Action for M.E. submission to third and final DSM-5 public review (closes June 15)

June 12, 2012 by

Action for M.E. submission to third and final DSM-5 public review (May 2 – June 15 2012)

Page #179: Shortlink: http://wp.me/pKrrB-2eC

A reminder there are just 4 days left in which to submit feedback.

Comment period scheduled to close June 15.

Organizations, professionals, patients and advocates submitting comments in the third DSM-5 draft proposal review process are invited to provide me with copies of their submissions for publication. Submissions to the third and final DSM-5 public review are being collated on this page: http://wp.me/PKrrB-1Ol

Today, Action for M.E., has forwarded its response to the third draft:

Action for M.E.

DSM-5 Action for M.E. response

12 June 2012

Action for M.E. has formally commented on the latest draft of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), due to be published in May 2013 by the American Psychiatric Association (APA).

We told the APA that:

“Action for M.E. notes the revised draft of DSM-5 and remains opposed to any attempt to classify CFS/M.E. as a somatic symptom disorder either explicitly or implicitly.

Comments made previously in the APA Work Group on somatoform disorders and in public by Dr Dimsdale, the SSD Work Group Chair, are far from reassuring in this respect.

Regrettably there are still General Practitioners in the UK who fail to take CFS/ME seriously and are ill informed about how to achieve a specific diagnosis. So there should be nothing in DSM-5 that will give any support to outdated views that are severely detrimental to patient care.

The presumption that ME/CFS is a somatic symptom disorder is not supported by the increasing body of research evidence pointing to the existence of underlying physical pathology. While not challenging the underlying structure of DSM-V, in our view ME/CFS would be appropriately classified in sections S03 or S04, mild or severe neurocognitive disorders secondary to underlying physical diseases, in particular neurodegenerative diseases.”

We have also responded to previous drafts.

Related content and posts:

Somatic Symptom Disorders, DSM-5 Development site

Call to action – DSM-5 comments needed by June 15, 2012:  http://wp.me/pKrrB-2bO

Somatic Symptom Disorder criteria could capture millions more under mental health diagnosis: http://wp.me/pKrrB-29B

DSM-5 Somatic Symptom Disorders: Differences between second and third draft for CSSD: http://wp.me/pKrrB-27y

DSM-5 Somatic Symptoms Work Group submissions 2012: Last chance to tell SSD Work Group why it needs to ditch unsafe and scientifically flawed proposals: http://wp.me/pKrrB-26q

Filed under Action for M.E., American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 third draft, Somatic Symptom Disorder, Somatoform Disorders Tagged with , , , , , , , ,

DSM-5 controversy: Lane on “SAD”, Frances Follows the Money, Spitzer et al on Kappa reliability

June 12, 2012 by

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.

# # #

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

Filed under Allen Frances, American Psychiatric Association (APA), Christopher Lane, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-5 third draft, Robert Spitzer Tagged with , , , , , , , , ,

Allen Frances: “Follow the Money”

June 10, 2012 by

Allen Frances writing on Huffington Post: “Follow the Money”

Post #177 Shortlink: http://wp.me/pKrrB-2e3

Allen Frances, who had oversight of the development of DSM-IV, responds to DSM-5 Inaccuracies: Setting the Record Straight by James H Skully, CEO and Medical Director to the American Psychiatric Association.

Huffington Post Blogs | Allen Frances

Follow the Money

Allen Frances MD | June 9, 2012

…The APA budget depends heavily on the huge publishing profits generated by its DSM monopoly. APA needs the money badly. It is losing paying members; other sources of funding are also on a downward trend; and its budget projections require a big May 2013 injection of DSM-5 cash…

…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 on Huff Po

Filed under Allen Frances, American Psychiatric Association (APA), DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-5 third draft, DSM-V, SLAPP suit Tagged with , , , , , , , , ,

DSM-5 round-up: Lane on “DSM-5 Facts” site, Frances on DSM-5, Kupfer on Frances

June 5, 2012 by

DSM-5 round-up: Lane on new “DSM-5 Facts” site, Frances on DSM-5, Kupfer on Frances

Post #176 Shortlink: http://wp.me/pKrrB-2cQ

What we were waiting for were the “full results” of the reliability data from the DSM-5 field trials.

What we got was a public relations sticking plaster.

Christopher Lane reported in Side Effects on the American Psychiatric Association’s new platform DSM-5 Facts – a website launched, last week, to “correct the record, highlight key omissions – and provide essential perspective so that the public has a complete and accurate view…“

Side Effects

Christopher Lane, Ph.D. | June 4, 2012

The APA’s PR Problem
Why is the American Psychiatric Association hiring a PR company to market DSM-5?

As the news tumbled out last week that the American Psychiatric Association had hired GYMR, an expensive PR company, to help the organization “execute strategies that include image and alliance building, public education campaigns or media relations to harness the formidable forces of Washington and produce successful results for clients” (services that GYMR brags about in its mission statement), it became clearer than ever that the APA has more than an image-problem with DSM-5…

Read on

In a long interview with Allen Frances, Stephen M. Strakowski asks: What’s wrong with DSM-5 and what needs to be done to put it right?

Medscape Psychiatry

What’s Wrong With DSM-5?

Stephen M. Strakowski, MD; Allen J. Frances, MD | June 1, 2012

Addressing Prescription Drug Abuse: Introduction
The Biggest Problems With DSM-5?
What Would Dr. Frances Do?
A Safe, Credible DSM-5 by 2013?

…The reliability-test results for stage 1 show that DSM-5 badly flunked and that stage 2 is desperately needed. The leadership lowered expectations with statements indicating that they are willing to accept diagnostic agreements far below historical levels and include proposals achieving diagnostic agreements that are little better than chance. This is simply not acceptable and should not be accepted…

…it is discouraging that DSM-5 has not accepted the need for external review, is going forward with poorly written and unreliable criteria sets, and still contains so many unsafe and scientifically unsound proposals. It remains to be seen whether DSM-5 will be responsive to what is certain to be increasing external pressure to trim its sails and improve its quality. If it attempts to hang tough, I think DSM-5 will no longer be used much (if at all) overseas and will also lose much of its following in the United States…

Task Force Chair, David J. Kupfer, MD, responds:

Medscape Psychiatry

Dr. Kupfer Defends DSM-5

David J. Kupfer, MD | June 1, 2012

Editor’s Note:
In a recent Medscape interview with Dr. Stephen Strakowski, DSM-IV Task Force Chair Dr. Allen J. Frances expressed serious concerns about a number of proposals being considered for inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), scheduled for release in May 2013. Below, DSM-5 Task Force Chair Dr. David Kupfer defends the proposed revision.

A DSM-5 Defense
Will DSM-5 Inflate Prevalence?

A third Medscape report from the APA’s Annual Conference by Nassir Ghaemi, MD:

Medscape Psychiatry

DSM-5: Finding a Middle Ground

Nassir Ghaemi, MD | June 1, 2012

Professor of Psychiatry, Tufts University School of Medicine; Director, Mood Disorders Program, Psychiatry Department, Tufts Medical Center, Boston, Massachusetts

DSM-5: Validity vs Reliability
But DSM-IV Has Limitations, Too

Two more commentaries from 1 Boring Old Man on DSM-5 process and field trial Kappa results:

the APA Trustees must intervene in the DSM-5…

1 Boring Old Man | June 4, 2012

and will…

1 Boring Old Man | June 3, 2012

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, David Kupfer, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-5 third draft Tagged with , , , , , , , , ,

American Psychiatric Association (APA) Assembly Notes and Full Treasurer’s Report

May 29, 2012 by

American Psychiatric Association (APA) Assembly Notes and Full Treasurer’s Report

Post #174 Shortlink: http://wp.me/pKrrB-2bX

Update @ June 1, 2012

James H. Scully, Jr., M.D., CEO and Medical Director of the American Psychiatric Association, has published a response to Allen Frances’ Huff Po blog of May 30:

DSM-5 Inaccuracies: Setting the Record Straight

Update @ May 30, 2012

1 Boring Old Man

reform, or accept your fate…

1 Boring Old Man | May, 30 2012

Huffington Post Blogs Allen Frances, MD

DSM-5 Costs $25 Million, Putting APA in a Financial Hole

Allen Frances | May 30, 2012

The American Psychiatric Association just reported a surprisingly large yearly deficit of $350,000. This was caused by reduced publishing profits, poor attendance at its annual meeting, rapidly declining membership, and wasteful spending on DSM-5. APA reserves are now below “the recommended amount for a non-profit (reserves equal to a year’s operating expenses).”

APA has already spent an astounding $25 million on DSM-5. I can’t imagine where all that money went. As I recall it, DSM-IV cost about $5 million, and more than half of this came from outside research grants. Even if the DSM-5 product were made of gold instead of lead, $25 million would be wildly out of proportion. The rampant disorganization of DSM-5 must have caused colossal waste. One obvious example is the $3 million spent on the useless DSM-5 field trial, with its irrelevant question, poorly conceived design, and embarrassing results…

Full commentary

On May 8, in an article for Medscape Medical News, Deborah Brauser reported:

     …Members of the task force said they hope to publish the full results [of the DSM-5 field trials] “within a month.” However, the third and final public comment period for the manual opened last week and ends on June 15. Although the entire period is 6 weeks long, the public may only have 2 weeks to comment after the publication of the field trials’ findings. DSM-5 Field Trials Generate Mixed Results

With less than three weeks to go before the stakeholder and public comment period closes, there is still no sign of a report on the DSM-5 field trials.

If the Task Force does not get a report out soon, stakeholders will be obliged to submit feedback without the benefit of data from the trials to inform their comments. Once again, this third and final stakeholder review smacks of a purely tokenistic exercise.

For the two previous draft reviews, some disorders were accompanied by PDF documents expanding on new and revised disorder descriptions and work group rationales.

For the Somatic Symptom Disorders, no updated “Disorder Descriptions” or “Rationale/Validity” documents have been published that reflect substantial revisions made to proposals and criteria between the second and third drafts. The documents as published for the second review have been taken down from the DSM-5 Development site but have not been revised and reissued.

I have twice contacted APA Media and Communications for clarification of whether the Work Group intends to publish revised documents before the end of the comment period. Evidently APA Media and Communications don’t wish to provide me with a response.

 

I will update if and when a report on the field trials emerges from the Task Force.

In the meantime, here are two public domain documents that may be of interest to APA watchers:

APA Assembly Notes Spring 2012

or download here:

http://alabamapsych.org/wp-content/uploads/2012/02/apa_assembly_notes_may_2012.pdf

APA Treasurer’s Report May 2012  [.ppt compatible PowerPoint reader required]

or view here:

https://docs.google.com/file/d/0BzWdENl1wkVSYk5aXzRZelFYUjA/edit?pli=1

Filed under American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, Darrel Regier, David Kupfer, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 third draft, DSM-5 timeline Tagged with , , , , , , , , ,

Call to action – DSM-5 comments needed by June 15, 2012

May 29, 2012 by

Call to action – DSM-5 comments needed by June 15, 2012

Post #173 Shortlink: http://wp.me/pKrrB-2bO

The stakeholder comment period for the third and final review of draft proposals for DSM-5 categories and criteria closes on June 15. Patients, patient organizations and professional stakeholders have three weeks left in which to submit comments.

US advocate, Mary Dimmock, has prepared a “Call to action”

Call to action – DSM-5 comments needed by June 15, 2012

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used in the U.S. to categorize mental disorders for patient diagnosis, treatment and insurance. The new version, DSM-5, includes a proposal for Somatic Symptom Disorder (SSD) that will have profound implications for ME/CFS patients. Your input is needed by June 15, 2012 to ensure that the DSM-5 authors understand your concerns…

…SSD can be applied to patients regardless of whether the symptoms are considered to be medically unexplainable or not. Severity is rated by the count and frequency of somatic symptoms. The “Justification for Criteria – Somatic Symptoms”, issued in May 2011, states that CBT, focused on “the identification and modification of dysfunctional and maladaptive beliefs”, is one of the most promising treatments.

Why this matters to ME/CFS patients
A diagnosis of SSD can be “bolted” onto any patient’s diagnosis. All that is required is for the medical practitioner to decide that the patient is excessively concerned with their somatic symptoms and their health. This is done using highly subjective and difficult to measure criteria for which very few independent reliability studies have been undertaken.

For patients with diseases that are poorly understood and misdiagnosed by the medical community, like ME/CFS, this will be disastrous. Once diagnosed inappropriately with SSD, the implications for diagnosis, treatment, disability and insurance will be profound…

Download Mary’s Call to action document here:

Word .docx format DSM-5 Response 2012

Word .doc format DSM-5 Response 2012 (MS 2004)

Filed under American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 third draft, DSM-V, Functional Somatic Syndrome (FSS), Somatic Symptom Disorder, Somatoform Disorders Tagged with , , , , , , , , ,

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