The six most essential questions in psychiatric diagnosis: a pluralogue: conceptual and definitional issues in psychiatric diagnosis Parts 1 and 2

The six most essential questions in psychiatric diagnosis: a pluralogue: conceptual and definitional issues in psychiatric diagnosis, Parts 1 and 2

Post #161 Shortlink: http://wp.me/pKrrB-248

Below, I am posting the Abstract and Introduction to Parts 1 and 2 of Philos Ethics Humanit Med Review “The six most essential questions in psychiatric diagnosis: a pluralogue: conceptual and definitional issues in psychiatric diagnosis.”

Part 1 of this Review was published on January 13, 2012; Part 2 was published (as a provisional PDF) on April 18, 2012. I will post Part 3 when it becomes available.

Below Parts 1 and 2, I have posted the PDFs for Phillips J (ed): Symposium on DSM-5: Part 1. Bulletin of the Association for the Advancement of Philosophy and Psychiatry 2010, 17(1):1–26 and Phillips J (ed): Symposium on DSM-5: Part 2. Bulletin of the Association for the Advancement of Philosophy and Psychiatry 2010, 17(2):1–75 out of which grew the concept for the Philos Ethics Humanit Med Review Parts 1 and 2.

This is an interesting series of exchanges which expand on conceptual and definitional issues discussed in these two Bulletins but these are quite lengthy documents, 29 and 30 pp, respectively; PDFs are provided rather than full texts.

Review Part One

The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305603/

Philos Ethics Humanit Med. 2012; 7: 3.
Published online 2012 January 13. doi: 10.1186/1747-5341-7-3 PMCID: PMC3305603

Copyright ©2012 Phillips et al; licensee BioMed Central Ltd.
Received August 15, 2011; Accepted January 13, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

      The six most essential questions Part 1

or: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305603/pdf/1747-5341-7-3.pdf

Html: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305603/

or http://www.peh-med.com/content/7/1/3

James Phillips,corresponding author1 Allen Frances,2 Michael A Cerullo,3 John Chardavoyne,1 Hannah S Decker,4 Michael B First,5 Nassir Ghaemi,6 Gary Greenberg,7 Andrew C Hinderliter,8 Warren A Kinghorn,2,9 Steven G LoBello,10 Elliott B Martin,1 Aaron L Mishara,11 Joel Paris,12 Joseph M Pierre,13,14 Ronald W Pies,6,15 Harold A Pincus,5,16,17,18 Douglas Porter,19 Claire Pouncey,20 Michael A Schwartz,21 Thomas Szasz,15 Jerome C Wakefield,22,23 G Scott Waterman,24 Owen Whooley,25 and Peter Zachar10
 
1Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT 06511, USA
2Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St., Durham, NC 27710, USA
3Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH 45219, USA
4Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA
5Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
6Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
7Human Relations Counseling Service, 400 Bayonet Street Suite #202, New London, CT 06320, USA
8Department of Linguistics, University of Illinois, Urbana-Champaign 4080 Foreign Languages Building, 707 S Mathews Ave, Urbana, IL 61801, USA
9Duke Divinity School, Box 90968, Durham, NC 27708, USA
10Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL 36117, USA
11Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago IL, 60654, USA
12Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Department of Psychiatry, McGill University, 4333 cote Ste. Catherine, Montreal H3T1E4 Quebec, Canada
13Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, USA
14VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA
15Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY 13210, USA
16Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
17New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY 10032, USA
18Rand Corporation, 1776 Main St Santa Monica, California 90401, USA
19Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA 70113, USA
20Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320 Philadelphia, PA 19104, USA
21Department of Psychiatry, Texas AMHSC College of Medicine, 4110 Guadalupe Street, Austin, Texas 78751, USA
22Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10003, USA
23Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY 10016, USA
24Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, Vermont 05405, USA
25Institute for Health, Health Care Policy, and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St., New Brunswick, NJ 08901, USA

Abstract

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

General Introduction

This article has its own history, which is worth recounting to provide the context of its composition.

As reviewed by Regier and colleagues [1], DSM-5 was in the planning stage since 1999, with a publication date initially planned for 2010 (now rescheduled to 2013). The early work was published as a volume of six white papers, A Research Agenda for DSM-V [2] in 2002. In 2006 David Kupfer was appointed Chairman, and Darrel Regier Vice-Chairman, of the DSM-5 Task Force. Other members of the Task Force were appointed in 2007, and members of the various Work Groups in 2008.

From the beginning of the planning process the architects of DSM-5 recognized a number of problems with DSM-III and DSM-IV that warranted attention in the new manual. These problems are now well known and have received much discussion, but I will quote the summary provided by Regier and colleagues:

Over the past 30 years, there has been a continuous testing of multiple hypotheses that are inherent in the Diagnostic and Statistical Manual of Mental Disorders, from the third edition (DSM-III) to the fourth (DSM-IV)… The expectation of Robins and Guze was that each clinical syndrome described in the Feighner criteria, RDC, and DSM-III would ultimately be validated by its separation from other disorders, common clinical course, genetic aggregation in families, and further differentiation by future laboratory tests–which would now include anatomical and functional imaging, molecular genetics, pathophysiological variations, and neuropsychological testing. To the original validators Kendler added differential response to treatment, which could include both pharmacological and psychotherapeutic interventions… However, as these criteria have been tested in multiple epidemiological, clinical, and genetic studies through slightly revised DSM-III-R and DSM-IV editions, the lack of clear separation of these syndromes became apparent from the high levels of comorbidity that were reported… In addition, treatment response became less specific as selective serotonin reuptake inhibitors were found to be effective for a wide range of anxiety, mood, and eating disorders and atypical antipsychotics received indications for schizophrenia, bipolar disorder, and treatment-resistant major depression. More recently, it was found that a majority of patients with entry diagnoses of major depression in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study had significant anxiety symptoms, and this subgroup had a more severe clinical course and was less responsive to available treatments… Likewise, we have come to understand that we are unlikely to find single gene underpinnings for most mental disorders, which are more likely to have polygenetic vulnerabilities interacting with epigenetic factors (that switch genes on and off) and environmental exposures to produce disorders. [[2], pp. 645-646]

As the work of the DSM-5 Task Force and Work Groups moved forward, a controversy developed that involved Robert Spitzer and Allen Frances, Chairmen respectively of the DSM-III and DSM-IV Task Forces. The controversy began with Spitzer’s Letter to the Editor, “DSM-V: Open and Transparent,” on July 18, 2008 in Psychiatric Times [3], detailing his unsuccessful effort to obtain minutes of the DSM-5 Task Force meetings. In ensuing months Allen Frances joined him in an exchange with members of the Task Force. In a series of articles and blog postings in Psychiatric Times, Frances (at times with Spitzer) carried out a sustained critique of the DSM-5 work in which he focused both on issues of transparency and issues of process and content [4-16]. The latter involved the Task Force and Work Group efforts to address the problems of DSM-IV with changes that, in Frances’ opinion, were premature and not backed by current scientific evidence. These changes included new diagnoses such as mixed anxiety-depression, an expanded list of addictive disorders, the addition of subthreshold conditions such as Psychosis Risk Syndrome, and overly inclusive criteria sets – all destined, in Frances’ judgment, to expand the population of the mentally ill, with the inevitable consequence of increasing the number of false positive diagnoses and the attendant consequence of exposing individuals unnecessarily to potent psychotropic medications. The changes also included extensive dimensional measures to be used with minimal scientific foundation.

Frances pointed out that the NIMH was embarked on a major effort to upgrade the scientific foundation of psychiatric disorders (described below by Michael First), and that pending the results of that research effort in the coming years, we should for now mostly stick with the existing descriptive, categorical system, in full awareness of all its limitations. In brief, he has argued, we are not ready for the “paradigm shift” hoped for in the 2002 A Research Agenda.

We should note that as the DSM-5 Work Groups were being developed, the Task Force rejected a proposal in 2008 to add a Conceptual Issues Work Group [17] – well before Spitzer and Frances began their online critiques.

In the course of this debate over DSM-5 I proposed to Allen in early 2010 that we use the pages of the Bulletin of the Association for the Advancement of Philosophy and Psychiatry (of which I am Editor) to expand and bring more voices into the discussion. This led to two issues of the Bulletin in 2010 devoted to conceptual issues in DSM-5 [18,19]. (Vol 17, No 1 of the AAPP Bulletin will be referred to as Bulletin 1, and Vol 17, No 2 will be referred to as Bulletin 2. Both are available at http://alien.dowling.edu/~cperring/aapp/bulletin.htm. webcite) Interest in this topic is reflected in the fact that the second Bulletin issue, with commentaries on Frances’ extended response in the first issue, and his responses to the commentaries, reached over 70,000 words.

Also in 2010, as Frances continued his critique through blog postings in Psychiatric Times, John Sadler and I began a series of regular, DSM-5 conceptual issues blogs in the same journal [20-33].

With the success of the Bulletin symposium, we approached the editor of PEHM, James Giordano, about using the pages of PEHM to continue the DSM-5 discussion under a different format, and with the goal of reaching a broader audience. The new format would be a series of “essential questions” for DSM-5, commentaries by a series of individuals (some of them commentators from the Bulletin issues, others making a first appearance in this article), and responses to the commentaries by Frances. Such is the origin of this article. (The general introduction, individual introductions, and conclusion are written by this author (JP), the responses by Allen Frances.

For this exercise we have distilled the wide-ranging discussions from the Bulletin issues into six questions, listed below with the format in which they were presented to commentators. (As explained below, the umpire metaphor in Question 1 is taken from Frances’ discussion in Bulletin 1.)…

Full document in PDF format

 

Review Part Two

(Note: Part Two was published on April 18, 2012 and addresses Questions 3 and 4. The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production. I will replace with the final version when available.)

The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis

Philosophy, Ethics, and Humanities in Medicine 2012, 7:8 doi:10.1186/1747-5341-7-8

http://www.peh-med.com/content/7/1/8/abstract

Published: 18 April 2012

      The six most essential questions Part 2 Provisional

The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis

James Phillips, Allen Frances, Michael A Cerullo, John Chardavoyne, Hannah S Decker, Michael B First, Nassir Ghaemi, Gary Greenberg, Andrew C Hinderliter, Warren A Kinghorn, Steven G LoBello, Elliott B Martin, Aaron L Mishara, Joel Paris, Joseph M Pierre, Ronald W Pies, Harold A Pincus, Douglas Porter, Claire Pouncey, Michael A Schwartz, Thomas Szasz, Jerome C Wakefield, G Scott Waterman, Owen Whooley and Peter Zachar

Abstract (provisional)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 

Symposium on DSM-5: Parts 1 and 2

      Bulletin Vol 17 No 1

Phillips J (ed): Symposium on DSM-5: Part 1. Bulletin of the Association for the
Advancement of Philosophy and Psychiatry 2010, 17(1):1–26

      Bulletin Vol 17 No 2

Phillips J (ed): Symposium on DSM-5: Part 2. Bulletin of the Association for the Advancement of Philosophy and Psychiatry 2010, 17(2):1–75

 

One focus for this site has been the monitoring of the various iterations towards the revision of the Somatoform Disorders categories of DSM-IV, for which radical reorganization of existing DSM categories and criteria is proposed.

As the DSM-5 Development site documentation currently stands (April 27, 2012), the “Somatic Symptom Disorders” Work Group (Chaired by Joel E. Dimsdale, M.D.) proposes to rename Somatoform Disorders to “Somatic Symptom Disorders” and to fold a number of existing somatoform disorders together under a new rubric, which the Work Group proposes to call “Complex Somatic Symptom Disorder.”

Complex Somatic Symptom Disorder (CSSD) would include the previous DSM-IV diagnoses of somatization disorder [DSM IV code 300.81], undifferentiated somatoform disorder [DSM IV code 300.81], hypochondriasis [DSM IV code 300.7], as well as some presentations of pain disorder [DSM IV code 307].

There is a more recently proposed, Simple Somatic Symptom Disorder (SSSD), which requires symptom duration of just one month, as opposed to the six months required to meet the CSSD criteria. There is also an Illness Anxiety Disorder (hypochondriasis without somatic symptoms); and a proposal to rename Conversion Disorder to Functional Neurological Disorder and possibly locate under Dissociative Disorders.

There is some commentary on the Somatoform Disorders in DSM-IV in this discussion from Bulletin 1:

Bulletin Vol 17 No 1, Page 19:

Doing No Harm: The Case Against Conservatism

G. Scott Waterman, M.D. David P. Curley, Ph.D.

Department of Psychiatry, University of Vermont College of Medicine

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Conflicts of interest and DSM-5: the media reaction; APA Rebuts Study on Autism and Christopher Lane On What’s Wrong With Modern Psychiatry

Conflicts of interest and DSM-5: the media reaction; APA Rebuts Study on Autism and Christopher Lane On What’s Wrong With Modern Psychiatry

Post #154 Shortlink: http://wp.me/pKrrB-20T

Links for full text, PDF and further coverage following publication of the PloS Essay by Cosgrove and Krimsky:

March 17, 2012: DSM-5 controversies, Cosgrove and Krimsky on potential COIs, counter statement from APA’s John Oldham and APA May Annual Meeting preliminary program

March 14, 2012: Cosgrove, Sheldon: 69% of DSM-5 task force members report pharmaceutical industry ties – review identifies potential COIs

PLoS Blogs

Speaking of Medicine

Conflicts of interest and DSM-5: the media reaction

Clare Weaver | March 26, 2012

…Last week PLoS Medicine published an analysis by Lisa Cosgrove and Sheldon Krimsky, who examined the disclosure policy and the panel members’ conflicts of interest, and call for the APA to make changes to increase transparency before the manual’s publication.

Within three days of publication the paper had been viewed over 4000 times, and several major media outlets reported on the authors’ findings and the wider issues they relate to…

Read full post

Psychiatric Times

American Psychiatric Association Press Release No. 12-15: March 27, 2012

      Commentary Takes Issue with Criticism of New Autism Definition

APA Rebuts Study on Autism

DSM-5 Experts Call Study Flawed

Laurie Martin, Web Editor | 30 March 2012

In a recent commentary, the DSM-5 Neurodevelopmental Disorders Work Group responded to a study that challenges the proposed DSM-5 diagnostic criteria on autism spectrum disorder (ASD).1 The commentary, published in the April issue of the Journal of the American Academy of Child & Adolescent Psychiatry (JAACAP), takes issue with the study by James McPartland and colleagues,2 and addresses what it deems “serious methodological flaws.”

The Work Group refutes the authors’ conclusions that the “Proposed DSM-5 criteria could substantially alter the composition of the autism spectrum. Revised criteria improve specificity but exclude a substantial portion of cognitively.” Dr McPartland and colleagues’ research study, titled Sensitivity and Specificity of Proposed DSM-5 Diagnostic Criteria for Autism Spectrum Disorder, also states, “a more stringent diagnostic rubric holds significant public health ramifications regarding service eligibility and compatibility of historical and future research.” The study in question is also published in the April issue of JAACAP…

Read full article by Laurie Martin, Web Editor

Related material: American Psychiatric Association Press Release No. 12-03

      DSM-5 Proposed Criteria for Autism Spectrum Disorder Designed to Provide More Accurate Diagnosis and Treatment  January 20, 2012

The Sun Interview

March 2012

Side Effects May Include

Christopher Lane On What’s Wrong With Modern Psychiatry

by Arnie Cooper
The complete text of this selection is available in our print edition.

Six years ago Lane began to hear from his students at Northwestern University in Evanston, Illinois, that many of them were on psychiatric drugs. They would come to his office to ask for extensions on their assignments, explaining that they were suffering from anxiety or depression but were on medication for it. He had just published Hatred and Civility: The Antisocial Life in Victorian England, for which he had studied the transition from Victorian psychiatry, out of which psychoanalysis was born, to contemporary psychiatry, with its intense focus on biomedicine and pharmacology. He was already skeptical about the emergence in 1980 of dozens of new mental disorders in the DSM-III, the third edition of the manual. Among these new ailments were the curious-sounding “social phobia” and “avoidant personality disorder.” Lane wanted to know how and why those new disorders had been approved for inclusion and whether they were really bona fide illnesses…

Read Arnie Cooper interview with Christopher Lane

Cosgrove, Sheldon: 69% of DSM-5 task force members report pharmaceutical industry ties

Cosgrove, Sheldon: 69% of DSM-5 task force members report pharmaceutical industry ties – review identifies potential COIs

Post #151 Shortlink: http://wp.me/pKrrB-1ZM

“Board of Trustee Principles” here:
http://www.dsm5.org/about/Pages/BoardofTrusteePrinciples.aspx

“DSM-V Task Force and Work Group Acceptance Form” here:
Approved by BOT July2006 Amended and Approved by BOT October 2007
http://www.dsm5.org/about/Documents/DSM%20Member%20Acceptance%20Form.pdf

DSM-5 Task Force members’ bios and disclosures here: http://www.dsm5.org/MeetUs/Pages/TaskForceMembers.aspx

DSM-5 Work Group members’ bios and disclosures here: http://www.dsm5.org/MeetUs/Pages/WorkGroupMembers.aspx

(All 13 DSM-5 Work Group Chairs are members of the Task Force, which totals 29 members.)

A number of stories following publication of PLoS Medicine Essay by Linda Cosgrove and Sheldon Krimsky:

A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists

Full text available on PLoS site under “Open-access”

Or open PDF here

Citation: Cosgrove L, Krimsky S (2012) A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists. PLoS Med 9(3): e1001190. doi:10.1371/journal.pmed.1001190

Published: March 13, 2012

 

ABC News

DSM-5 Criticized for Financial Conflicts of Interest

Katie Moisse | March 13, 2012

Controversy continues to swell around the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, better known as DSM-5. A new study suggests the 900-page bible of mental health, scheduled for publication in May 2013, is ripe with financial conflicts of interest.

The manual, published by the American Psychiatric Association, details the diagnostic criteria for each and every psychiatric disorder, many of which have pharmacological treatments. After the 1994 release of DSM-4, the APA instituted a policy requiring expert advisors to disclose drug industry ties. But the move toward transparency did little to cut down on conflicts, with nearly 70 percent of DSM-5 task force members reporting financial relationships with pharmaceutical companies – up from 57 percent for DSM-4.

“Organizations like the APA have embraced transparency too quickly as the solution,” said Lisa Cosgrove, associate professor of clinical psychology at the University of Massachusetts-Boston and lead author of the study published today in the journal PLoS Medicine. “Our data show that transparency has not changed the dynamic.”…

Read on


New Scientist

Many authors of psychiatry bible have industry ties

Peter Aldhous | March 13, 2012

Just as many authors of the new psychiatry “bible” are tied to the drugs industry as those who worked on the previous version, a study has found, despite new transparency rules…

…”Transparency alone can’t mitigate bias,” says Lisa Cosgrove Havard University of Harvard University, who along with Sheldon Krimsky of Tufts University in Medford, Massachusetts, analysed the financial disclosures of 141 members of the “work groups” drafting the manual. They found that just as many contributors – 57 per cent – had links to industry as were found in a previous study of the authors of DSM-IV and an interim revision, published in 1994 and 2000 respectively.

Cosgrove also points out that the $10,000-per-year limit on payments excludes research grants. “Nothing has really changed,” she says…

Read on

Journal reference: PLoS Medicine, DOI: 10.1371/ journal.pmed.1001190

Please note that the petition launched in October by an ad hoc committee of the Society for Humanistic Psychology (Division 32 of the American Psychological Association) referred to in this article is intended for signing by mental health professionals.


Nature | News

Industry ties remain rife on panels for psychiatry manual
Review identifies potential conflicts of interest among those drawing up DSM-5.

Heidi Ledford | March 13, 2012

Potential conflicts of interest among the physicians charged with revising a key psychiatric manual have not declined despite changes to the rules on disclosing ties to industry, says a study published today1.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used to diagnose patients, shape research projects and guide health-insurance claims. The fifth edition of the manual, DSM-5, currently being prepared by the American Psychiatric Association (APA) in Arlington, Virginia, is scheduled for publication in May 2013. But some of the suggested revisions are proving to be contentious. In particular, some psychiatrists worry that the broader diagnostic criteria for selected psychiatric conditions would encroach into the realm of the normal, thereby pathologizing ordinary behaviour and expanding the market for drug prescriptions (see ‘Diagnostics tome comes under fire’ and ‘Mental health guide accused of overreach’)…

Read on


From TIME Magazine:

TIME Magazine

What Counts As Crazy?

John Cloud | Online March 14, 2012

Print edition | March 19, 2012

…The mind, in our modern conception, is an array of circuits we can manipulate with chemicals to ease, if not cure, depression, anxiety and other disorders. Drugs like Prozac have transformed how we respond to mental illness. But while this revolution has reshaped treatments, it hasn’t done much to help us diagnose what’s wrong to begin with. Instead of ordering lab tests, psychiatrists usually have to size up people using subjective descriptions of the healthy vs. the afflicted.

…Which is why the revision of a single book is roiling the world of mental health, pitting psychiatrists against one another in bitter…

Full article available to subscribers


From last week’s New Scientist:

New Scientist

Should we rewrite the autism rule book?

Fred Volkmar and Francesca Happé | March 7, 2012
Magazine issue 2855.

AN EFFORT is under way to update the American Psychiatric Association’s diagnostic guide – the Diagnostic and Statistical Manual of Mental Disorders (DSM). In particular, changes suggested for diagnosis of autism are the focus of much debate.

There are clear reasons for changing and tweaking DSM categories and criteria in the light of new research, but the impact in this case is likely to be major…

Full article available to subscribers


Human Givens

International society removes ‘schizophrenia’ from its title

March 13, 2012

A statement from the ISPS today reveals that the society has voted to remove the word ‘schizophrenia’ from its title due to the term being deemed ‘unscientific and stigmatizing’:

“Members of the International Society for the Psychological Treatments of the Schizophrenias and Other Psychoses ( www.isps.org ) have just voted, by an overwhelming majority, to change the society’s name to the International Society for Psychological and Social Approaches to Psychosis. The new logo and letterhead are to be adopted by the end of March…”

Read on

Part Two: William Heisel: Slap: American Psychiatric Association Targets One DSM5 Critic, Ignores Others

Part Two: William Heisel: Slap: American Psychiatric Association Targets One DSM5 Critic, Ignores Others

Post #150 Shortlink: http://wp.me/pKrrB-1Z6

Update @ March 1, 2012

Additional commentary:

Neurobonkers, March 1, 2012

APA Shut Down DSM-5 Blogger

—————-

Knight Science Journal Tracker, Paul Raeburn, March 1, 2012

Psychiatrists issue legal threat, silencing blogger critical of diagnostic manual.

also

National Association of Science Writers

—————-

On Monday, investigative health reporter, William Heisel, published Part One of his report on the two “cease and desist” letters served to me on December 22, on behalf of the publishing arm of the American Psychiatric Association.

You can view these letters and correspondence here:

    APA correspondence

 

Read Part One of William Heisel’s report here:

Slap: American Psychiatric Association Pressures Brit DSM5 Blogger Suzy Chapman

 

Today, William Heisel continues the story:

Reporting on Health

William Heisel’s Antidote Investigating Untold Health Stories

William Heisel | February 29, 2012

Slap: American Psychiatric Association Targets One DSM5 Critic, Ignores Others

From the way the American Psychiatric Association threatened UK writer Suzy Chapman, one would think APA is fighting legal battles everywhere to protect its trademarks.

But Chapman appears to be in an elite category. Antidote wrote Monday about how APA forced Chapman to change the name and URL of her DSM-5 and ICD-11 Watch site, saying it infringed on APA’s trademark for its main guidebook, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

But similar sites and uses of APA trademarks abound. Why hasn’t the APA gone after them?

Read on

 

Related posts:

Earlier commentaries:

Media coverage: American Psychiatric Association (APA) “cease and desist” v DSM-5 Watch website; Legal information and resources for bloggers and site owners

Is DSM 5 A Public Trust Or An APA Cash Cow? Commercialism And Censorship Trump Concern For Quality by Allen Frances APA forces domain name change for DSM-5 and ICD-11 Watch site

Pity the poor American Psychiatric Association, Parts 1 and 2: Gary Greenberg

DSM 5 Censorship Fails: Support From Professionals and Patients Saves Free Speech by Allen Frances


William Heisel’s Antidote: Slap: American Psychiatric Association Pressures Brit DSM5 Blogger Suzy Chapman

William Heisel’s Antidote: Slap: American Psychiatric Association Pressures Brit DSM5 Blogger Suzy Chapman

Post #149 Shortlink: http://wp.me/pKrrB-1Yx

On December 22, I was served with two “cease and desist” letters on behalf of the publishing arm of the American Psychiatric Association, publishers of the Diagnostic and Statistical Manual of Mental Disorders – the DSM.

Which disorders go into the next DSM and how those disorders are defined is a public interest issue. Public interest and public trust are best served by an open and transparent development process – not by issuing threats of legal action against those providing internet platforms on which patients and professionals rely for timely and accurate information around the DSM-5 development process and how they might participate in that process, as stakeholders.

The American Psychiatric Association’s publishing arm has the right to protect its intellectual property and pursue trademark infringements where a case for improper use can be made. But employing heavy-handed, punitive, partial and legally questionable tactics against “fair use” of the DSM 5 mark, forcing internet site owners to change web addresses, is putting commercial interests before public participation – a PR fail and a disturbing abuse of power.

    APA correspondence

William Heisel takes up the story:

Reporting on Health

William Heisel’s Antidote Investigating Untold Health Stories

Slap: American Psychiatric Association Pressures Brit DSM5 Blogger Suzy Chapman

http://www.bit.ly/ydSocK

William Heisel | February 27, 2012

If you have a serious interest in a brand, product or company, you can, in a few minutes, set up your own website with a clever domain name that includes your target.

Jim Romenesko did this with Starbucks Gossip. A group of unions and activists did this with Making Change at Wal-Mart. And a team of obsessive Clark Kent loyalists did this with the Superman Super Site.

A few years ago, British writer Suzy Chapman started tracking the proposed changes by the American Psychiatric Association (APA) to psychiatry’s guidebook: the Diagnostic and Statistical Manual of Mental Disorders (DSM)…

Read on

Related posts:

Is DSM 5 A Public Trust Or An APA Cash Cow? Commercialism And Censorship Trump Concern For Quality by Allen Frances APA forces domain name change for DSM-5 and ICD-11 Watch site

Media coverage: American Psychiatric Association (APA) ”cease and desist” v DSM-5 Watch website; Legal information and resources for bloggers and site owners

Pity the poor American Psychiatric Association, Parts 1 and 2: Gary Greenberg

DSM 5 Censorship Fails: Support From Professionals and Patients Saves Free Speech by Allen Frances


The Trouble with Timelines: DSM-5 round up

The Trouble with Timelines: DSM-5 round up

Post #136 Shortlink: http://wp.me/pKrrB-1LJ

In a November 9, 2011 interview with Deborah Brauser for Medscape Medical News, Darrel Regier, MD, APA Director of Research and Task Force Vice-chair, uttered some chilling statements.

According to Dr Regier:

“Our plan is that these [judgements] will be immediately tested once the DSM is official, and then one will be able to see if revisions can be made…

“Our workgroups are struggling with this balance…for what might be the most appropriate fix. Some of these fixes are not as well studied as others and we recognize that. But we can’t move forward without some of these put into practice. So we think this is a much more testable set of scientific hypotheses…”

“And that’s what the DSM is — a set of scientific hypotheses that are intended to be tested and disproved if the evidence isn’t found to support them…”

“We’re thinking of having a DSM-5.1, DSM-5.2, etc, in much the same way is done with software updates…”

So come May 2013, does APA plan to publish an unvalidated beta as though it were the next release of Firefox, test out its pet theories then release post publication “patches” to fix the flaws?

 

First up, Allen Frances blogging, today, on Psychology Today:

Allen Frances, MD, who chaired the Task Force that had oversight of the development of DSM-IV, is a former chief of psychiatry at Duke University Medical Center and currently professor emeritus at Duke

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

APA Should Delay Publication Of DSM 5 until it can achieve adequate reliability and quality

Allen Frances, MD | January 31, 2012

“…With less than a year remaining before DSM 5 is scheduled to go to print, the signs are clear that it cannot possibly be completed on time unless we are willing to settle for a third rate product. The unmistakable red flag is the recent embarrassing admission that DSM 5 will accept diagnoses that achieve reliabilities as unbelievably low as 0.2-0.4 (barely beating the level of chance agreement two monkeys could achieve throwing darts at a diagnostic board). This dramatic departure from the much higher standards of previous DSM’s is a sure tip-off that many DSM 5 proposals must be failing to achieve adequate diagnostic agreement in the much delayed and yet to be reported field trials. Unable to meet expected standards, the DSM 5 Task Force is drastically and desperately trying to lower our expectations…”

“…The wise, safe, and responsible thing for APA to do now is to delay publication of DSM 5 until the missing second stage of rewriting and retesting can be completed. The wordings that do poorly in the first stage of field testing should be rewritten to finally attain the clarity and consistency necessary in an official manual of psychiatric diagnosis. The newly revised (and hopefully final) versions should then undergo the second stage of field testing as originally envisaged to ensure that they now work…”

“…Will APA do what is needed to protect us from a poor quality DSM 5 and instead provide us with one that is safe and scientifically sound? It seems unlikely. The DSM 5 publishing profits that are essential to APA budget projections require there be a May 2013 debut of the manual in bookstores, come hell or high water. So instead of getting DSM 5 up to minimal standards of quality, DSM 5 is trying to drop the standards to minimal – 0.2-0.4 will have to do.

“What about the DSM 5 claim that its field trials so rigorous that we should entertain only the lowest possible expectations of them? This is nonsense. The DSM 5 field trials were in fact conducted under very privileged circumstances that would guarantee much higher levels of reliability than could ever be achieved in everyday clinical practice: 1) Testing was performed in academic centers with a homogeneous corps of well trained raters interested in psychiatric diagnosis and trying their best because judgments were being observed; 2) Raters had access to the results of a computerized self report instrument, thus reducing information variance; 3) Each site specialized in a limited number of target diagnoses that were known to the raters who would therefore be on the watch for them; 4) The unrealistically high prevalences of target disorders in the sites made agreement much easier than the more needle-in-haystack situation of routine practice; 5) Academic settings attract a selected group of the more severely ill patients who are easier to diagnose reliably; and 6) The time allotted for diagnostic interviews exceeded what is typical in clinical practice…”

“…The May 2013 publication date appears to be completely unrealistic unless we are to settle for a DSM 5 so poorly done that its reliabilities will return us to the dark ages of DSM II. DSM 5 is in a very deep hole with very few remaining options.

“My recommendations: 1) Make the publication date flexible and contingent on delivery of a quality product that the field can trust; 2) Subject the current drafts and texts to extensive editing for clarity and consistency; 3) Drop the controversial suggestions that risk harmful unintended consequences or at least subject them to external scientific review; 4) Have the rewritten drafts reviewed word for word by many experts in the clinical, research, and forensic uses of DSM 5; and 5) Field test again to make sure the new versions work adequately…”

Full commentary here on DSM5 in Distress

 

On Monday, William E. Narrow, MD, in a Q & A for Pittsburgh Post Gazette:

William E. Narrow, M.D., M.P.H., is Associate Director, Division of Research, Research Director, DSM-5 Task Force for American Psychiatric Association

Q&A with Dr. William Narrow, research director for the DSM 5 Task Force

William Narrow | January 30, 2012

The Pittsburgh Post-Gazette asked the American Psychiatric Association to comment on the DSM 5:

Q: Do you think the final form of the DSM-V will differ substantially from the current draft version?

A: There is currently no draft version of DSM-5. The information on the DSM-5 Web site consists of proposed DSM-5 diagnostic criteria and assessment instruments, along with rationales for all changes that have been proposed. The first draft version of the DSM-5, which also includes explanatory text for each disorder and introductory chapters, is currently being developed. We anticipate that many of the proposed changes will be officially adopted. Most notable among these is the proposed change in chapter organization to better reflected a developmental, lifespan approach as well as purported neuroscientific and genetic linkages between diagnostic categories (e.g., placement of the psychosis chapter alongside the bipolar disorders chapter, then followed by the mood disorders chapter). We also anticipate that the proposed inclusion of dimensional assessments will be accepted for DSM-5, although these too were field tested and results are currently being examined. Proposed changes that are considered minimal (e.g., minor changes in wording or criteria) that did not require field testing and, at this point, appear to be sufficiently supported by findings from the literature have a high likelihood of being adopted.

Read the rest of Dr Narrow’s responses here

 

From January 6, John M. Oldham, M.D., President, American Psychiatric Association comments on the APA’s December Board of Trustees meeting, in Psychiatric News:

Psychiatric News | January 06, 2012
Volume 47 Number 1 page 4-6
© American Psychiatric Association

From the President

Your Board’s Agenda Focuses on the Future

John M. Oldham, M.D.

At the  foot of Dr Oldham’s Board meeting commentary you will find a link for a collection of PDF files of meeting materials available to download as a “Board packet”. (This bundle of PDFs may take a while to load.)

See file 11 Item 11.A – DSM Task Force Report.pdf   Retrieved: 01.31.12

Item: 11.A
Board of Trustees
December 2011

DSM-5 TASK FORCE AND WORK GROUP UPDATE

APA Division of Research Report to the APA Board of Trustees
Submitted by: David J. Kupfer, M.D. and Darrel A. Regier, M.D., M.P.H.

———–

This report contains:

An overview of DSM-5 text development activities;
Current progress and timeline for the DSM field trials;
Scientific Oversight Committee’s (SOC) current progress and timeline for DSM field trials;
Scientific Oversight Committee’s progress in reviewing proposed DSM-5 disorders;
Overview of a Clinical and Public Health (CPH) review process that is to take place in conjunction with the Scientific Oversight Committee’s review;
Plans for the remainder of 2011 and for 2012.

Under Plans for 2012 it reports:

That the primary focus for 2012 will be on completion of initial draft text for all proposed DSM-5 disorders and data analysis of information gathered from the Large Academic Site and the Routine Clinical Practice (RCP) Field Trials.

That all of the text will receive editorial review throughout December and January.

That a penultimate draft of DSM-5 will be presented to the DSM-5 Task Force for their recommendations by February 1, though portions, it says, will be provided beginning in December, as these become available.

That the SOC and CPH will continue to conduct reviews through Spring of 2012.

That DSM criteria and text will continue to undergo changes based on reviews and recommendations of these various parties as well on comments received from a third public posting of the DSM-5 criteria on the DSM5.org web site, slated for May, 2012.

That the final draft of DSM-5 will be submitted to the APA Assembly and to the Board of Trustees in Fall of 2012 and submitted to APPI press for publication by December 31.

This report provides further confirmation that in December, it was anticipated that the third and final public review of proposals for changes to DSM-IV categories and criteria would be held in May, this year. (Note that the DSM-5 Development website Timeline was updated a few days ago but gives, only vaguely, “Spring”, as the date for a two month public review and comment period).

 

On January 29, Gary Greenberg, author of Inside the Battle to Define Mental Illness, Wired, December 2010, for NYT Op-Ed:

Op-Ed Contributor

Not Diseases, but Categories of Suffering

Gary Greenberg | January 29, 2012

“…On the other hand, given that the current edition of the D.S.M. has earned the association — which holds and tightly guards its naming rights to our pain — more than $100 million, we might want to temper our sympathy. It may not be dancing at the ball, but once every mental health worker, psychology student and forensic lawyer in the country buys the new book, it will be laughing all the way to the bank…”

The Autism Society and Autistic Self Advocacy Network have put out a joint statement on DSM-5:

“The Autism Society and Autistic Self Advocacy Network encourage other organizations and groups to join with us in forming a national coalition aimed at working on issues related to definition of the autism spectrum within the DSM-5.”

The joint statement by the Autistic Self Advocacy Network and the Autism Society of America on the DSM-5 can be read here

 

Benjamin Nugent, Op-Ed piece, NYT:

New York Times

Op-Ed Contributor

I Had Asperger Syndrome. Briefly.

Benjamin Nugent | January 31, 2012

FOR a brief, heady period in the history of autism spectrum diagnosis, in the late ’90s, I had Asperger syndrome…”

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