DSM 5 Disorganization, Disarray, and Missed Deadlines Allen Frances, Psychology Today

DSM 5 Disorganization, Disarray, and Missed Deadlines Allen Frances, Psychology Today

Post #120 Shortlink: http://wp.me/pKrrB-1zt

DSM5 in Distress
The DSM’s impact on mental health practice and research.
by Allen Frances, M.D

DSM 5 Disorganization, Disarray, and Missed Deadlines
Beware The Final Mad Rush

Allen Frances, M.D. |  December 29, 2011

Dr Dayle Jones has become one of the world’s leading experts on DSM 5 and on psychiatric diagnosis. As Chair of the American Counseling Association’s DSM 5 Task Force, she closely follows the DSM 5 process and trenchantly critiques the DSM 5 proposals (see her blogs at http://my.counseling.org/category/dayle-jones/).

Dr Jones just sent me the following alarming email: “DSM 5 keeps missing its own deadlines and the DSM 5 publication date is fast approaching. I am afraid there is insufficient time left for thoughtful preparation or adequate public input. Here’s a brief history of DSM 5’s consistent failure to deliver on time…

…Here’s a brief history of DSM 5’s consistent failure to deliver on time.

On the DSM-5 Field Trials in Academic/Large Clinic Settings: These were originally scheduled to begin in 2009, prior even to the draft proposals being reviewed and vetted by outside mental health professionals. But, after much criticism, the DSM-5 Task Force wisely postponed the start date to June 2010. Unfortunately, the Task Force then came up with an impossibly complicated field trial design that was roundly criticized for missing the relevant questions and having a completely unrealistic timetable…

…On the Routine Clinical Practice Field Trial: I have serious concerns whether this will ever get done…Finally, after these many miscues, the field trials ‘officially’ began in September 2011. In November, APA announced it was extending the field trials to March 2012 in order to recruit more participants. There’s a desperate failure motivating this extension- according to the APA flyer, out of “over 5000 clinicians” eligible to participate, only 195 have completed the training, and a mere 70 (1.4%) are enrolling patients.

This field trial is clearly a total bust.

On The Open Periods For Public Comment: APA has repeatedly bragged about the “unprecedented” open comment periods whereby clinicians can post comments about the DSM-5 proposals online during specified time periods. Ironically, the first comment period in February/April 2010 was initiated only after outside pressure insisted that all proposed revisions be reviewed and vetted by the field before field trials could begin. And, interestingly, very few substantive changes have been made in response to public comments since the first drafts were posted- despite the fact that so many DSM 5 proposals have been so heavily criticized. The final public comment period was originally scheduled for September/October 2011, but has been twice postponed because everything is so far behind- first to January/February 2012 and recently to May 2012. Given this late date, new public feedback will almost certainly have no impact whatever on DSM-5 and appears to be no more than a public relations gimmick…”

…In various blogs since, I have warned that the DSM 5 process has suffered from continued disarray- with constantly missed deadlines, reckless proposals, and a poorly written product. I have long predicted that there would be a headlong and heedless rush at the end to meet the new deadline of May 2013 – with the inevitable mistakes, inconsistencies, and poor quality…

…Given all that is undone and poorly done and the ongoing remarkable state of disarray, the May 2013 publication date for DSM 5 has itself become impossibly premature. In any sensible world there would be yet another year’s delay to clean up the current mess. But because projected DSM 5 publishing profits are essential to the meeting the projected APA budget, May 2013 will almost certainly be the one and only deadline DSM 5 will ever meet. It now seems clear that DSM 5 will be born well before its time in an impossibly ragged and possibly unusable state.

Read full article by Allen Frances on Psychology Today


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