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

When is the third stakeholder and public review of draft categories and criteria for DSM-5 scheduled?

When is the third stakeholder and public review of draft categories and criteria for DSM-5 scheduled?

Post #119 Shortlink: http://wp.me/pKrrB-1yz

Most likely not according to the schedule posted on the DSM-5 Development website.

The first stakeholder and public review of draft proposals for changes to DSM-IV categories and criteria ran for ten weeks, from February 10 to April 20, 2010. The APA reported receiving over 8,600 comments [1].

The second public review ran for just six weeks, from May 4 to June 15, 2011 (at which point it was extended a further month, to July 15). During this second review period, Task Force Chair, David Kupfer, MD, told Deborah Brauser for Medscape Medical News, that 2,100 individual comments had been submitted [2].

 

Slip slidin’ away…

According to the current DSM-5 Development Timeline, the final draft is scheduled for release in January–February 2012, although the DSM-5 Development home page states:

“In spring 2012, we will open the site for a third and final round of comments from visitors which will again be systematically reviewed by each of the work groups for consideration of additional changes.”

This article, Patient-Centered Revisions to the DSM-5, co-authored by Emily A. Kuhl, PhD, David J. Kupfer, MD, and Darrel A. Regier, MD, MPH, Virtual Mentor. December 2011, Volume 13, Number 12: 873-879.

states:

“…Given the high utility of patient and public feedback in drafting revisions thus far, a third open commenting period has been scheduled to take place in 2012, following completion of the DSM-5 field trials.”

But completion dates for field trials are slipping targets.

(See: DSM 5 in Distress: Disorganization, Disarray, and Missed Deadlines, Beware The Final Mad Rush, Allen Frances, Psychology Today, December 29, 2011).

In this November 9, 2011 report by Deborah Brauser for Medscape Medical News, DSM-5 Task Force vice-chair, Darrel Regier, MD, predicts a final public feedback period “no later than May 2012.”

APA Answers DSM-5 Critics

“…Although the routine clinical settings field trials were expected to be completed by the end of December, it has been extended to around March 2012. Dr. Regier said that this will probably push back the final public feedback period to no later than May 2012.”

So, April–May? May–June? I will update when a firm release date is published or other information received.

DSM-5 Development Timeline

References

[1] DSM-5 Development website

[2] DSM-5 Task Force Ponders Round 2 of Public Feedback: Deborah Brauser for Medscape Medical News
August 31, 2011 [Registration required to view this Medscape article.]

[3] Current DSM-5 proposals for changes to DSM-IV categories and criteria

[4] DSM-5 Development Timeline

Psychiatric Times Editor invites readership to submit views on DSM-5 for potential publication

Editor of Psychiatric Times invites its readership to submit views on DSM-5 for potential publication

Post #117 Shortlink: http://wp.me/pKrrB-1sx

Although the current DSM-5 Development Timeline has a third draft scheduled for release in January-February, 2012, for a two month period for public comment, this final draft is expected to be delayed until spring, pending completion of the DSM-5 field trials.

In this November 9, 2011 report by Deborah Brouser for Medcape Medical News, DSM-5 Task Force vice-chair, Darrel Regier, MD, says “no later than May 2012.”

 APA Answers DSM-5 Critics

“…Although the routine clinical settings field trials were expected to be completed by the end of December, it has been extended to around March 2012. Dr. Regier said that this will probably push back the final public feedback period to no later than May 2012.”

When the third and final draft has been published, a notice and links will be posted on my sites with instructions on how to register with the DSM-5 Development site for submitting feedback to the Task Force and 13 work groups.

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

December 16, 2011

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

(Free registration is required for access to Pyschiatric Times Editorial.)

 

Related content:

DSM-5 on Psychiatric Times January 3 – December 16, 2011

December 16, 2011
The Debate Over DSM-5: We Invite Your Views

November 23, 2011
DSM-5: APA Responds to American Counseling Association Concerns

November 21, 2011
DSM-5: Petitions, Predictions, and Prescriptions

November 17, 2011
Counselors Turn Against DSM-5: Can APA Ignore 120,000 Users?

November 11, 2011
DSM-5: Living Document or Dead on Arrival?

November 10, 2011
The User’s Revolt Against DSM-5: Will It Work?

November 8, 2011
APA Responds Lamely to the Petition to Reform DSM-5

November 7, 2011
The Great DSM-5 Personality Bazaar

November 4, 2011
Why Psychiatrists Should Sign The Petition To Reform DSM-5

November 3, 2011
Why Doesn’t DSM-5 Defend Itself? Perhaps Because No Defense Is Possible

November 2, 2011
DSM-5 Will Not Be Credible Without An Independent Scientific Review

November 1, 2011
DSM-5 Against Everyone Else: Research Types Just Don’t Understand The Clinical World

October 31, 2011
What Would A Useful DSM-5 Look Like? And An Update On The Petition Drive

October 26, 2011
Petition Against DSM-5 Gets Off To Racing Start: A Game Changer?

October 24, 2011
Psychologists Petition Against DSM-5: Users Revolt Should Capture APA Attention
Several divisions of the American Psychological Association have just written an open letter highly critical of DSM-5.

October 13, 2011
Should Temper Tantrums Be Made Into A DSM-5 Diagnosis?

October 12, 2011
Do We Need a DSM-V?

September 30, 2011
PTSD, DSM-5, and Forensic Misuse

September 29, 2011
An Alternative To The DSM-5 Personality Proposals

September 21, 2011
Why Psychiatry Is Wonderful—Even If DSM-5 Isn’t

September 14, 2011
DSM-5 Proposals Should Undergo An Independent Cochrane Review Of Scientific Evidence

September 13, 2011
Warning to DSM-5: Mental Health Clinicians Can Use ICD-10-CM

August 23, 2011
The Leaders’ Report on DSM-5

August 10, 2011
DSM-5 Stubbornly Circles The Wagons Against Opposition From The Field
Bob Spitzer was prophetic 4 years ago when he warned that the closed DSM-5 process would lead to a flawed DSM-5 product…

August 5, 2011
Scandalous Off Label Use Of Antipsychotics: Another Warning For DSM-5

July 27, 2011
DSM-5 Will Further Inflate the ADD Bubble: Child Work Group Fails to Learn From Experience

July 25, 2011
The British Psychological Society Condemns DSM-5

June 8, 2011
Who Needs DSM-5? A Strong Warning Comes From Professional Counselors

May 12, 2011
DSM-5 Rejects Coercive Paraphilia: Once Again Confirming That Rape Is Not A Mental Disorder

April 28, 2011
Marijuana Withdrawal Syndrome: Should Cannabis Withdrawal Disorder Be Included in DSM-5?

April 15, 2011
The Constant DSM-5 Missed Deadlines And Their Consequences: the Future is Closing In
Aside from its reckless proposals for dangerous new diagnoses, the most characteristic thing about DSM-5 has been its remarkably poor planning…

April 13, 2011
DSM-5 and the NIMH Research Domain Criteria Project

April 11, 2011
DSM-5 Will Medicalize Everyday Worries Into Generalized Anxiety Disorder

February 25, 2011
DSM-5: When To Change and When Not to Change

February 22, 2011
Temper Tantrums, Mental disorder, and DSM-5: The Case for Caution

January 25, 2011
DSM-5 Promotes A 60% Jump In The Rate Of Alcohol Use Disorders

January 20, 2011
An Independent View of DSM-5

January 19, 2011
DSM-5: A Year End Summary

January 11, 2011
DSM-5 and Practical Consequences

January 10, 2011
Does Research Support “Craving” as a Core Symptom of Substance Use Disorders in DSM-5?

January 3, 2011
DSM-5: Dissent From Within

British Psychological Society issues statement in response to DSM-5 encouraging members to sign Coalition for DSM-5 Reform petition

British Psychological Society issues statement in response to DSM-5 encouraging members to sign Coalition for DSM-5 Reform petition for mental health professionals

Post #116 Shortlinkhttp://wp.me/pKrrB-1sa

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

British Psychological Society statement on the open letter to the DSM-5 Taskforce

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

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 which has, to date, been endorsed by 12 other APA Divisions.

A major concern raised in the letter is that the proposed revisions include lowering diagnostic thresholds across a range of disorders. It is feared that this could lead to medical explanations being applied to normal experiences, and also to the unnecessary use of potentially harmful interventions.

Particular concern is expressed about the inclusion of a new diagnostic category “Attenuated Psychosis Syndrome”. This proposes to include individuals who are experiencing hallucinations, delusions or disorganized speech “in an attenuated form with intact reality testing” but who do not meet current criteria for a psychotic disorder. The Society shares the concerns expressed in the open letter about the potentially harmful consequences of lowering diagnostic thresholds in general and the questionable validity of this proposed diagnosis in particular.

Another concern raised is about the impact of proposed revisions on vulnerable groups such as children and the elderly. The letter highlights that the proposed new diagnostic category “Mild Neurocognitive Disorder” might be diagnosed in elderly people whose memory decline simply reflects normal ageing. The Society welcomes the use of an  objective psychometric criterion within this particular DSM-5 diagnosis but shares concerns expressed in the letter about potential for misdiagnosis of normal ageing. We would further highlight the importance of valid psychological interpretation of test results since the proposed psychometric threshold encompasses 1 in 8 of the normal population. There is a particular danger that cognitive functioning of people from ethnic minorities is under-represented on psychometric tests. The Society also shares concerns about the potential for children and adolescents to be misdiagnosed with Disruptive Mood Deregulation Disorder.

We also concur that there is a lack of a solid basis in clinical research literature for this disorder and are also concerned about the risk of harm from inappropriate treatment with neuroleptic medication.

The proposals for the revision of the personality disorders section in DSM-5 are described in the open letter as “perplexing”, “complex” and “idiosyncratic”. The Society has welcomed the move to a dimensional-categorical model for personality disorder. However, we have said that this has not been as visible as expected in the draft revisions.

Moreover, we share concerns expressed in the open letter about the inconsistency of the proposed changes and their limited empirical basis.

Finally, the open letter also draws attention to proposals to revise the basic “Definition of a Mental Disorder” and, in particular, a statement proposed by Stein et al that it “reflects an underlying psychobiological dysfunction”. The Society shares concerns about any unsubstantiated shift in emphasis towards biological factors and in particular the entirely unjustified assertion that all mental disorders represent some form of biological dysfunction. We are, however, reassured by the response from the APA task force (4 November 2011) which states that there is no intent “to diminish the importance of environmental and cultural exposure factors” and hope that this will be reflected in the final version.

In conclusion, the British Psychological Society endorses the concerns expressed in the open letter from the Society of Humanistic Psychology (Division 32) of the APA and encourage members to view the letter themselves and consider signing the petition (http://www.ipetitions.com/petition/dsm5/ ). We also urge the DSM 5 taskforce to consider seriously the issues raised therein. These have been now been endorsed by a broad range of experts in mental health, including members of the British Psychological Society and two chairs of previous DSM revision taskforces.

We are, however, encouraged that the DSM taskforce has already responded positively to the open letter and that in their letter (4 November 2011) they emphasized that the manual is “still more than a year away from publication and is continually being refined and reworked”. They commented that “Final decisions about proposed revisions will be made on the basis of field trial data as well on a full consideration of other issues such as those raised by the signatories of the petition.”

In a statement issued on 2 December 2011 the American Psychological Association (APA) 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”. The British Psychological Society would certainly echo this call.

The final draft of the DSM-5 criteria is due for publication in early 2012 followed by a third, two month, period of public feedback. The Society encourages those members who have relevant expertise to contribute to the on-going process of refinement and improvement of the DSM-5. As a Society we are, as is our counterpart the APA, committed to promoting and disseminating psychological knowledge and, as such, we are keen to ensure that the final version of DSM-5, and other internationally used diagnostic frameworks such as ICD-11, are based on the best available psychological science and will continue to monitor the DSM-5 revision process and contribute further as appropriate.

[Ends]

References:

1] DSM-5 Development site
2] Somatic Symptoms Disorders current proposals
3] DSM-5 Timeline 
4] Coalition for DSM-5 Reform website
5] Petition for mental health professionals can be signed here
6] Dr Allen Frances MD, Chair, DSM-IV Task Force, blogs on DSM-5 on “Psychology Today”
7] Updates and developments on the Coalition for DSM-5 Reform’s petition
8] Media coverage for Coalition for DSM-5 Reform’s petition

%d bloggers like this: