DSM-5 November Round up #1

Post #285 Shortlink: http://wp.me/pKrrB-3zQ

Recent documents issued by the American Psychiatric Association at DSM-5 Development

Coding Changes Update: Important Coding and Criteria Updates: UPDATED 11/22/13

APA Statement issued 10.31.13: Statement on DSM-5 Text Error Pedophilic disorder text error to be corrected

Text Corrections: DSM-5 Paraphilic Disorders 10/31/13

Criteria Update: Updates to DSM-5 Adjustment Disorders: 10/15/13

Coding Changes Update: Neurocognitive Disorders Coding Updates: UPDATED 10/18/13

Psychiatric News Article: ICD Codes for Some DSM-5 Diagnoses Updated, Mark Moran, 10/7/13

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Commentary, Dx Summit

Attenuated Psychosis Syndrome Was Not Actually Removed from DSM-5

by Sarah Kamens

Note from Dx Revision Watch: Here is another codable diagnosis slipped in by APA before going to press. Between closure of the third DSM-5 draft review and publication of the final code sets a “Brief somatic symptom disorder,” where duration of symptoms is less than 6 months, was added under new category, “Other specified Somatic Symptom and Related Disorder” cross-walked to ICD 300.89 (F45.8) [DSM-5, Page 327]. This “Other specified” category can be used for symptom presentations that do not meet the full criteria for any of the disorders in the Somatic symptom and related disorders diagnostic class.
This means that as little as a single, distressing physical symptom + just one psychobehavioural symptom from the Somatic symptom disorder “B type” criteria, with less than 6 months chronicity would meet criteria for a codable mental disorder. A “Brief illness anxiety disorder” diagnosis of less than 6 months duration has also been inserted under this code – neither of which were in the third draft.

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Commentary from Christopher Lane, Ph.D., at Side Effects, Psychology Today:

The OECD Warns on Antidepressant Overprescribing Antidepressant consumption not matched by an increase in global diagnoses

Christopher Lane | November 22, 2013

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Commentary by Athena Bryan for Brown Political Review:

A Tale of Two Codices: the DSM, ICD and Definition of Mental Illness in America

Athena Bryan | November 21, 2013

Note from Dx Revision Watch: I have added a comment to this article, noting that APA has proposed the following new DSM-5 disorders for inclusion in the forthcoming U.S. specific ICD-10-CM via the September 18-19, 2013 meeting of the ICD-9-CM Coordination and Maintenance Committee: Binge eating disorder (BED); Disruptive mood dysregulation disorder (DMDD); Social (pragmatic) communication disorder; Hoarding disorder; Excoriation (skin picking) disorder; Premenstrual dysphoric disorder (PMDD); that DSM-5′s new constructs, Somatic symptom disorder (SSD) and Illness anxiety disorder were also proposed for insertion into the ICD-10-CM Tabular List and Index; that the ICD-10-CM is a “clinical modification” of WHO’s ICD-10 and is scheduled for U.S. implementation in October 2014; that its development from the ICD-10 has been the responsibility of NCHS.

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Three DSM-5 Somatic symptom disorder related items:

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Editorial British Journal of Psychiatry:

Editorial: Michael Sharpe, DSM-5 Somatic symptom disorder Work Group member BJP November 2013 203:320-321; doi: 10.1192/bjp.bp.112.122523:

Editorial: Somatic symptoms: beyond ‘medically unexplained’

Abstract:

Somatic symptoms may be classified as either ‘medically explained’ or ‘medically unexplained’ – the former being considered medical and the latter psychiatric. In healthcare systems focused on disease, this distinction has pragmatic value. However, new scientific evidence and psychiatric classification urge a more integrated approach with important implications for psychiatry.

Note from Dx Revision Watch: Unless NCHS rejects the proposal submitted at the September 18-19, 2013 meeting of the ICD-9-CM Coordination and Maintenance Committee, Somatic symptom disorder is destined for insertion into the ICD-10-CM Tabular List under F45 Somatoform Disorders as an inclusion term to F45.1 Undifferentiated somatoform disorder and for adding to the Alphabetic Index. See http://wp.me/pKrrB-3×1.

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Slide presentation: Francis Creed, University of Manchester, UK:

Can we now explain medically unexplained symptoms?

Francis Creed | Exeter, June 13, 2013 | PDF format

or open PDF [1.5MB] here Creed June 2013 slide presentation

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Book chapter: Polypharmacy in Psychiatry Practice, Volume I: Multiple Medication Use Strategies:

Polypharmacy in Psychiatry Practice, Volume I: Multiple Medication Use Strategies, Ritsner, Michael S (Ed.) 2013, XVII, 287 p ISBN: 978-94-007-5804-9 (Print) 978-94-007-5805-6 (Online)

Chapter 11: Multiple Medication Use in Somatic Symptom Disorders: From Augmentation to Diminution Strategies  

Most of Chapter 11, Pages 243-254 (pp 247-249 omitted) can be previewed on Google Books here

APA finally posts DSM-5 Field Trials online and DSM-5 Round up

APA finally posts DSM-5 Field Trials online and DSM-5 Round up

Post #206 Shortlink: http://wp.me/pKrrB-2vu

Three papers discussing the results of the DSM-5 field trials were posted online yesterday by the American Journal of Psychiatry. The papers describe the methods and results of the 23 diagnoses assessed during the field trials.

APA failed to publish field trial results during the life of the third and final public review and comment period.

Access to the abstracts is free but you will need subscriber or institution access for the full PDFs or cough up $$ for the papers. ($35 per paper for 24 hours’ access. Why have these reports not been published on the DSM-5 Development website? Many classes of stakeholder will be disenfranchised.)

The article states that criteria were tested in October 2010 through February 2012 by 279 clinicians at 11 U.S. and Canadian academic centers. A second set of data from small group practices and private practices is expected to be reported early next year (that is, after the finalized draft has gone to the publishers).

Proposed criteria are still under review and won’t be finalized until approved by APA Board of Trustees.

DSM-5 draft proposals for criteria and categories as issued for the third and final stakeholder review can be read here on the DSM-5 Development website.

Note that the draft is now frozen and criteria sets and manual texts subject to embargo until publication of the DSM-5 manual. Any revisions made by the Task Force and Work Groups since the third iteration was released in May, this year, won’t be reflected on the DSM-5 Development website.

Published yesterday in the American Journal of Psychiatry and at Psychiatry Online:

Tuesday, October 30, 2012

Full text of article:

DSM-5 Field Trials Posted Online by AJP

http://alert.psychiatricnews.org/2012/10/dsm-5-field-trials-posted-online-by-ajp.html

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Article 1 | October 30, 2012

Abstract: http://psychiatryonline.org/article.aspx?articleid=1387935

DSM-5 Field Trials in the United States and Canada, Part I: Study Design, Sampling Strategy, Implementation, and Analytic Approaches

Diana E. Clarke, Ph.D., M.Sc.; William E. Narrow, M.D., M.P.H.; Darrel A. Regier, M.D., M.P.H.; S. Janet Kuramoto, Ph.D., M.H.S.; David J. Kupfer, M.D.; Emily A. Kuhl, Ph.D.; Lisa Greiner, M.S.S.A.; Helena C. Kraemer, Ph.D.

Am J Psychiatry 2012;:. 10.1176/appi.ajp.2012.12070998

PDF for those with subscriber access: http://ajp.psychiatryonline.org/data/Journals/AJP/0/appi.ajp.2012.12070998.pdf

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Article 2 | October 30, 2012

Abstract: http://psychiatryonline.org/article.aspx?articleid=1387906

DSM-5 Field Trials in the United States and Canada, Part II: Test-Retest Reliability of Selected Categorical Diagnoses

Darrel A. Regier, M.D., M.P.H.; William E. Narrow, M.D., M.P.H.; Diana E. Clarke, Ph.D., M.Sc.; Helena C. Kraemer, Ph.D.; S. Janet Kuramoto, Ph.D., M.H.S.; Emily A. Kuhl, Ph.D.; David J. Kupfer, M.D.

Am J Psychiatry 2012;:. 10.1176/appi.ajp.2012.12070999

PDF for those with subscriber access:
http://ajp.psychiatryonline.org/data/Journals/AJP/0/appi.ajp.2012.12070999.pdf

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Article 3 | October 30, 2012

Abstract: http://psychiatryonline.org/article.aspx?articleid=1387907

DSM-5 Field Trials in the United States and Canada, Part III: Development and Reliability Testing of a Cross-Cutting Symptom Assessment for DSM-5

William E. Narrow, M.D., M.P.H.; Diana E. Clarke, Ph.D., M.Sc.; S. Janet Kuramoto, Ph.D., M.H.S.; Helena C. Kraemer, Ph.D.; David J. Kupfer, M.D.; Lisa Greiner, M.S.S.A.; Darrel A. Regier, M.D., M.P.H.

Am J Psychiatry 2012;:. 10.1176/appi.ajp.2012.12071000

PDF for those with subscriber access:
http://ajp.psychiatryonline.org/data/Journals/AJP/0/appi.ajp.2012.12071000.pdf

Commentaries:

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

by Allen Frances, M.D.

DSM 5 Field Trials Discredits APA

You can’t turn a sow’s ear into a silk purse.

…According to the authors, 14 of the 23 disorders had “very good” or “good” reliability; 6 had questionable, but ‘acceptable’ levels; and just three had “unacceptable” rates. Sounds okay until you look at the actual data and discover that the cheerful words used by the DSM 5 leaders simply don’t fit their extremely disappointing results. The paper is a classic example of Orwellian ‘newspeak’…

Allen Frances, M.D. | August 30, 2012

Read full article here

Also on Huffington Post

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1 Boring Old Man

finally…

1 Boring Old Man | October 30, 2012

Well, they finally published the results of the DSM-5 Field Trials. Here are the links to the abstracts and the main table of kappa values to look over…

 

DSM-5 Round up

Public Lecture St Mary’s College of Maryland

http://www.smcm.edu/calendar/events/index.php?com=detail&eID=2317

DSM-V: Social, Political, and Ethical Implications

November 2

3:00 PM – 5:00 PM

Cole Cinema, Campus Center

This presentation will describe the DSM-V, scheduled for publication in May 2013, and the controversy surrounding its development. Dr. Ancis will provide an overview of the newly proposed classification system and diagnoses.

It is imperative that those involved in using the DSM-V, or potentially impacted by the DSM, be duly informed. Questions associated with the DSM-V revision process; the empirical bases of proposed changes; social, legal, and political implications; and ethical and cultural considerations will be addressed.

Dr. Ancis will describe her involvement in a number of initiatives related to DSM-V proposals, including those of the Association of Women in Psychology and Counselors for Social Justice. She will also review concerns of major mental health organizations worldwide, such as the American Psychological Association, the American Counseling Association, and the British Psychological Society, and related divisions.

Dr. Ancis is currently a Professor of Counseling and Psychological Services at Georgia State University. She earned her Bachelors, Masters, and Ph.D from the University at Albany, State University of New York. Her major areas of interest are multicultural competency training, diversity attitudes, race and gender issues, education and career development, and legal system experiences.

Event Contact Info

Janet Kosarych-Coy

Email: jmkosarychcoy@smcm.edu

Phone: 2408954283

Website: Click to Visit

Location: Cole Cinema, Campus Center

18952 E. Fisher Rd

St. Mary’s City, MD 20686

Categories:





Psychology Today

Side Effects

From quirky to serious, trends in psychology and psychiatry

The Tranquilizer Trap The scandal over benzodiazepines gets different emphasis in the UK and U.S.

Published on October 3, 2012 by Christopher Lane, Ph.D. in Side Effects

Anti-DSM Sentiment Rises in France Why French psychiatrists and psychoanalysts are opposed to the diagnostic manual  (French Stop DSM-5 Campaign)

Published on September 28, 2012 by Christopher Lane, Ph.D. in Side Effects

New York Times

Report Sees Less Impact in New Autism Definition

By BENEDICT CAREY | Published: October 2, 2012

Proposed changes to the official diagnosis of autism will not reduce the proportion of children found to have it as steeply as many have feared, scientists reported on Tuesday, in an analysis that contradicts several previous studies…

Medscape

Medscape Medical News > Psychiatry

Controversial New Diagnosis in DSM-5 May Be Faulty

Pam Harrison | October 17, 2012

Attenuated psychosis syndrome (APS), a new and controversial diagnosis for potential inclusion in the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is questionable, new research suggests…

DSM-5 and Employment Law

In September, Douglas Hass (Franczet Radelet) published an article Could the American Psychiatric Association Cause You Headaches? The Dangerous Interaction between the DSM-5 and Employment Law:

Abstract:

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2153268

Since its first publication in 1952, the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) has long served not only as the primary reference for mental health disorders for medical practitioners, but also as a primary authority for the legal community…

Full text in PDF format: Hass

Research Article

http://onlinelibrary.wiley.com/doi/10.1002/da.22012/abstract

Research Article

The Effect of Draft DSM-V Criteria on Posttraumatic Stress Disorder Prevalence

Patrick S. Calhoun Ph.D.1,2,3,*,
Jeffrey S. Hertzberg B.A.3,
Angela C. Kirby M.S.3,
Michelle F. Dennis B.A.2,
Lauren P. Hair M.S.3,
Eric A. Dedert Ph.D.1,2,3,
Jean C. Beckham Ph.D.1,2,3
Article first published online: 26 OCT 2012

DOI: 10.1002/da.22012

© 2012 Wiley Periodicals, Inc.

Journal of Psychosomatic Research

November 2012 Issue, Journal of Psychosomatic Research

http://www.jpsychores.com/current

Issue: Vol 73 | No. 5 | November 2012 | Pages 325-400

http://www.jpsychores.com/article/S0022-3999(12)00225-5/abstract

Predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder – Comparison with DSM-IV somatoform disorders and additional criteria for consideration

Katharina Voigt
Affiliations
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany

Corresponding author at: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Tel.: +49 40 7410 54408; fax: +49 40 7410 54975.

Eileen Wollburg
Affiliations
Schön Klinik Bad Bramstedt, Bad Bramstedt, Germany

Nina Weinmann
Affiliations
Schön Klinik Bad Bramstedt, Bad Bramstedt, Germany

Annabel Herzog
Affiliations
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany

Björn Meyer
Affiliations
GAIA AG, Hamburg, Germany

Gernot Langs
Affiliations
Schön Klinik Bad Bramstedt, Bad Bramstedt, Germany

Bernd Löwe
Affiliations
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany

Received 3 July 2012; received in revised form 29 August 2012; accepted 30 August 2012; published online 24 September 2012.

Abstract

Objective
Major changes to the diagnostic category of somatoform disorders are being proposed for DSM-5. The effect of e.g. the inclusion of psychological criteria (criterion B) on prevalence, predictive validity, and clinical utility of “Somatic Symptom Disorder” (SSD) remains unclear. A prospective study was conducted to compare current and new diagnostic approaches.

Methods
In a sample of N=456 psychosomatic inpatients (61% female, mean age=44.8±10.4years) diagnosed with somatoform, depressive and anxiety disorders, we investigated the current DSM-5 proposal (SSD) plus potential psychological criteria, somatic symptom severity, and health-related quality of life at admission and discharge.

Results
N=259 patients were diagnosed with DSM-IV somatoform disorder (56.8%). With a threshold of 6 on the Whiteley Index to assess psychological criteria, the diagnosis of SSD was similarly frequent (51.8%, N=230). However, SSD was a more frequent diagnosis when we employed the recommended threshold of one subcriterion of criterion B. Patients diagnosed with only SSD but not with DSM-IV somatoform disorder showed greater psychological impairment. Both diagnoses similarly predicted physical functioning at discharge. Bodily weakness and somatic and psychological attributions at admission were among significant predictors of physical functioning at discharge. Reduction of health anxiety, bodily weakness, and body scanning significantly predicted an improvement of physical functioning.

Conclusions
Psychological symptoms enhance predictive validity and clinical utility of DSM-5 Somatic Symptom Disorder compared to DSM-IV somatoform disorders. The SSD diagnosis identifies more psychologically impaired patients than its DSM-IV precursor. The currently suggested diagnostic threshold for criterion B might increase the disorder’s prevalence.

Keywords: Somatoform disorder, Diagnosis, Diagnostic and Statistical Manual of Mental Disorders, Classification of diseases, Validation studies as topic

Ed: Note: Between publication of the second iteration of the DSM-5 draft proposals for public review and publication of the third set of draft proposals, the SSD “B type criteria” were reduced from the requirement to meet at least two from the “B type” criteria to at least one [1].

1] http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=368

Somatic Symptom Disorder Criteria

Three professional organization responses to third and final DSM-5 stakeholder review

Three professional organization responses to the third and final DSM-5 stakeholder review

Post #185 Shortlink: http://wp.me/pKrrB-2hS

According to DSM-5 Task Force Vice-chair, Darrel Regier M.D., the specific diagnostic categories that received most comments during the second public review of draft proposals (May-June 2011) were the sexual and gender identity disorders, followed closely by somatic symptom disorders and anxiety disorders.

The American Psychiatric Association (APA) has yet to report how many comments the DSM-5 Task Force and its 13 Work Groups received during this third and final review period (which closed last Friday), or which categories garnered the most responses, this year.

 

No publication of field trial data

Following posting of the third draft on May 2, it was anticipated APA would publish full results from the DSM-5 field trials “within a month”. [Source: Deborah Brauser for Medscape Medical News: interview with Darrel Regier, May 8, 2012.]

No report emerged and stakeholders had little choice but submit feedback on this latest iteration without the benefit of scrutiny of reliability data to inform their submissions.

APA has yet to account for its failure to place its field trial results in the public domain while the feedback exercise was in progress, other than releasing some Kappa data at its May 5-9 Annual Conference.

American Psychiatric Association CEO and Medical Director, James H. Scully, Jr., M.D., blogs at Huffington Post. Last week, I asked Dr Scully why the field trial report has been withheld; whether Task Force still intends publishing field trial data and when that report might now be anticipated. 

I’ve received no response from Dr Scully and APA has put out no clarification.

 

No publication of list of Written Submissions

These three DSM-5 public reviews of draft proposals for changes to DSM-IV categories and criteria have not been managed as formal stakeholder consultation exercises.

APA publishes no aggregations of key areas of concern identified during public comment periods nor publishes Work Group or Task Force responses to key areas of professional or lay public concern on the DSM-5 Development website  – an issue I raised with the Task Force during both the first and second reviews.

Although some published submissions (ACA, British Psychological Society and the DSM-5 Reform Open Letter and Petition Committee) have received responses from the Task Force and which APA has elected to place in the public domain, submissions from the majority of professional bodies and organizations disappear into a black hole.

In the interests of transparency, APA could usefully publish lists of the names of US and international professional bodies, academic institutions, patient advocacy organizations etc. that have submitted comments, in the way that Written Submissions are listed in the annexes to reports and public inquiries.

That way, interested parties might at least approach organizations to request copies of submissions or suggest that these are placed in the public domain.

APA could not legitimately claim it would require permissions before publishing full lists of the names of professional body, academic institution and organization respondents that tendered formal responses – its legal department’s boilerplate Terms and Conditions of Use gives APA carte blanche to make use of and publish uploaded submissions in any way it sees fit.*

*See Terms and Conditions of Use, under “User Submissions” 

 

The following have released their submissions in response to the third draft:

Submission from The American Mental Health Counselors Association (AMHCA)

The American Mental Health Counselors Association is a nationwide organization representing 6,000 clinical mental health counselors. Their submission includes concerns for the lowering of the “B type” threshold requirement for “Somatic Symptom Disorder” criteria between the second and third drafts.

[In the CSSD field trials, about 15% of the “diagnosed illness” study group (patients with cancer and coronary disease) met the criteria for coding with an additional mental health diagnosis of “SSD” when “one B type” cognition was required; about 10% met the criteria when “two B type” were required. About 26% of the “functional somatic” arm of the study group (patients with irritable bowel and “chronic widespread pain” – a term used synonymously with fibromyalgia) met the criteria for coding with an additional mental health diagnosis of “SSD” when “one B type” cognition was required; about 13% met the criteria when “two B type” were required. AMHCA recommends raising the threshold back to at least two from the three B type criteria, as the criteria for CSSD had stood for the second draft. I consider the category of “SSD” should be rejected in the absence of a substantial body of independent evidence for the reliability, validity and safety of “SSD” as a construct.]

AMHCA Submits Comments on DSM-5 06/19/12

June 18, 2012 – Alexandria, VA – The DSM-5 Task Force of the American Mental Health Counselors Association (AMHCA) has submitted comments for the third period of public comment on the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

AMHCA’s comments addressed 12 disorder categories and the Cultural Formulation Interview Guide. Per the site requirements, each was sent separately to the particular disorder site.

    Download compilation of comments submitted by AMHCA DSM-5 Task Force

Somatic Symptom Disorders

“Somatic Symptom Disorder

“A major change in this revision is the merger of Complex Somatic Symptom Disorder and Simple Somatic Symptom Disorder into one disorder, Somatic Symptom Disorder. The increased emphasis placed on cognitive distortions (along with the presence of somatic symptoms ) provides greater clarity about the nature of the disorder. However, the notion that a single B.2 criteria could be used as the sole basis for identifying these cognitive aspects seems to open the door to diagnosing individuals who have legitimate “high anxiety” about their symptoms. We recommend considering “two of three” criteria under B be required.”

 

The British Psychological Society writes:

The British Psychological Society still has concerns over DSM-V

…For all the reasons stated above, the BPS, having reviewed the currently proposed revisions of the new diagnostic criteria in DSM 5, continues to have major concerns. These have, if anything, been increased by the very poor reliabilities achieved in many of the recent field trials (Huffington Post, 2012), especially given the limited time available to attempt to achieve more satisfactory outcomes. Since validity depends, at the very least, on acceptable levels of reliability, the unavoidable conclusion is that many of the most frequently-used categories will be unable to fulfil their purported purposes, i.e. identification of appropriate treatments, signposting to support, providing a basis for research…

Read full submission to third draft here in PDF format.

Response to second draft here.

Christopher Lane comments:

Psychology Today | Side Effects

Arguing Over DSM-5: The British Psychological Society Has Serious Concerns About the Manual

The BPS expresses “serious reservations” about the next DSM.

Christopher Lane, Ph.D. in Side Effects | June 20, 2012

Although the American Psychiatric Association recently closed its window allowing comments on proposed changes to the DSM, the organization has yet to report on the field trials it devised for the next edition of the psychiatric manual, themselves meant to support—indeed, serve as a rationale for—the changes it is proposing in the first place.

While this unhappy outcome points to some of the organization’s chicken-and-egg problems with the manual and the disorders it is seeking to adjust or make official, those wanting to respond to the draft proposals have had to do so in the dark, unaware of the results of the field trials and thus whether the proposals draw from them any actual empirical support…

Read on

 

Submission from American Counseling Association (ACA)

The American Counseling Association (ACA), represents more than 50,000 counselors – one of the largest groups of DSM-5 users in the US.

ACA provides final comments on the DSM-5

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

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

Letter from President Lynn Linde, April 16, 2010

Letter from President Don Locke, November 8, 2011

Response from APA President John Oldham, November 21, 2011

 

Submission by Coalition for DSM-5 Reform Committee

The Coalition for DSM-5 Reform Open Letter and Petition has garnered support from over 13,700 professionals and concerned stakeholders and the endorsement of nearly 50 organizations, since launching last October.

The DSM-5 Reform Committee continues to call for independent scientific review of draft proposals and submitted the following response during this third and final comment period:

Submission from Coalition for DSM-5 Reform (Society for Humanistic Psychology)Division 32 of the American Psychological Association)

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

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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