DSM-5 Round up: January #2

DSM-5 Round up: January #2

Post #220 Shortlink: http://wp.me/pKrrB-2Ce

Round up of recent media coverage of DSM-5 issues from US and UK spanning January 18 to January 28:

Scientific American

The Newest Edition of Psychiatry’s “Bible,” the DSM-5, Is Complete

The APA has finished revising the DSM and will publish the manual’s fifth edition in May 2013. Here’s what to expect

Ferris Jabr | January 28, 2013

For more than 11 years, the American Psychiatric Association (APA) has been laboring to revise the current version of its best-selling guidebook, the Diagnostic and Statistical Manual of Mental Disorders (DSM) (see “Psychiatry’s Bible Gets an Overhaul” in Scientific American MIND). Although the DSM is often called the bible of psychiatry, it is not sacred scripture to all clinicians—many regard it more as a helpful corollary to their own expertise. Still, insurance companies in the U.S. often require an official DSM diagnosis before they help cover the costs of medication or therapy, and researchers find it easier to get funding if they are studying a disorder officially recognized by the manual. This past December the APA announced that it has completed the lengthy revision process and will publish the new edition—the DSM-5—in May 2013, after some last (presumably minor) rounds of editing and proofreading. Below are the APA’s final decisions about some of the most controversial new disorders as well as hotly debated changes to existing ones, including a few surprises not anticipated by close observers of the revision process…

Update: New material above

New York Times | New Old Age Blogs | Medical Issues

Time to Recognize Mild Cognitive Disorder?

Paula Span| January 25, 2013

Dr. Allen Frances, chairman of the task force that developed the previous Diagnostic and Statistical Manual of Mental Disorders, predicts inclusion of Mild Neurocognitive Disorder in the new version will lead to “wild overdiagnosis.”

The Diagnostic and Statistical Manual of Mental Disorders, published and periodically updated by the American Psychiatric Association, is one of those documents few laypeople ever read, but many of us are affected by…

Medscape Medical News Psychiatry

No Impact of DSM-5 Criteria on Alcohol Disorder Prevalence

Deborah Brauser | January 25, 2013

Although criteria used to assess serious alcohol problems will be revised in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), these changes will not likely affect the prevalence of these disorders, new research suggests…

Huffington Post Blogs | Allen Frances, MD

Why Will DSM-5 Cost $199 a Copy?

Allen Frances, MD | January 25, 2013

DSM-5 has just announced its price — an incredible $199 (and the paperback is also no bargain at a hefty $149). Compare this to $25 for a DSM III in 1980; $65 for a DSM IV in 1994; and $84 for a DSM-IV-TR in 2000. The price tag on a copy of DSM is escalating at more than twice the rate of inflation.

What’s going on?

Huffington Post Blogs | Allen Frances, MD

Terrible News: DSM-5 Refuses to Reduce Overdiagnosis of ‘Somatic Symptom Disorder’

Allen Frances, MD | January 18, 2013

Many of you will have read a previous blog prepared by Suzy Chapman and me that contained alarming information about the new DSM-5 diagnosis “somatic symptom disorder” (SSD).

DSM-5 defines SSD so over-inclusively that it will mislabel one in six people with cancer and heart disease, one in four with irritable bowel syndrom and fibromyalgia, and one in 14 who are not even medically ill.

I hoped to be able to influence the DSM-5 work group to correct this in two ways: 1) by suggesting improvements in the wording of the SSD criteria set that would reduce mislabeling, and 2) by letting them know how much opposition they would face from concerned professionals and an outraged public if DSM-5 failed to slam on the brakes while there was still time…

New York Times | New Old Age Blogs | Medical Issues

Grief Over New Depression Diagnosis

Paula Span | January 24, 2013, 6:40 am

The next edition of the Diagnostic and Statistical Manual of Mental Disorders will not only abandon the Roman numerals, but will also leave grief considerations out of diagnoses for depression.
When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue…

TIME | Alcohol

Revisions to Mental Health Manual May Turn Binge Drinkers into ‘Mild’ Alcoholics

Maia Szalavitz | January 23, 2013

Are you an alcoholic— or just a problem drinker? It may not matter, according to the latest version of the DSM, psychiatry’s diagnostic manual.

And now, in a new study of the different levels of alcohol misuse, scientists say the changes made to the DSM-5 may not even represent a significant improvement in the diagnosis of alcoholism. In fact, the revised definition collapses the medical distinction between problem drinking and alcoholism, potentially leading college binge drinkers to be mislabeled as possible lifelong alcoholics. The changes take effect in May, when the DSM-5 will be released…

EurekAlert! Press Release | January 22, 2013

Will Proposed DSM-5 Changes to Assessment of Alcohol Problems Do Any Better?

Proposed changes to the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will affect the criteria used to assess alcohol problems. One change would collapse the two diagnoses of alcohol abuse (AA) and alcohol dependence (AD) into a single diagnosis called alcohol use disorder (AUD). A second change would remove “legal problems,” and a third would add a criterion of “craving.” A study of the potential consequences of these changes has found they are unlikely to significantly change the prevalence of diagnoses…

Medpage Today

Psych Group Posts Glimpses of Final DSM-5

John Gever, Senior Editor, MedPage Today | January 21, 2013

Peeks into the final DSM-5, the controversial new edition of the American Psychiatric Association’s diagnostic manual, are now available from the group prior to the guide’s official May 22 debut…

British Psychological Society

Professor Peter Kinderman writes on DSM-5 for the BBC News website

January 18, 2013

People diagnosed with a mental illness need help and understanding, not labels and medication. That is the message of an article published on the BBC News Health pages today by Professor Peter Kinderman from the University of Liverpool, a former chair of our Division of Clinical Psychology…

[BBC News Health report below]

BBC News Health

‘Grief and anxiety are not mental illnesses’

Peter Kinderman, Professor of Clinical Psychology | January 18, 2013

The forthcoming edition of an American psychiatric manual will increase the number of people in the general population diagnosed with a mental illness – but what they need is help and understanding, not labels and medication.

Many people experience a profound and long-lasting grieving process following the death of a loved one. Many soldiers returning from conflict suffer from trauma. Many of us are shy and anxious in social situations or unmotivated and pessimistic if we’re unemployed or dislike our jobs…

Psychiatric Times

DSM-5 Field Trials: What Was Learned

James Phillips, MD | January, 8 2013

With DSM-5 now approved by the APA Board of Trustees—and, to the dismay of this reader, all discussion removed from the DSM-5 Web site—how are we to evaluate the results of the field trials for the end product? I suggest beginning with the short piece published in Psychiatric News, “What We Learned from DSM-5 Field Trials.”1 Authors David Kupfer and Helena Kraemer wrote, “We ultimately tested the criteria for 23 disorders. The question we asked was a straightforward one: In the hands of regular clinicians, assessing typically symptomatic patients in no different way than they would during everyday practice, was a particular disorder reliable?”

DSM-5 rejects call for urgent reconsideration of new “Somatic Symptom Disorder” category

DSM-5 rejects call from lead psychiatrist for DSM-IV Task Force for urgent reconsideration of new “Somatic Symptom Disorder” category 

Post #219 Shortlink: http://wp.me/pKrrB-2C0

Today, Allen Frances, M.D., publishes a follow-up to our December 8 commentary in which we set out the implications for all chronic illness patient populations of misdiagnosis with “Somatic Symptom Disorder (SSD)” or misapplication of an additional diagnosis of “SSD.”

In the second of three commentaries, Dr Frances reports on the outcome of his representations to the DSM-5 Somatic Symptom Disorder Work Group, key APA Board of Trustees office holders and DSM-5’s Task Force chair and vice-chair, for urgent reconsideration of this new “catch-all” mental health disorder.

The texts for DSM-5 are expected to be finalized for the publishers by the end of this month.

Dr Frances’ first commentary on SSD is approaching 20,000 views and has received over 300 comments on Psychology Today, alone. It is also published at Huffington Post and at Education Update and widely circulated on other platforms.

There has been an overwhelming response to our concerns with comments pouring in from patients with diverse chronic illnesses and medical conditions including Ehlers-Danlos Syndrome, Interstitial Cystitis, Behcet’s disease, Endometriosis, Lupus, Hashimotos thyroid disorder, Hughes Syndrome, Pancreatitis and Chronic Lyme disease –patients whose symptoms had been dismissed for years before finally receiving a diagnosis or who are still struggling to obtain a diagnosis, many of whom had been mislabelled with a somatoform disorder.

We’ve also received many emails from patients and international patient organizations.

Please circulate this follow-up commentary. I am particularly keen to reach platforms for patients with common chronic diseases and conditions – cancer, heart disease, diabetes, COPD, MS, RA, chronic pain; also Lyme disease, chemical injury and rare diseases, IBS and Fibromyalgia, ME and CFS.

Allen Frances, M.D., was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.

Psychology Today

DSM5 in Distress

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

Published on January 16, 2013 by Allen J. Frances, M.D., in DSM5 in Distress

Bad News: DSM 5 Refuses To Correct Somatic Symptom Disorder
Medical Illness Will Be Mislabeled Mental Disorder

“Many of you will have read a previous blog prepared by Suzy Chapman and me that contained alarming information about the new DSM 5 diagnosis ‘Somatic Symptom Disorder.’

“SSD is defined so over inclusively by DSM 5 that it will mislabel 1 in 6 people with cancer and heart disease; 1 in 4 with irritable bowel and fibromyalgia; and 1 in 14 who are not even medically ill.

“I hoped to be able to influence the DSM 5 work group to correct this in 2 ways: 1) by suggesting improvements in the wording of the SSD criteria set that would reduce mislabeling; and 2) by letting them know how much opposition they would face from concerned professionals and an outraged public if DSM 5 failed to slam on the brakes while there was still time…”

Read on here:

Bad News: DSM 5 Refuses To Correct Somatic Symptom Disorder
Medical Illness Will Be Mislabeled Mental Disorder

 

The most recent proposals for new category “J 00 Somatic Symptom Disorder”

IASP and the Classification of Pain in ICD-11  Prof. Dr. Winfried Rief, University of Marburg, Germany

Slide 9

Ed: Note that the requirement for “at least two from the B type criteria” was reduced to “at least one from the B type criteria” for the third iteration of draft proposals. This lowering of the threshold is presumably in order to accommodate the merging of the previously proposed “Simple Somatic Symptom Disorder” category into the “Complex Somatic Symptom Disorder” category, a conflation now proposed to be renamed to “Somatic Symptom Disorder,” also the disorder section name. A revised “Rationale/Validity” PDF document was not issued for the third and final draft. A brief, revised “Rationale” text was published on a Tab Page for the Somatic Symptom Disorder proposal and criteria but is no longer accessible.

Proposals, criteria and rationales, as posted for the third draft in May 2012, were removed from the DSM-5 Development website on November 15, 2012 and placed behind a non public log in. Criteria as they had stood for the third draft can no longer be viewed but are set out on Slide 9 in this presentation, which note, does not include three, optional Severity Specifiers that were included with the third draft criteria.

 

Related material

Mislabeling Medical Illness As Mental Disorder: The Eleventh DSM-5 Mistake, Psychology Today, DSM5 in Distress, Allen Frances, MD, December 8, 2012

Somatic Symptom Disorder could capture millions more under mental health diagnosis, Suzy Chapman

Submission to Somatic Symptom Disorder Work Group in response to third draft proposals, Suzy Chapman

Additional commentary

Oak Park Behavioral Medicine, Mind Your Body blog

Moving in the Wrong Direction

Dr Tiffany Taft, Ph.D., Northwestern University, December 13, 2012

IBS Impact IBS Impact blog

Proposed DSM-5 Criteria May Unfairly Label Physical Conditions as Psychological Disorders

DSM-5 Round up: January #1

DSM-5 Round up: January #1

Post #218 Shortlink: http://wp.me/pKrrB-2Bs

American Journal of Psychiatry

Editorials | January 01, 2013

The Initial Field Trials of DSM-5: New Blooms and Old Thorns

Robert Freedman, M.D.; David A. Lewis, M.D.; Robert Michels, M.D.; Daniel S. Pine, M.D.; Susan K. Schultz, M.D.; Carol A. Tamminga, M.D.; Glen O. Gabbard, M.D.; Susan Shur-Fen Gau, M.D., Ph.D.; Daniel C. Javitt, M.D., Ph.D.; Maria A. Oquendo, M.D., Ph.D.; Patrick E. Shrout, Ph.D.; Eduard Vieta, M.D., Ph.D.; Joel Yager, M.D.

Am J Psychiatry 2013;170:1-5. 10.1176/appi.ajp.2012.12091189

View Author and Article Information
Copyright © 2013 by the American Psychiatric Association

Article
Figures
References

“A rose is a rose is a rose” (1). For psychiatric diagnosis, we still interpret this line as Robins and Guze did for their Research Diagnostic Criteria—that reliability is the first test of validity for diagnosis (2). To develop an evidence-based psychiatry, the Robins and Guze strategy (i.e., empirically validated criteria for the recognizable signs and symptoms of illness) was adopted by DSM-III and DSM-IV. The initial reliability results from the DSM-5 Field Trials are now reported in three articles in this issue (3–5). As for all previous DSM editions, the methods used to assess reliability reflect current standards for psychiatric investigation (3). Independent interviews by two different clinicians trained in the diagnoses, each prompted by a computerized checklist, assessment of agreement across different academic centers, and a pre-established statistical plan are now employed for the first time in the DSM Field Trials. As for most new endeavors, the end results are mixed, with both positive and disappointing findings…

Full free text

Washington Post

Antidepressants to treat grief? Psychiatry panelists with ties to drug industry say yes

Peter Whoriskey | December 27, 2012

It was a simple experiment in healing the bereaved: Twenty-two patients who had recently lost a spouse were given a widely used antidepressant.

The drug, marketed as Wellbutrin, improved “major depressive symptoms occurring shortly after the loss of a loved one,” the report in the Journal of Clinical Psychiatry concluded.

When, though, should the bereaved be medicated? For years, the official handbook of psychiatry, issued by the American Psychiatric Association, advised against diagnosing major depression when the distress is “better accounted for by bereavement.” Such grief, experts said, was better left to nature.

But that may be changing…

Medscape Medical News > Psychiatry

APA Answers Criticism of Pharma-Influenced Bias in DSM-5

Deborah Brauser | January 4, 2013

The American Psychiatric Association (APA) has fired back a strong response to a recent article by the Washington Post questioning the possibility of pharmaceutical industry influence on decisions regarding the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)…

Ed: Note for watchers of DSM-5’s Timeline. Although the Timeline has the final texts schedule for submission to the publishers by December 2012, in his commentary below, Dr Frances discloses that DSM-5 will go to press at the end of January. The new edition of DSM is slated for release at the APA’s 166th Annual Meeting, May 18-22, 2013, San Francisco.

Psychology Today

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

Last Plea to DSM 5: Save Grief From the Drug Companies
Let us respect the dignity of love and loss.

Allen J. Frances, M.D. | January 3, 2013

Psychiatric News
Psychiatric News | January 04, 2013
Volume 48 Number 1 page 7-7
10.1176/appi.pn.2013.1a14
American Psychiatric Association
Professional News

Eating-Disorders Guideline Still Current and Valid, Panel Finds

Mark Moran | January 4, 2013

A review of the 2006 APA practice guideline on eating disorders finds that it is substantially current and is not affected by changes in diagnostic criteria in DSM-5.

Huffington Post

‘Eating Disorders Not Otherwise Specified’: What’s Changing With EDNOS In DSM-5?

Catherine Pearson | January 4, 2013

It took Autumn Whitefield-Madrano more than 20 years to seek treatment for her eating disorder. The writer was 9 when she started having symptoms, primarily binging, and 33 when she finally got help. When she did, the diagnosis surprised her. Whitefield-Madrano had EDNOS, or an “Eating Disorder Not Otherwise Specified…”

11th hour call: “Mislabeling Medical Illness As Mental Disorder” by Allen J. Frances, MD.

11th hour call: “Mislabeling Medical Illness As Mental Disorder” by Allen J. Frances, MD.

Post #217 Shortlink: http://wp.me/pKrrB-2AL

Image Copyright Dx Revision Watch 2012On December 8, Allen J. Frances, MD, blogged at Psychology Today on our shared concerns for the new DSM-5 category – Somatic Symptom Disorder. Dr Frances was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus, Duke.

One in six people suffering from cancer, heart and other serious diseases risks being saddled with a psychiatric diagnosis if they are considered to be “excessively” worried about their illness or spending more time on the internet researching their symptoms than the American Psychiatric Association (APA) thinks good for them.

But many illness groups – particularly the so-called “functional somatic syndromes” – stand to be captured by these new criteria and assigned an additional mental health diagnosis, or placed at risk of misdiagnosis.

The DSM-5 manual texts are still being finalized and the Somatic Symptom Disorder Work Group has been asked to reconsider its criteria and tighten them up before the next edition of DSM is sent to the publishers.

Please demonstrate to the APA and the Somatic Symptom Disorder Work Group the level of concern amongst clinicians and allied health professionals, patients, caregivers and advocacy organizations by visiting Dr Frances’ blog post and leaving a comment. You can read the commentary at the link, below.

If you share our concerns that these catch-all criteria will see thousands more patients tagged with a mental health label please forward the link to your colleagues and contacts and post on Twitter, blogs and social media platforms.

Thank you,

Suzy Chapman for Dx Revision Watch

Mislabeling Medical Illness As Mental Disorder: The Eleventh DSM-5 Mistake

Psychology Today, DSM5 in Distress, Allen Frances, MD, December 8, 2012

Additional commentary

Oak Park Behavioral Medicine, Mind Your Body blog

Moving in the Wrong Direction

Dr Tiffany Taft, Ph.D., Northwestern University, December 13, 2012

IBS Impact IBS Impact blog

Proposed DSM-5 Criteria May Unfairly Label Physical Conditions as Psychological Disorders

The most recent proposals for new category “J 00 Somatic Symptom Disorder”

Ed: Proposals, criteria and rationales, as posted for the third stakeholder review and comment period, in May 2012, were removed from the DSM-5 Development website on November 15, 2012 and placed behind a non public log in. Criteria as they had stood for the third draft can no longer be viewed but are set out on Slide 9 in this presentation, which note, does not include the three, optional Severity Specifiers that were included in the third iteration.

Note that the requirement for “at least two from the B type criteria” was reduced to “at least one from the B type criteria” between the second and third set of draft proposals.

IASP and the Classification of Pain in ICD-11  Prof. Dr. Winfried Rief, University of Marburg,

Slide 9

Related material

Somatic Symptom Disorder could capture millions more under mental health diagnosis

Submission to Somatic Symptom Disorder Work Group in response to third draft proposals

Bloomberg: How Many Billions a Year Will the DSM-5 Cost? Allen Frances, MD

Bloomberg: How Many Billions a Year Will the DSM-5 Cost? Allen Frances, MD

Post #216 Shortlink: http://wp.me/pKrrB-2Av

Update: Additional recent articles on DSM-5 development:

Healio Psychiatric Annals > Practice Management > News

DSM-5: a ‘living document’ that may impact practice, patients health

December 21, 2012

Bloomberg

How Many Billions a Year Will the DSM-5 Cost?

Illustration by Pete Gamlen

Allen Frances, MD | December 20, 2012

Further responses to the commentary on DSM-5 Somatic Symptom Disorder by Allen Frances and Suzy Chapman published last week on Psychology Today, Huffington Post and Education Update:

IBS Impact blog

Proposed DSM-5 Criteria May Unfairly Label Physical Conditions as Psychological Disorders

“Recently in the IBS and chronic illness community, several professionals and self-advocates have begun expressing concern about proposed changes in the Diagnostic and Statistical Manual for Mental Disorders, commonly known as the DSM…The DSM is revised periodically and the 5th edition is expected to be released in 2013. While there are many controversial proposed changes, one that has received relatively little attention in the mainstream media is particularly alarming in its potential implications for people with chronic illnesses, especially ones that are still scientifically poorly understood, like irritable bowel syndrome or commonly overlapping conditions like fibromyalgia, chronic fatigue syndrome and interstitial cystitis among others…”

Mind Your Body

Moving in the Wrong Direction

Dr Tiffany Taft, Ph.D., Northwestern University | December 13, 2012

“…Rather than repeating what’s in store in DSM 5, this article provides an excellent summary of the proposed changes. It’s really worth taking the time to read, whether you have diabetes, irritable bowel syndrome, lupus, or fibromyalgia. The bottom line is, regardless of the etiology of your chronic illness you are a candidate for the Somatic Symptom Disorder (SDD) diagnosis. If you’re a parent caregiver, your reactions to your child’s illness may be deemed pathological as well…”

The Reporting on Health Member Blog

DSM 5 – Misdiagnosing or Mislabeling of Medical Diseases

Kate Benson | December 19, 2012

Related material

Somatic Symptom Disorder could capture millions more under mental health diagnosis

Submission to Somatic Symptom Disorder Work Group in response to third draft proposals

One Last Chance For APA To Make DSM 5 Safer: Allen Frances, M.D.

One Last Chance For APA To Make DSM 5 Safer: Allen Frances, M.D.

Post #215 Shortlink: http://wp.me/pKrrB-2Ae

Psychology Today Blogs | DSM5 in Distress | Allen Frances, M.D.

One Last Chance For APA To Make DSM 5 Safer

Other wise there will likely be a buyer’s revolt.

Allen J. Frances, M.D. | December, 16 2012

Two weeks ago the Trustees of the American Psychiatric Association made the serious mistake of approving and rushing to press a DSM 5 that has many unsafe and untested suggestions.

The reaction has been unexpectedly heated: dozens of extremely negative news stories, many highly critical blogs, and a number of calls for a DSM 5 boycott in the US, England, France, Australia, Spain, and Italy…

Round up of recent DSM-5 media

The Daily Beast

The DSM’s Controversial Update

December 9, 2012

New Scientist

Magazine issue 2895.

Target faulty brain circuits to treat mental illness

Peter Aldhous | December 12, 2012

“Some critics argue that it’s time to rip up the manual and start again – with wider input. In the coming weeks, organisers of a petition to reform DSM-5 backed by 14,000 mental health professionals plan to launch an online forum to debate a new diagnostic system…”

Related material

Mislabeling Medical Illness As Mental Disorder  Allen J Frances MD, December 9, 2012

Somatic Symptom Disorder could capture millions more under mental health diagnosis 

Submission to Somatic Symptom Disorder Work Group in response to third draft proposals