DSM-5 released: professional and campaigning reaction: Round up #7

Post #262 Shortlink: http://wp.me/pKrrB-3cF

DSM-5 released: professional and campaigning reaction: Round up #7

A considerable amount of media coverage and commentary on DSM-5 has been published since posting Round up #6, on May 24. Occupied with other matters, I shall likely not catch-up. The world will continue to turn.

Here, though, are some recent commentaries from psychiatry and psychology professionals; a report from Prof Sir Simon Wessely on last week’s Institute of Psychiatry’s two day DSM-5 Conference; below that, new Online Assessment Measures documents from the APA’s DSM-5 Resource pages, including Somatic Symptom assessment instruments for 6-17 year olds, and a clarification from CMS on HIPAA and the status of the DSM-5 code sets.

Via Patrick Landman

Pédopsychiatre, Psychiatre, Président d’Initiative Pour une Clinique du Sujet Stop-Dsm, Psychanalyste Membre d’Espace Analytiquea

A statement written and signed by prominent French psychiatrists in response to recent comments by APA President-Elect, Jeffrey Lieberman, was issued, yesterday:

Full text on the STOP-DSM campaign website:

To oppose the DSM-5 is not to oppose psychiatry

Recently, some of the DSM-5 supporters have been trying to portray the opposition against the fifth edition of this manual of the American Psychiatric Association as an opposition to psychiatry and a form of antipsychiatry. This political argument aims to discredit the movement and to subsume it in its entirety, including its numerous variations, under a single label, one that can easily be identified and connected with a certain history, the sixties. Such specious rhetoric allows its authors not to have to respond to serious and well-documented arguments of the DSM-5 critics. In reality, its many opponents from Europe, Australia, South America and even the United States include a great number of psychiatrists, clinical psychologists, social workers and other mental health practitioners… Read on


Report on the website of South London and Maudsely NHS Foundation Trust from Prof Sir Simon Wessely on the Institute of Psychiatry’s recent DSM-5 Conference.

Prof Wessely is Head of the Department of Psychological Medicine and Vice Dean, Institute of Psychiatry, King’s College London. 

DSM-5 at the IoP

Monday June 10, 2013

The latest and fifth version of the Diagnostic and Statistical Manual of the American Psychiatric Association (APA), invariably known as the DSM, was published on 18 May 2013. To mark the occasion, we hosted an international conference at the Institute of Psychiatry from 3-4 June. This was the first such meeting since the launch and the first platform for Professor David Kupfer, Chair of Psychiatry at the Western Psychiatric Institute in Pittsburgh, but more importantly for us, the man who has directed the compilation and development of DSM-5, and who is justly regarded as its architect…

…I used the somatoform disorders as an example of where “DSM feared to tread”. The latest attempt to come up with something that is both empirically rigorous but also suitable for real world use in this particular area represents a small step forward, at least in simplifying an area of previous mind numbing complexity, but I suggested, was unlikely to represent real progress. This is because the DSM (and for that matter the ICD) are both diagnostic systems that are written by psychiatrists but which in this area need to be used by physicians, who ignore them, and concern patients who don’t like them, often fiercely so… Full Text


Essay by Sarah Kamens MA on the Dx Summit platform

DSM-5′s Somatic Symptom Disorder: From Medical Enigma to Psychiatric Sphinx

Sarah Kamens is a Ph.D. candidate in clinical psychology at Fordham University and in media & communications at the European Graduate School (EGS). Her work focuses on diagnostic discourse and sociopolitics in the psy disciplines.


Spiked Review of Books

‘This manual is, frankly, a disaster for children’

Christopher Lane talks to spiked about the new edition of the bible of psychiatry – ‘a legal document facilitating the medication of millions’.

by Helene Guldberg


http://www.psychiatry.org/dsm5

DSM-5 Online Assessment Measures

APA is inviting clinicians and researchers to provide feedback on the instruments’ usefulness in characterizing patient status and improving patient care. There are a large number of documents that can be downloaded from the link above, including:

For Adults

LEVEL 2–Somatic Symptom–Adult (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])

For Parents of Children Ages 6–17

LEVEL 2—Somatic Symptom—Parent/Guardian of Child Age 6-17 (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])

For Children Ages 11–17

LEVEL 2—Somatic Symptom—Parent/Guardian of Child Age 11-17 (Patient Health Questionnaire 15 Somatic Symptom Severity Scale [PHQ-15])

Clinician-Rated

Clinician-Rated Severity of Somatic Symptom Disorder


Finally, a note on the FAQ pages of the CMS.gov website which clarifies the non official status of DSM-5 code sets:

Frequently Asked Questions

(FAQ1817)

[Q] In current practice by the mental health field, many clinicians use the DSM-IV in diagnosing mental disorders. As of May 19, 2013, the DSM-5 was released. Can these clinicians continue current practice and use the DSM-IV and DSM-5 diagnostic criteria?

[A] Yes. The Introductory material to the DSM-IV and DSM-5 code set indicates that the DSM-IV and DSM-5 are “compatible” with the ICD-9-CM diagnosis codes. The updated DSM-5 codes are crosswalked to both ICD-9-CM and ICD-10-CM. As of October 1, 2014, the ICD-10-CM code set is the HIPAA adopted standard and required for reporting diagnosis for dates of service on and after October 1, 2014.

Neither the DSM-IV nor DSM-5 is a HIPAA adopted code set and may not be used in HIPAA standard transactions. It is expected that clinicians may continue to base their diagnostic decisions on the DSM-IV/DSM-5 criteria, and, if so, to crosswalk those decisions to the appropriate ICD-9-CM and, as of October 1, 2014, ICD-10 CM codes. In addition, it is still perfectly permissible for providers and others to use the DSM-IV and DSM-5 codes, descriptors and diagnostic criteria for other purposes, including medical records, quality assessment, medical review, consultation and patient communications.

Dates when the DSM-IV may no longer be used by mental health providers will be determined by the maintainer of the DSM-IV/DSM-5 code set, the American Psychiatric Association, http://www.dsm5.org

(FAQ1817)

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DSM-5 released: Media, professional and advocacy reaction: Round up #6

Post #256 Shortlink: http://wp.me/pKrrB-34A

For earlier responses to the release of DSM-5 see Round up Posts #255, #254, #253, #252, #251 and #249

On May 16, CDC published a new report on children’s mental health which I am including in this DSM-5 round up.

Washington Post: CDC says 20 percent of U.S. children have mental health disorders Tony Pugh, May 19, 2013

Up to one in five American youngsters — about 7 million to 12 million, by one estimate — experience a mental health disorder each year, according to a new report billed as the first comprehensive look at the mental health status of children in the country.

CDC article on new Report released May 16, 2013 can be accessed here:

http://www.cdc.gov/features/childrensmentalhealth/

Report in text format here: Children’s Mental Health – New Report

Report in PDF format here: PDF Children’s Mental Health – New Report

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Thompson Reuters News & Insight: Lawyers worry new measure of mental retardation could prompt more executions Elizabeth Dilts, May 13, 2013


Lexology, US: “DSM-5 anxiety” may be new disorder for employers trying to navigate ADA Squire Sanders, Ryan A. Sobel, May 22, 2013


Pacific Standard, US: Now That the ‘DSM-5′ Is Out Can We Start Talking About the Effect It Will Have? Michael Dahr, May 23, 2013

The newly revised, hotly contested book of psychiatric diagnoses is finally here. How will it change the way we consider and treat substance use problems?

Michael Dahr is a medical and science writer who has written for Livescience.com, Science & Medicine, Iowa Outdoors, and various medical and research institutions.

The Conversation: DSM-5 won’t increase mental health work claims – here’s why Nick Glozier, May 23, 2013

Professor of Psychological Medicine, BMRI & Discipline of Psychiatry at University of Sydney


Times Higher Education: Psychiatry’s cause for anxiety Matthew Reisz, May 23, 2013

Focus on people, not technology or the DSM, to treat mental illness, Tom Burns tells Matthew Reisz


Telegraph, UK: Why are women still considered more insane than men? Will Nicholl, May, 23, 2013


ABC Australia: The Pulse DSM-5: why all the fuss? Claudine Ryan, May 23, 2013

…Dr Maria Tomasic, president of the Royal Australian and New Zealand College of Psychiatrists, says the DSM-5 is a useful tool designed to be used by medical professionals who understand its limitations. “We are concerned about the use of classification systems such as the DSM-5 by institutions such as courts or government bodies who often do not understand the complexity of diagnosis, and seek to simplify difficult decisions about funding or eligibility…”

[Professor Perminder] Sachdev says “it should not be used as a legal document or to help bench-mark social services and welfare payments, nor is it suitable for use in seven-minute consultations in a GPs office”.


Wood TV, US: Shrinks, critics face off over psychiatric manual Associated Press Medical Writer Lindsey Tanner, May 22, 2013


The Take Away, US: Presenter John Hockenberry

The show is a co-production of WNYC Radio and Public Radio International, in collaboration with New York Times Radio and WGBH Boston.

Listen again The DSM and Mental Health in America, May 22, 2013

Guest: Allen Frances, MD | Produced by: Nikolay Nikolov and Jillian Weinberger

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Listen again In Defense of the DSM-5 May 23, 2013

Guest: Jeffrey Lieberman, MD | Produced by: Kristen Meinzer

…the incoming president of the American Psychiatry Association, which revises the DSM, says the criticism is unwarranted. His name is Jeffrey Lieberman, MD, and he’s also chairman of psychiatry at Columbia University.

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From Dx Summit platform

Counselors for Social Justice Position Statement on DSM-5 (first published August, 2011)

For earlier responses to the release of DSM-5 see Posts #255, #254, #253, #252, #251 and #249

DSM-5 released: Media, professional and advocacy reaction: Round up #5

Post #255 Shortlink: http://wp.me/pKrrB-346

For earlier responses to the release of DSM-5 see Posts #254, #253, #252, #251 and #249

Division of Clinical Psychology

Earlier this month, the Division of Clinical Psychology (DCP), a division of the British Psychological Society, published a Position Statement on the “Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses, Time for a Paradigm Shift.”

Lucy Johnstone, who helped formulate the DCP’s Position Statement, contributed to a BBC Radio 3 broadcast, last night.

BBC Radio 3

Duration: 45 minutes | One year left to listen | First broadcast: Wednesday 22 May 2013

Night Waves May 22, 2013

Segment starts at 23:45 mins in and runs for 15 mins

Khaled Hosseini, Man Booker International Prize, Disgraced, the Future of Psychiatry, with Rana Mitter

“The British Psychological Society’s division of clinical psychology is calling for a ‘paradigm shift’ in psychiatry away from diagnosis. They claim treating ‘mental distress’ as an illness stigmatises sufferers and leads us to ignore more complicated social dimensions to conditions like depression or schizophrenia. So what is the way forward for psychiatry? Rana is joined by Lucy Johnstone who helped formulate the BPS’s position, consultant psychiatrist Tom Burns, and the historian of psychiatry Matthew Smith.”


Critical Psychiatry Network

The Critical Psychiatry Network (CPN) has issued a statement on DSM-5, dated May 22, 2013. The Statement can be downloaded from this page or the PDF opened, here, on Dx Revision Watch: CPN statement on DSM-5


Social Justice Solutions

“Is a social worker conceived and operated organization born out of the Stony Brook School of Social Welfare’s commitment to active participation in creating a socially just world.”

In DSM-5: A Call to Opposition for Social Workers, Georgianna Dolan-Reilly, LMSW, calls on the organization’s constituency to oppose DSM-5sign the Open Letter developed by the Society for Humanistic Psychology, Division 32 of the American Psychological Association, and criticizes the National Association of Social Workers (NASW) for not issuing its position on DSM-5.


Social Work Helper

Follow Up Interview with Dr Allen Frances: Dishing the Dirt on the DSM 5 Deona Hooper, MSW May 20, 2013

Article links to: Mother Jones: Psychiatry’s New Diagnostic Manual: “Don’t Buy It. Don’t Use It. Don’t Teach It.” By Michael Mechanic, May 14, 2013, which I don’t think has been previously posted.


Science Live Chat: Does ‘Psychiatry’s Bible’ Need to Be Rewritten? (Video)

Talk to experts in a live Google Hangout about the controversy over the DSM-5 Emily Underwood, May 20, 2013

With Frank Farley, William Eaton and Allen Frances

Join us on Thursday, 23 May, at 3 p.m. EDT on this page for a live Google Hangout to chat with experts about the fate of the DSM. Be sure to leave your questions for our guests in the comment box below. [See site for more details]


New Internationalist: Corporates cashing in on mental-health diagnosis Adam McGibbon, May 21, 2013


Pittsburgh Post-Gazette: Critics blast new manual on mental disorders David Templeton, May 21, 2013

Interview with Brent Dean Robbins, who heads the Psychology Department at Point Park University, is a leading critic of DSM-5 and committee member of the recently launched, Global Summit on Diagnostic Alternatives: An Online Platform for Rethinking Mental Health http://dxsummit.org/


AHRP: Two NIMH Directors Debunk DSM & Deplore Psychiatry’s Unscientific Modus Operandi Vera Sharav, May 8, 2013


San Francisco Weekly: Brain Distrust: Shrinks and Scientologists Find Weird Common Ground Over the DSM-5 Joe Eskenazi, May 22, 2013


Counterpunch, US: Taking on Big Pharma A Mental Health Declaration of Independence Bruce E Levine, May 21, 2013


Economist, US: The DSM-5 Attention, everyone CH, May 22, 2013


New York Times: Mind: The Book Stops Here Richard A Friedman, MD, May 20, 2013


Lexology, US: Employers beware: psychiatry’s latest Diagnostic Manual (DSM-5) creates new mental disorders, expands others, Hunton & Williams LLP, May 20, 2013


Education Week, US: Revised Psychiatric Disorders ‘Bible’ Changes Disability Definitions Christina Samuels on May 20, 2013


Human Resource Executive Online, US: New Mental-Health Manual Likely to Impact HR James J McDonald, Jr., May 22, 2013

Making accommodations for employees with mental disabilities has never been easy, and it’s about to get more difficult with the release of the American Psychiatric Association’s new manual of mental disorders.


Fox News, US: The new DSM-5 fails to accurately describe mental illness Dr Keith Ablow, May 22, 2013


Huffington Post: The Role of Biological Tests in Psychiatric Diagnosis Allen Frances, MD, May 22, 2013


Slate, US: You Do Not Have Asperger’s Amy S F Lutz, May 22, 2013

What psychiatry’s new diagnostic manual means for people on the autism spectrum

For earlier responses to the release of DSM-5 see Posts #254, #253, #252, #251 and #249

APA to release DSM-5 at Annual Meeting (May 18-22): What next?

Post #249 Shortlink: http://wp.me/pKrrB-313

Media coverage following release of DSM-5 is compiled in Posts #251 and #252


Update: APA issued this press release today

Click link for PDF document   APA Press Release No. 13-31 May 17, 2013

American Psychiatric Association Releases DSM-5, Publication of diagnostic manual culminates 14-year development process


Purpleblue1DSM-5 is scheduled for release at the 2013 American Psychiatric Association Annual Meeting (May 18-22), in San Francisco. The official APA publication date is May 22.

Amazon US had been quoting a release and shipping date of May 22, but the site currently gives May 27 for both hardback and paperback editions. Amazon UK currently gives the release and shipping date for both hardback and paperback as May 31.

APA is anticipated to release DSM-5 on Saturday, May 18, with an early morning press briefing.

No heads-up yet from UK Science Media Centre, but SMC New Zealand has already put out press briefing materials here.

Australian SMC DSM-5 background briefing materials and presentation here:
BACKGROUND BRIEFING: DSM 5 – Psychiatric bible or fatally flawed?

DSM-5 will launch; a lot of stuff will be written about it.

What next?

On Monday, May 13, the Division of Clinical Psychology, a division of the British Psychological Society, published a “Position Statement on the Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses, Time for a Paradigm Shift.”

You can download a copy of this document here: Position Statement on Diagnosis.

Two new platforms for discussion launched this week:

The first, Dx Summit website. Article on Mad in America here DxSummit Officially Launches, by Jonathan Raskin, May 15.

http://dxsummit.org/

DxSummit Officially Launches

by Diagnostic Summit Committee

DSM-5 Is Widely Criticized, and Pursuit Of Alternatives in Mental Health Care Is Underway

For Immediate Release:

The latest edition of the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association is being released on May 22, 2013. It is the fifth revision of this widely influential manual for diagnosing mental distress and illness, and has been the subject of national and international criticism for the quality of its science, its criteria for defining disorders and categories, its rationale for inclusion or exclusion of particular symptoms or features, and the considerable inflation in its number of diagnosable disorders since the original DSM was published in the 1950s. Over the past several decades, there has been sharp criticism of the various DSM revisions, but in the case of DSM-5, a critical mass of scholarly opposition has reached a tipping point, including an unprecedented rebuke by the U.S. government’s National Institute of Mental Health, which has stated it will be reorienting away from research that involves the DSM-5. For many mental health professionals it seems clear that fresh thinking–about ways to possibly improve the DSM, prospects for developing possible alternatives to it, and what those prospects might look like–are called for. Regardless of where one stands on these issues, it is clear that new approaches to diagnosis are sorely needed, as both a national and global health concern.

To that end, a new website (dxsummit.org) has been launched to help create an on-line, on-going global forum for scholarly and professional dialogue of humane approaches to mental health diagnosis. Sponsored by the Diagnostic Summit Committee (DSC), a national committee of concerned psychologists, this collaborative effort provides an opportunity for the widest possible input and deliberation of mental health diagnosis from the ground-up. Offering blogs, discussion posts, and psychiatric and psychological articles by stakeholders and leaders in the field, dxsummit.org will open up the discussion of diagnosis to its full range of possibilities, from brain science to cultural variations to the examination of normal human responses to difficult life challenges. The website, underwritten by the efforts of the Society for Humanistic Psychology (SHP) will be a platform for international debate and consensus of comprehensive and valid approaches to mental health diagnosis.

Media inquiries should be directed to Dr. Frank Farley, co-chair of the DSC, and former President of the American Psychological Association and the SHP, at frank.farley@comcast.net or (215) 668-7581; or Dr. Donna Rockwell.

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The second new platform is Tom Nickel’s DSMOOC, introduced by Allen Frances, MD, in a May 16 blog at Huffington Post:

DSM-5: Where Do We Go From Here? 

Dr Frances writes:

“That’s why I am so pleased that Thomas Nickel Ph.D., Head of Continuing Education at Alliant International University, has set up a new interactive DSMOOC web site that will undoubtedly become the focal point for diagnostic discussion and remediation. Check it out.

Dr. Nickel writes:

“Now that DSM-5 is about to be released, it is time to determine how best to reduce, if not entirely eliminate, the risk that people will be misdiagnosed and improperly treated.”

“Solutions will not come from one group or one project. As one of what will hopefully be many initiatives, we have developed a MOOC (Massive Open Online Conversation) to bring together concerned clinicians and the public in order to give voice to the many different perspectives about psychiatric diagnosis.”

“Our intention is to stimulate conversations that will lead to useful products. People will find each other and work together to produce materials that can empower patients and influence practitioners. Suggestions for guidelines, practice standards, public policy, and research will hopefully emerge. Certainly, we will make every effort to facilitate this.”

“Previous MOOCs have resembled traditional university courses with lectures and quizzes on technical topics like artificial intelligence or mechanical engineering. Until now, MOOCs have not been closely linked to events happening in the world, nor have they been a channel for real world action. In this regard, a MOOC focused on DSM-5 may be pioneering.”

“Our MOOC will consist of about 15 channels, each one dedicated to one area of significant change or controversy in DSM-5. Each will provide background information; videotaped discussions by leading experts and consumer advocates; references; links; vivid portrayals of psychiatric diagnosis in films and fiction; and an opportunity for discussion. There are even Google Hangouts all set up for study groups to use.”

“Our DSMOOC should be equally interesting for professionals and consumers- and will provide a uniquely open forum for interaction between them.”

“We hope that you will roll up your virtual sleeves, join us at: http://discuss.thementalhealthmanual.com

Follow DSMOOC on Twitter @RethinkingDSM

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DSM-5 Development site

The APA’s DSM-5 Development site will remain online.

On May 15, the Home Page text was revised and the site’s content is being reorganized. As everything on the site is nailed down with Licensing and Permissions clauses, you will need to visit the site to read what new text has gone up so far. No doubt APA would like to register the trademark rights to hex #260859, too.

See: UNDER CONSTRUCTION: DSM-5 Implementation and Support

According to what little text is currently displaying, the site will be reorganized to serve as a resource for stakeholders: providers, payers, researchers and patients.

New content is planned to include FAQs, information on implementation of the manual and a mechanism for submitting questions and feedback. Professional users will be able to provide feedback on online assessment measures; there will be links to educational webinars and training courses for US and other countries. The site will list DSM-5 corrections.

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Additional media coverage from this week

Too much to include this week, so just a few links:

Concern for the implications of DSM-5‘s new Somatic Symptom Disorder was highlighted by Allen Frances in a Diane Rehm radio broadcast, on May 14. The programme also included an interview with DSM-5 Task Force Chair, David J Kupfer, MD, on the understanding that he would not be engaging with Dr Frances.

The Diane Rehm Show May 14, 2013: http://tinyurl.com/byxupm6

Transcript

Listen again: http://thedianerehmshow.org/audio-player?nid=17729  [51.40 mins including listener phone in]

The site page includes an excerpt from the book “Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life” by Allen Frances. Published by William Morrow. Copyright © 2013 by Allen Frances. Reprinted with permission.


Somatic Symptom Disorder also featured in a Susan Donaldson James’ article, for ABC News Health, on May 14:

Brain Science Upstages DSM-V, So-Called Mental Health ‘Bible’


Christopher Lane, Ph.D., published The Distortion of Grief on May 14, which has been widely syndicated.


DSM-5: Mental Health Professionals, Critics Face Off Over Upcoming Psychiatric Manual by Lindsey Tanner at Huffington Post, May 15:

“The psychiatric industry, allied with Big Pharma, have massively misled the public,” the Occupy Psychiatry group contends. Organizers include Alaska lawyer Jim Gottstein, who has long fought against overuse of psychiatric drugs.

“The new manual “will drastically expand psychiatric diagnosis, mislabel millions of people as mentally ill, and cause unnecessary treatment with medication,” says the website for the Committee to Boycott the DSM-5, organized by New York social worker Jack Carney.”


More on Occupy APA from Jack Carney, DSW, for Mad in America, May 17:
Occupy APA in San Francisco: Joined in Spirit

NIMH Director issues joint statement with APA President-elect on DSM’s validity as diagnostic tool

NIMH Director issues joint statement with APA President-elect on DSM’s validity as a diagnostic tool

Post #248 Shortlink: http://wp.me/pKrrB-308

180degrees

Less than two weeks after throwing DSM under the bus, NIMH’s Director, Thomas Insel, has issued a joint statement with APA President-elect, Jeffrey Lieberman.

This week, DSM…

…represents the best information currently available for clinical diagnosis of mental disorders

In a Pharmalot report titled NIMH Director Says The Bible Of Psychiatry Is Valid, After All, Ed Silverman writes:

‘Just 10 short days after trashing the widely regarded bible of psychiatry for lacking validity, National Institutes of Mental Health director Tom Insel has had a change of heart. Along with American Psychiatric Association president-elect Jeff Lieberman, he has now issued a statement saying the forthcoming version…is a valuable diagnostic tool. Their missive amounts to a combination of face saving and damage control…’

Report, here, from Sharon Jayson, for USA Today:

NIH official clarifies criticism of diagnostic manual

‘The groups also make it clear that DSM-5 isn’t going away.

‘DSM-5 and RDoC represent complementary, not competing, frameworks…As research findings begin to emerge from the RDoC effort, these findings may be incorporated into future DSM revisions and clinical practice guidelines,” the statement says. “But this is a long-term undertaking. It will take years to fulfill the promise that this research effort represents for transforming the diagnosis and treatment of mental disorders.”‘

1 Boring Old Man’s take here: a long and winding road…

Gary Greenberg at the New Yorker: The Rats of N.I.M.H.

Tuesday’s joint statement from Thomas Insel and Jeffrey Lieberman, here:

 Click link for PDF document   Joint APA and NIMH Statement

Or here on NIMH site: DSM-5 and RDoC: Shared Interests

Full text APA Release No. 13-37

For Information Contact:
Eve Herold, 703-907-8640 May 14, 2013
press@psych.org Release No. 13-37
Erin Connors, 703-907-8562
econnors@psych.org
DSM-5 and RDoC: Shared Interests
Thomas R. Insel, M.D., director, NIMH
Jeffrey A. Lieberman, M.D., president-elect, APA

NIMH and APA have a shared interest in ensuring that patients and health providers have the best available tools and information today to identify and treat mental health issues, while we continue to invest in improving and advancing mental disorder diagnostics for the future.

Today, the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), along with the International Classification of Diseases (ICD) represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5. As NIMH’s Research Domain Criteria (RDoC) project website states, “The diagnostic categories represented in the DSM-IV and the International Classification of Diseases-10 (ICD-10, containing virtually identical disorder codes) remain the contemporary consensus standard for how mental disorders are diagnosed and treated.”

Yet, what may be realistically feasible today for practitioners is no longer sufficient for researchers. Looking forward, laying the groundwork for a future diagnostic system that more directly reflects modern brain science will require openness to rethinking traditional categories. It is increasingly evident that mental illness will be best understood as disorders of brain structure and function that implicate specific domains of cognition, emotion, and behavior. This is the focus of the NIMH’s Research Domain Criteria (RDoC) project. RDoC is an attempt to create a new kind of taxonomy for mental disorders by bringing the power of modern research approaches in genetics, neuroscience, and behavioral science to the problem of mental illness.

The evolution of diagnosis does not mean that mental disorders are any less real and serious than other illnesses. Indeed, the science of diagnosis has been evolving throughout medicine. For example, subtypes of cancers once defined by where they occurred in the body are now classified on the basis of their underlying genetic and molecular causes.

All medical disciplines advance through research progress in characterizing diseases and disorders. DSM-5 and RDoC represent complementary, not competing, frameworks for this goal. DSM-5, which will be released May 18, reflects the scientific progress seen since the manual’s last edition was published in 1994. RDoC is a new, comprehensive effort to redefine the research agenda for mental illness. As research findings begin to emerge from the RDoC effort, these findings may be incorporated into future DSM revisions and clinical practice guidelines. But this is a long-term undertaking. It will take years to fulfill the promise that this research effort represents for transforming the diagnosis and treatment of mental disorders.

By continuing to work together, our two organizations are committed to improving outcomes for people with some of the most disabling disorders in all of medicine.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in diagnosis, treatment, prevention, and research of mental illnesses including substance use disorders.

Visit the APA at www.psychiatry.org
###

 

More on the RDoC from the NIMH website

Research Domain Criteria

The National Institute of Mental Health Strategic Plan Released August 2008

Division of Clinical Psychology (DCP) calls for paradigm shift away from ‘disease model’

British Division of Clinical Psychology (DCP) calls for paradigm shift away from ‘disease model’

Post #247 Shortlink: http://wp.me/pKrrB-2Zj

Update: Prof Richard Bentall on BBC Radio 4 Start the Week, Monday, May 13, 2013

http://www.bbc.co.uk/programmes/b01sd3jq

Lucy Johnstone on BBC Radio 4 Today programme, Monday, May 13, 2013 | 2 hours 50 mins in from start

http://www.bbc.co.uk/programmes/b01sd3jn

Lucy Johnstone article at Mad in America, May 13, 2013:

UK Clinical Psychologists Call for the Abandonment of Psychiatric Diagnosis and the ‘Disease’ Model

Lucy Johnstone World Service interview  | MP3 file | 8.2 MB at Dropbox (no Dropbox account required)

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Update: Statement released: May 13, 2013

Division of Clinical Psychology

Position Statement on the Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses

Time for a Paradigm Shift

Click link for PDF document   Position Statement on Diagnosis

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Today’s Observer reports on the release, tomorrow, of a Position Statement by the British Division of Clinical Psychology (DCP), a sub-division of the British Psychological Society, calling for the abandonment of diagnosis and the ‘illness/disease’ model.

Observer

Psychiatrists under fire in mental health battle
(British) Psychological Society to launch attack on rival profession, casting doubt on biomedical model of mental illness

Jamie Doward | May 12, 2013

“…In a groundbreaking move that has already prompted a fierce backlash from psychiatrists, the British Psychological Society’s division of clinical psychology (DCP) will on Monday issue a statement declaring that, given the lack of evidence, it is time for a “paradigm shift” in how the issues of mental health are understood. The statement effectively casts doubt on psychiatry’s predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out “reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems”, used by psychiatry…”

Also in today’s Observer, opposing positions from Oliver James and Professor Sir Simon Wessely, a member of the Royal College of Psychiatrists and chair of psychological medicine at King’s College London, in which he defends the need to create classification systems for mental disorder and downplays the influence of the DSM:

Do we need to change the way we are thinking about mental illness?
Experts on both sides of the debate over the classification of mental disorders make their case

The Observer | Oliver James | Prof Sir Simon Wessely | Sunday 12 May 2013

Comment from Allen Frances, MD, on Huffington Post, on today’s Observer report:

[Note the position statement is issued by the Division of Clinical Psychology (DCP), a sub-division of the British Psychological Society (BPS) and is not the official position of the BPS.]

 The Inmates Seem to Have Taken Over the Asylum

“…Then the NIMH recklessly renounced all syndromal DSM diagnosis as invalid. But NIMH has nothing to offer now in its place except an oversold and undeliverable promise of some future strictly biological model of mental illness that will take decades to deliver — assuming it can ever be delivered at all…

“…Now the British Psychological Society has produced its own brand of extremist posturing, offering its own quixotic paradigm shift..”


Further mainstream media coverage of the DSM debate

An Editorial and an Opinion piece in the New York Times:

Editorial

Shortcomings of a Psychiatric Bible

The Editorial Board | May 11, 2013

Opinion

Why the Fuss Over the D.S.M.-5?

Sally Satel | May 11, 2013


Nature | News

Psychiatry framework seeks to reform diagnostic doctrine

Critics say clinical manual unfit for mental-health research.

Heidi Ledford | May 10, 2013

Quotes from NIMH’s director, Thomas Insel; epidemiologist, Jane Costello, who resigned from the DSM-5 Work Group for Child and Adolescent Disorders in 2009, and Steven Hyman, a former NIMH director and a former DSM-5 Task Force member, who has chaired the APA-WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders [Members].


New Scientist Print edition

Feature article This Week

How a scientific DSM will transform psychiatry

Peter Aldhous, Andy Coghlan and Sara Reardon | May 8, 2013

This article appears in the print edition under the headline “A revolution in mental health, Patients deserve better than an unscientific manual, says leading health institute.”

Also in this week’s New Scientist print edition:

Editorial Opinion

Don’t count on this manual, The future of psychiatric research lies in simpler questions

Allen Frances, MD | May 8, 2013

A longer version of this Allen Frances opinion piece appeared online, earlier in the week, here