsm5.org/proposedrevision/Pages/Conditions-Proposed-by-Outside-Sources.aspx

We do not assume that the Task Force is intentionally deemphasizing social and psychological explanations. However, the proposed language deemphasizes social and psychological explanations and may lead to the pathologization of sociopolitical deviance. We emphasize again that the Stein et al. definition of mental disorder would result in the scientifically unsubstantiated reduction of all DSM-defined disorders to biological bases.

We are aware that the DSM-5 Task Force and Work Groups include not only psychiatrists but also some psychologists and other mental health professionals. However, these teams represent a highly selective and circumscribed group of academic mental health professionals whose experiences differ from those of mental health professionals working in the field on an everyday basis. The purpose of the open letter is to represent the wide spectrum of voices in our community.

We believe it is important that the Task Force give serious consideration to the public feedback by thousands of mental health professionals and others who have signed the open letter to date. The open letter’s list of individual and organizational signatories continues to grow. As of today, we have over 4,600 individual signatures as well as endorsements from the following organizations: Behavioral Neuroscience and Comparative Psychology (Division 6 of the American Psychological Association), the Division of Developmental Psychology (Division 7 of the American Psychological Association), the Society for Community Research and Action: Division of Community Psychology (Division 27 of the American Psychological Association), Psychotherapy (Division 29 of the American Psychological Association), the Society for the Psychology of Women (Division 35 of the American Psychological Association), the Division of Psychoanalysis (Division 39 of the American Psychological Association), Psychologists in Independent Practice (Division 42 of the American Psychological Association), the Society for Group Psychology and Psychotherapy (Division 49 of the American Psychological Association), the Society for the Psychological Study of Men & Masculinity (Division 51 of the American Psychological Association), the Association for Women in Psychology, the Society for Personality Assessment, the Society for Descriptive Psychology, the UK Council for Psychotherapy (UKCP), the Constructivist Psychology Network (CPN), the Taos Institute, Psychoanalysis for Social Responsibility (Section IX of Division 39 of the American Psychological Association), and the Association for Counselor Education and Supervision (Division of the American Counseling Association). In addition, some are now considering a consumer petition that could tap into the concerns of hundreds of thousands of consumers. We believe you are also aware that the British Psychological Society (nearly 50, 000 members), the American Counseling Association (45,000 members), and two previous chairs of DSM Task Forces have also raised concerns about the current proposals for DSM-5.

Again, we appreciate the Task Force’s assurance that the concerns expressed in our open letter will be taken into consideration. However, we believe these concerns to be of sufficient gravity to warrant more than confidential deliberations among those who invented and supported the problematic proposals. Further, the scientific review of DSM-5 conducted by the American Psychiatric Association was internal, and both the methods and findings of that review remain completely undisclosed to the public.

In view of the above concerns, as well as the unprecedented level of criticism of DSM-5 as currently proposed, we respectfully request an external review of the DSM-5 proposals by scientists and scholars who are not appointed by or affiliated with the American Psychiatric Association. We believe that only such an external review (alongside the implementation of any revisions recommended by the reviewers) will assure the mental health professions that DSM-5 is credible and safe to use.

For the future welfare of our clients/patients, as well as for the credibility of our professions, we hope you will submit the DSM-5 to independent, comprehensive, and scientific review.

Yours sincerely,

David N. Elkins, Ph.D.
President, Society for Humanistic Psychology, Division 32 of the American Psychological Association

Brent Dean Robbins, Ph.D.
Secretary, Division 32, Society for Humanistic Psychology, American Psychological Association

Sarah R. Kamens, M.A.
Doctoral Candidate in Clinical Psychology, Fordham University, Student Representative, Division 32


November 4, 2011: Special Projects Manager, Office of Communications & Public Affairs, American Psychiatric Association, sends letter via email from DSM-5 Task Force to Editor, Psychiatric Times

Curiously, the letter (incorrectly dated “October 4″) was unsigned by either Task Force Chair, David Kupfer, MD, or Vice-chair, Darrel Regier, MD. And although it was addressed to both Melba J. T. Vasquez, PhD, President American Psychological Association, and David N. Elkins, PhD, President, Society for Humanistic Psychology and chair, Open Letter and Petition committee, neither was sent a copy by the Task Force or the American Psychiatric Association’s Office of Communications & Public Affairs.

In the absence of clarification, we can only surmise that the Task Force had submitted their letter to the Editor of Psychiatric Times with a view to publication.

The American Psychiatric Association subsequently published a copy of the Task Force’s response to the Open Letter and Petition, here on the DSM-5 Development website (with the date amended).

Or open a PDF version of the Task Force’s letter here:

    DSM-5 Task Force response to Society for Humanistic Psychology 11.04.11

Text version follows:

American Psychiatric Association

1000 Wilson Boulevard
Suite 1825
Arlington, VA 22209
Telephone 703.907.7300
Fax 703.907.1085
E-mail apa@psych.org
nternet www.psych.org

November 4, 2011

Melba J.T. Vasquez, Ph.D., President
American Psychological Association
750 First Street, N.E.
Washington, DC 20002-4242

David N. Elkins, Ph.D., President
Society for Humanistic Psychology
750 First Street, N.E.
Washington, DC 20002-4242

Dear President Vasquez and President Elkins,

We are appreciative of the thoughtful concerns expressed in the Open Letter about the introduction of new diagnoses, proposals for modifying criteria definitions and thresholds for existing diagnoses. The current draft of the DSM-5 diagnostic criteria, still more than a year away from publication, is continually being refined and reworked by the DSM-5 Task Force and Work Group members. Final decisions about proposed revisions will be made on the basis of field trial data as well as on a full consideration of other issues such as those raised by the signatories to this petition, the 10,000 individuals who responded to the February 2010 and April 2011 postings of draft criteria on DSM5.org, other internal reviews by a Scientific Review Committee, the DSM-5 Task Force, and the APA Board of Trustees.

This level of both internal and external review and field trial exposure has never before been undertaken by any previous DSM or ICD revision proposals.

We wish to clarify several specific issues you raise. Several disorders that were mentioned, such as Parental Alienation Syndrome, were proposed by outside groups but have not been proposed for inclusion by the Task Force. Some of the newer diagnoses, including Disruptive Mood Dysregulation Disorder (DMDD), Attention Deficit Hyperactivity Disorder (ADHD), Attenuated Psychosis Syndrome Disorder (APSD), Complex Somatic Symptom Disorder (CSDD) [sic], Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and Personality Disorders are all being tested in the 11 large academic field trial centers that have enrolled over 2,000 patients in a rigorous test-retest design to assess the reliability and clinical utility of proposed criteria. Based on the results of these field trials the DSM-5 Task Force and Work Groups will review the criteria for any necessary changes.

The definition of a mental disorder that is contained in DSM-IV is also undergoing thorough review by the Task Force, which has not adopted the proposed revision that was published by Stein et al. in Psychological Medicine. There is certainly no intent on the part of the DSM-5 Task Force to diminish the importance of environmental and cultural exposure factors as etiological contributors to mental disorders – as indicated by an active study group charged with developing a cultural formulation section as well as culture specific expression issues for individual diagnoses.

We should also note that the DSM-5 Task Force and Work Groups include a multi-disciplinary mix of clinical and research experts in which psychologists are prominent members. There is also another field trial taking place in Routine Clinical Practice settings that will include psychiatrists and approximately 500 of each mental health specialty group of psychologists, social workers, psychiatric nurses clinical counsellors, and marriage and family counselors. The full range of disorders will be assessed in this field trial and the findings will contribute to the final decisions about the diagnoses.

We wish to express our appreciation to all of the clinicians and research investigators who have invested such intense interest and energy in assuring that the next revision of DSM will be based on the best available clinical experience and research evidence in an effort to improve patient care and our understanding of mental illnesses. We hear your concerns and are aware of those from others in the mental health field, and take them under serious consideration in our deliberations.

Please continue to visit and review the DSM-5 website for changes to the criteria, the rationale for proposed changes from DSM-IV, and an extensive set of research analyses on www.dsm5.org. We will be opening the website for public comment on the draft criteria and chapter organization one final time in 2012. We invite you all to submit your comments during that time so they can be reviewed thoroughly and systematically by the DSM-5 Task Force and Work Group members.

We would be most appreciative if you would share this information with your members.

Sincerely,

DSM-5 Task Force Members

[Ends]

October 22, 2011: Society for Humanistic Psychology (Division 32 of the American Psychiatric Association) launches iPetition calling for reform of DSM-5 and independent review

Open Letter and iPetition here


Looking for media coverage on the Coalition for DSM-5 Reform Petition?  Go to Page 2

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