American Psychiatric Association launches new pages for DSM-5 – DSM-5 to cost $199

American Psychiatric Association (APA) launches new pages for DSM-5 – DSM-5 to cost $199

Post #220 Shortlink:

Unless you’ve had your head stuck in a bucket this last three years, you’ll be aware that the next edition of the American Psychiatric Association’s diagnostic manual is slated for release this May.

APA has spent $25 million on the development of DSM-5.

DSM-5 will be published by American Psychiatric Publishing Inc. and planned for release at the APA’s 166th Annual Meeting in San Francisco (May 18-22).

A hardback copy is going to set you back $199, though paid up members of the American Psychiatric Association are being offered a discount.

Psychiatrists, psychologists, primary health care physicians, therapists, counselors, social workers and allied health professionals don’t have to use DSM-5.

Instead, when codes are required they can use the codes in Chapter 5 of ICD-9-CM (Mental Disorders) and Chapter 5 of ICD-10-CM (Mental, Behavioral and Neurodevelopmental disorders), when ICD-10-CM is implemented*.

*Effective implementation date for ICD-10-CM (and ICD-10-PCS) is currently October 1, 2014. Until that time the codes in ICD-10-CM are not valid for any purpose or use.

Image Copyright Dx Revision Watch 2013

Don’t like it? Don’t use it. Use ICD codes instead.

Since 2003, ICD-9-CM diagnostic codes have been mandated for third-party billing and reporting by HIPAA for all electronic transactions for billing and reimbursement. The codes in DSM are crosswalked to ICD codes.

So you can use ICD-9-CM codes.

And when ICD-10-CM is implemented, it isn’t going to cost you a cent – it will be freely available on the internet.

The ICD-10-CM draft, currently subject to partial code freeze, and its associated documentation can be accessed here on the CDC site; so you can already have a poke around:

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)

On January 23, Allen Frances, MD, who had oversight of the Task Force that developed DSM-IV had this to say about the $199 manual:

Price Gouging: Why Will DSM-5 Cost $199 a Copy?


APA launches new pages for DSM-5

Last week the APA launched new pages to promote DSM-5.

Report by John Gever for 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…

PR piece by Mark Moran for Psychiatric News, organ of the American Psychiatric Association:

Psychiatric News | January 18, 2013
Volume 48 Number 2 page 1-6
American Psychiatric Association
Professional News

Continuity and Changes Mark New Text of DSM-5

Mark Moran

The DSM-5 Task Force chair discusses conceptual themes driving changes to the new manual. This is the first in a series continuing through May that will summarize the diagnostic and organizational differences between DSM-IV and DSM-5.

DSM-5, approved by the APA Board of Trustees in December, reflects the “state of the clinical science” in psychiatric diagnosis, incorporating important findings from genetic, neurobiological, and treatment research, while also maintaining substantial continuity for maximum clinical utility…

Go here for the DSM-5 Collection.

Psychiatric News Alert, where those not intending to boycott DSM-5 are encouraged to explore and pre-order a copy ($199):

Psychiatric News Alert

Tuesday, January 22, 2013

New DSM-5 Series Includes Supplementary Information; Order Your Manual Now!

The new DSM-5 pages can be found here, with articles, fact sheets and videos:

Documents include:

DSM-5 Table of Contents  [Lists disorder sections and the categories that sit under them.]

Changes to DSM-5

Continuity and Changes Mark New Text of DSM-5, Psychiatric News, January 18, 2013

Highlights of Changes from DSM-IV-TR to DSM-5
DSM-5 Provides New Take on Developmental Disorders, Psychiatric News, January 18, 2013

DSM-5 Fact Sheets

From Planning to Publication: Developing DSM-5
The People Behind DSM-5
The Organization of DSM-5

Making a Case for New Disorders
Autism Spectrum Disorder
Specific Learning Disorder
Intellectual Disability
Social Communication Disorder
Attention-Deficit/Hyperactivity Disorder

DSM-5 Video Series

How and why was DSM-5 developed?
What has been the goal for revising DSM-5?

What are the changes to autism spectrum disorder in DSM-5?
What will be the impact of DSM-5 changes to autism spectrum disorder?
What are the changes to learning disorder in DSM-5?
What will be the impact of the revised specific learning disorder diagnosis?

The APA’s DSM-5 Development site can still be found here DSM-5 Development.

Proposals for changes to DSM-IV categories and criteria, as they had stood at the third draft, were frozen on June 15, 2012.

Any revisions made to criteria sets following closure of the third and final comment period are subject to embargo and the DSM-5 Development site has not been updated to reflect changes made to categories and criteria beyond June 15.

The entire third draft of proposals was removed from the DSM-5 Development site on November 15.

You can read APA’s rationale for removing the draft on an updated Permissions, Licensing & Reprints page.


Media coverage: Open Letter and Petition to DSM-5 Task Force by Society for Humanistic Psychology

Round up 1: Media coverage: Open Letter and Petition to DSM-5 Task Force by Society for Humanistic Psychology

Post #108 Shortlink:

An Open Letter and Petition sponsored by a coalition of several Divisions of the American Psychological Association has attracted nearly 7000 signatures since its launch on October 22.

The Petition sponsors are inviting mental health professionals and mental health organizations to sign up in support of an Open Letter to the American Psychiatric Association’s DSM-5 Development Task Force.

The Open Letter, which is highly critical of proposals for the revision of DSM-IV by American Psychiatric Association DSM-5 Work Groups, is sponsored by the Society for Humanistic Psychology (Division 32 of the American Psychological Association) in alliance with the following:

Open Letter and Petition Sponsors

Division of Behavioral Neuroscience and Comparative Psychology (Division 6 of APA)
Division of Developmental Psychology (Division 7 of APA)
Society of Counseling Psychology (Division 17 of APA)
Society for Community Research and Action: Division of Community Psychology (Division 27 of APA)
Division of Psychotherapy (Division 29 of APA)
Society for the Psychology of Women (Division 35 of APA)
Division of Psychoanalysis (Division 39 of APA)
Psychoanalysis for Social Responsibility (Section IX of Division 39 of APA)
Psychologists in Independent Practice (Division 42 of APA)
Society for the Psychological Study of Lesbian, Gay, Bisexual, and Transgender Issues (Division 44 of APA)
Society for Group Psychology and Psychotherapy (Division 49 of APA)
Society for the Psychological Study of Men & Masculinity (Division 51 of APA)

Association for Counselor Education and Supervision (Division of the American Counseling Association)
Association for Humanistic Counseling (Division of the American Counseling Association)
The Association for Creativity in Counseling (ACC, Division of the American Counseling Association)
The Association for Women in Psychology,
The Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling (ALGBTIC)
Society of Indian Psychologists
National Latina/o Psychological Association
The Society for Personality Assessment,
The Society for Descriptive Psychology,
The UK Council for Psychotherapy (UKCP),
The Constructivist Psychology Network (CPN),
The Taos Institute
Psychoanalysis for Social Responsibility (Section IX of Division 39 of APA)

[See Coalition for DSM-5 Reform website for most recent list of official endorsers.]

For a copy of the coalition’s letter see previous Post #97 or go here iPetitions DSM-5

Media coverage is being collated below as it comes to my attention.


Media coverage

[See Coalition for DSM-5 Reform Tab page on Dx Revision Watch website for most recent media coverage.]



Expanding catalog of mental disorders worries some

Maiken Scott | November 16, 2011

The so-called bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, is getting a make-over. The latest version, DSM 5, will come out in 2013. In the meantime, conflicts over which diagnoses should be added, removed or changed are heating up.

Thousands of mental health professionals who are not happy with the direction of the new DSM are signing an online petition…

Read full article


Irish Medical Times

Pat Kelly is Web Editor and Sub Editor at Irish Medical Times

DSM-V revisions may ‘stigmatise eccentric people’

Pat Kelly | November 15, 2011

Read full article


American Counseling Association

ACA blogs, written by counselors, for counselors

Paul R. Peluso is a counselor and Associate Professor in the Department of Counselor Education at Florida Atlantic University

A Letter to my Colleagues on the DSM-5

Paul Peluso | November 15, 2011

When I read the response to the criticisms offered by Dr. Darrel A. Regier, vice-chair of the DSM-5 task force that the DSM is “a set of scientific hypotheses that are intended to be tested” I became deeply concerned. My first thought was: “When I go to my physician, I don’t want her to have a hypothesized diagnosis that she is going to test on me, I want her to know what is wrong and how to fix it!” And while Dr. Regier’s comment (and a subsequent one that he “hoped” that there would be regular updates to DSM 5, like software) might have been meant to ameliorate the criticism against DSM-5, the reality is that once it is published they will go from being “editable hypotheses” to “diagnostic canon” that insurance companies, government agencies, and courts will all hold clinicians to (to say nothing of the pharmaceutical industry), which will have serious consequences for the entire field. The problem is that the process and its proposed remedy fails to take into consideration the criticisms against it: namely, that it has been based on VERY shaky science (if any at all).

This should concern us all.

Read full commentary


Russell Friedman is Executive Director of The Grief Recovery Institute, and co-author of The Grief Recovery Handbook, When Children Grieve, and Moving On.

Psychology Today

Broken Hearts

Exploring myths and truths about grief, loss, and recovery.
by Russell Friedman

Speaking out on behalf of millions of unsuspecting grievers

From Travesty to Potential Tragedy

Russell Friedman | November 4, 2011

The intent of this blog post is to encourage you to read and sign a petition titled, Open Letter to the DSM-5. We are particularly focused on the proposed change in the bereavement exclusion which is one of the major protests in the petition. You can skip the blog and go directly to the petition:

The Dangerous DSM-5 Bereavement Exclusion Train Must Be Derailed BEFORE It Causes Permanent Harm To Unsuspecting Grievers

We are: John W. James and Russell Friedman, co-founders of The Grief Recovery Institute Educational Foundation, and co-creators of The Grief Recovery Method®. We are also co-authors of The Grief Recovery Handbook and When Children Grieve [both published by HarperCollins] and Moving On [M. Evans].

Read full commentary


Labor Related blog

David Foley’s Labor and Employment Law Blog

Furor Over DSM-V

David Foley | November 12, 2011


DSM5 in Distress

The DSM’s impact on mental health practice and research.

DSM 5- ‘Living Document’ or ‘Dead on Arrival: ‘untested ‘scientific hypotheses’ must be dropped

Allen J. Frances, MD | November 11, 2011

News flash From Medscape Medical News—“APA Answers DSM-5 Critics”—a defense of DSM-5 offered by Darrel A. Regier, MD, vice-chair of the DSM-5 Task Force. Wonderful news that the American Psychiatric Association (APA) is attempting to address the fact that DSM-5 alarms many of its potential users—it is long past time for an open dialog.

Unfortunately, however, Dr Regier dodges the concerns that must be addressed if DSM-5 is to become a safe and credible document. Five simple questions were previously posed to APA with a request for straight answers…

Read full commentary

also at

Psychiatric Times

(Registration for Psychiatric Times site required)

DSM-5: Living Document or Dead on Arrival

Allen J. Frances, MD | November 11, 2011

Read full commentary   


DSM5 in Distress

The DSM’s impact on mental health practice and research.

The User’s Revolt Against DSM 5
will it work?

Allen J. Frances, MD | November 10, 2011

When it comes to DSM 5, experience has proven conclusively that the American Psychiatric Association (APA) will not attend to the science, evaluate the risks, or listen to reason. A user’s revolt has become the last and only hope for derailing the worst of the DSM 5 suggestions…

…Will the petition work?

Read full commentary


USA Today

Psychologists challenge proposed new diagnoses in DSM-5

Rita Rubin, Special for USA TODAY | November 10, 2011



The New Mental Health Disorders Manual Is Driving Psychologists Nuts

Forbes | November 10, 2011

The new manual of mental disorders coins bizarre new psychological disorders, lowers the threshold for diagnosing old ones, and has some critics pulling their hair out…


Psychology Today

DSM-5 in Distress

APA Responds Lamely to the Petition to Reform DSM 5
How about straight answers to simple questions?

Allen J. Frances, MD | November 8, 2011


Registration is required in order to view Medscape article

Medscape Medical News > Psychiatry

APA Answers DSM-5 Critics

Deborah Brauser | November 9, 2011


Before you take that pill

New Questionable Diagnoses on the Horizon from the DSM-5 Committee

Doug Bremner | November 8, 2011


The Great DSM-5 Personality Bazaar

James Phillips, MD | November 7, 2011

Evaluating the evaluation

There is something quite elegant about the DSM-5 Personality Disorders diagnostic system—an architectonic of divisions, subdivisions, and sub-subdivisions. On the other hand, for all their scholastic erudition, the work group have created a monster—a bloated, pedantic, cumbersome diagnostic instrument that will never be used by anyone working in the hurly-burly of clinical practice. Just imagine doing a routine new-patient evaluation and trying to include the personality disorder assessment, each of the first two criteria with its many-item scale, each item to be scored on a 4- or 5-point rating system. It’s hard to imagine anyone having the patience or motivation to use this instrument.”

Read full article


Registration is required in order to view Medscape article

Medscape Medical News > Psychiatry

Petition Calls for Critical Changes to Upcoming DSM-5

Group Says It Has ‘Serious Reservations’ About Lowering Diagnostic Thresholds

Deborah Brauser | November 4, 2011

November 4, 2011 — Divisions of the American Psychological Association have created an online petition addressing “serious reservations” about the upcoming Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Launched October 22, the petition has already garnered more than 3000 signatures from mental health professionals, students, and organizations.


Psychology Today

DSM-5 in Distress

The DSM’s impact on mental health practice and research.

Why Psychiatrists Should Sign the Petition to Reform DSM 5 the fight for the future of psychiatry

Allen J. Frances, MD | November 4, 2011

Psychiatrists may be more reluctant than are other mental health clinicians to sign a petition questioning the safety and value of DSM 5. After all, it is the American Psychiatric Association that is sponsoring DSM 5 and there is a natural tendency to want to trust the wisdom of one’s own Association. We also tend to feel the greatest loyalty to our profession when it seems to be under sharp attack from without.

All this is completely understandable to me. I have not felt the least bit comfortable assuming the role fate assigned me as critic of DSM 5 and of the APA. It was a case of responsibility calling and my feeling compelled to answer. If DSM 5 were not proposing some really dangerous changes, I would have stayed comfortably on the sidelines. But I think DSM 5 is too risky to ignore and that all psychiatrists should feel the same call that I did to restrain it before it is too late.

Read full commentary

also on Psychiatric Times (Registration for Psychiatric Times site required)

Why Psychiatrists Should Sign the Petition to Reform DSM 5

Allen J. Frances, MD | November 4, 2011


More from Allen J Frances, MD

DSM5 in Distress

The DSM’s impact on mental health practice and research.

by Allen Frances, M.D.

Why Doesn’t DSM 5 Defend Itself?

Perhaps because no defense is possible

Allen J. Frances, MD | November 3, 2011


Nature News

Mental-health guide accused of overreach

Dispute grows over revisions to diagnostic handbook.

Heidi Ledford | Published online November, 2 2011

Nature 479, 14 (2011) | doi:10.1038/479014a

Corrected online: 3 November 2011

Psychologist David Elkins had modest ambitions for his petition. He and his colleagues were worried that proposed changes to an influential handbook of mental disorders could classify normal behaviours as psychological conditions, potentially leading to inappropriate treatments. So they laid out their concerns in an open letter, co-sponsored by five divisions of the American Psychological Association in Washington DC. “I thought, ‘Well, maybe we’ll get a couple or maybe 30 signatures’,” says Elkins, an emeritus professor at Pepperdine University in Malibu, California.

But the letter, posted online on 22 October (, touched a nerve. Within 10 days more than 2,800 people had signed it, many identifying themselves as mental-health professionals…

Read full article


Psychology Today Do the Right Thing

Thomas Plante, Ph.D., ABPP, is Professor of Psychology and Director of the Spirituality and Health Institute at Santa Clara University

All the Fuss with DSM-5: The Ethics of the Psychiatric Bible Is DSM5 sacred scripture?

Thomas G. Plante, Ph.D | November 1, 2011

There has been a great deal of controversy already about DSM5 and it isn’t scheduled to be published until May 2013! So, what’s up with that?

You may have heard of some of the controversy surrounding the new edition of the DSM, the “psychiatric bible,” published periodically by the American Psychiatric Association. It is the “go to” document that defines all mental health disorders and is used for diagnosis, treatment approaches, and perhaps most especially, for insurance coverage and reimbursement for professional psychiatric services. If you are a mental health professional or a patient of a mental health professional, this is an important document…

Read full commentary


A sixth commentary from Allen J Frances 

(Registration for Psychiatric Times site required)

Psychiatric Times

DSM-5 Will Not Be Credible Without An Independent Scientific Review

Allen J Frances, MD | November 2, 2011

After all this controversy and opposition, there is one thing (and one thing only) that will save the credibility of DSM-5 and guarantee its safety – a credible process of external scientific review. APA is conducting its own internal scientific review, but it strikes out badly on all 4 requirements that must be met before a review deserves to be taken seriously as a trustworthy stamp of approval…

Read full text


A fifth commentary from Allen J Frances 

Psychology Today


DSM5 in Distress

The DSM’s impact on mental health practice and research.

Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine

DSM 5 Against Everyone Else Its Research Types Just Don’t Understand The Clinical World

Allen J Frances, MD | DSM5 in Distress | November 1, 2011

also at

Psychiatric Times

(Registration for Psychiatric Times site required)

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

Allen J Frances, MD  | November 1, 2011


Psychology Today


Side Effects

From quirky to serious, trends in psychology and psychiatry.

by Christopher Lane, Ph.D.

Saving Psychiatry from Itself: The DSM-5 Controversy Heats Up Again

Why an Open Letter to the DSM-5 task force is generating widespread interest

Christopher Lane, PhD | October 31, 2011

Last weekend, without any fanfare or publicity, the Society for Humanistic Psychology, a division of the American Psychological Association, posted an open letter to the DSM-5 task force listing in precise, scholarly detail its many concerns about the edition’s working assumptions, procedures, and recommendations. Three other APA Divisions supported the move, which also was endorsed by the Association for Women in Psychology, the Society for Descriptive Psychology, and the UK Council for Psychotherapy (UKCP).

In the space of just a week, the open letter has caught fire…

Read full commentary


A fourth commentary from Allen J Frances 

Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine

Psychology Today

What Would A Useful DSM 5 Look Like? And An Update On The Petition Drive

Allen J Frances, MD | DSM5 in Distress | October 31, 2011

The petition to reform DSM 5 continues to gain momentum. After just one week, more than 2000 people have expressed their disapproval of the DSM 5 proposals and their desire to see dramatic changes. You can join them at

Read full commentary


The Constructivist Psychology Network | October 30, 2011

CPN Supports DSM-5 Petition 

The Constructivist Psychology Network has signed a petition supporting an open letter by psychologists to the DSM-5 task force. The open letter objects to many of the proposed revisions being considered by the for inclusion in its forthcoming DSM-5.

Read full statement


Psychology Today

Rethinking Depression

How to shed mental health labels and create personal meaning

by Eric Maisel, Ph.D. | October 28, 2011

The DSM-5 Controversy


The UK Council for Psychotherapy (UKCP)

UKCP signs an online petition about DSM-5 | October 26, 2011

UKCP has signed an online petition which expresses serious reservations about the proposed content of the future DSM-5. In the latest issue of The Psychotherapist (issue 49, autumn 2011), Tom Warnecke explains the controversy surrounding the forthcoming fifth edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders)…

Read full text

PDF The Psychotherapist (issue 49, autumn 2011) , Page 24, Mass psychosis or the brave new world of DSM-5: Tom Warnecke


A second blog from Karen Franklin

Forensic Psychologist

Karen Franklin Ph.D. | October 27, 2011

DSM-5 petition takes off like wildfire

Karen Franklin, Ph.D. is a forensic psychologist and adjunct professor at Alliant University in Northern California.


A second commentary  from Allen J Frances 

Psychiatric Times

DSM-5 Blog

Petition Against DSM-5 Gets Off To Racing Start: A Game Changer?

By Allen J Frances, MD | October 26, 2011

Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine

(Registration for Psychiatric Times site required)

also at Psychology Today | October 27, 2011

The Petition Against DSM 5 Gets Off To Fast Start

Could It Be A Game Changer


Counseling Today

Psychologists circulate petition against DSM-5 revisions

CT Daily | October 24, 2011

Heather Rudow


Britsh Psychological Society (BPS)

Psychologists petition against DSM-5 | October 25, 2011


Psychology Today

DSM-5 in Distress

Dr Allen Frances

Psychologists Petition Against DSM-5: Users Revolt Should Capture APA Attention

By Allen J Frances, MD | October 24, 2011

Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine

also (with registered access) same text at Psychiatric Times 


Forensic Psychologist

Karen Franklin, Ph.D. | October 23, 2011

Psychology coalition urges rethinking of DSM-5 expansions

Karen Franklin, Ph.D. is a forensic psychologist and adjunct professor at Alliant University in Northern California.

Dr Franklin also blogs at Psychology Today Witness, A blog about forensic psychology

Open Letter and Petition to DSM-5 Task Force by Society for Humanistic Psychology (Division 32 of the American Psychological Association)

Open Letter and Petition to DSM-5 Task Force by Society for Humanistic Psychology (Division 32 of the American Psychological Association)

Post #107 Shortlink:

Update @ January 11, 2012: The third and final draft of proposals for changes to DSM-IV categories and criteria is delayed because field trials and evaluations are running behind schedule and extended to March. The final draft is now expected to be released for public review and comment, “no later than May 2012”, according to DSM-5 Task Force Vice-chair, Darrel Regier, MD [1].

Third review of DSM-5 draft proposals on the horizon

This time last year, folk were mailing me saying – I don’t know why you bother continuing to monitor DSM-5 and ICD-11, XMRV is going to render the DSM-5 proposals meaningless.

Well that was then, and this is now. And in a couple of months’ time we’ll be anticipating the third and final public review and feedback on the APA’s draft proposals for changes to categories and criteria for the revision of DSM-IV.

During the first stakeholder feedback exercise, over 8,600 comments rolled in; during the second comment period (which was extended by an additional four weeks), the Task Force and work groups received over 2000 submissions.

According to the current DSM-5 Timeline:

September-November 2011: Work groups will be provided with results from both field trials and will update their draft criteria as needed. Field trial results and revised proposals will be reviewed at the November Task Force meeting.

January-February 2012: Revised draft diagnostic criteria will be posted on and open to a third public feedback period for two months. Feedback will be shared directly with work group members, and further edits to proposals will be made as needed.” [1]

According to the DSM-5 Development home page:

“…Following analysis of field trial results, we will revise the proposed criteria as needed and, after appropriate review and approval, we will post these changes on this Web site. At that time, we will again open the site to a third round of comments from visitors, which will be systematically reviewed by each of the work groups for consideration of additional changes. Thus, the current commenting period is not the final opportunity for you to submit feedback, and subsequent revisions to DSM-5 proposals will be jointly informed by field trial findings as well as public commentary…” [2]

Assuming the APA’s schedule remains on target, US and international patient organizations and advocates need to start preparing well in advance of the New Year for how best to engage our own medical and allied professionals in this process and encourage their input.

As soon as DSM-5 Draft 3 is posted on the DSM-5 Development site, I shall put out alerts on my websites, via Co-Cure and on other platforms and I shall be contacting UK patient organizations, as I have done for the previous two public review exercises.

But I hope that other advocates and groups, in the US and internationally, will work to take this forward and ensure that as many international patient organizations, ME and CFS clinicians and researchers, like those who collaborated on the new ME International Consensus Criteria, allied health professionals, medical lawyers, social workers and other end uses of the DSM are made aware of the proposals of the “Somatic Symptom Disorders” Work Group and the implications for ME, CFS, FM, IBS, CI, CS and GWS patient groups, and encouraged to submit comments as professional stakeholders.


Open Letter and Petition to DSM-5 Task Force

Today I was alerted to an Open Letter and Petition sponsored by the Society for Humanistic Psychology, Division 32 of the American Psychological Association, in alliance with the Society for Community Research and Action: Division of Community Psychology (Division 27 of APA) and the Society for Group Psychology and Psychotherapy (Division 49 of APA) [3]. (No press release, but I’ll update if one is issued.)

These American Psychological Association Divisions are inviting mental health professionals and mental health organizations to sign up in support of an open letter to the American Psychiatric Association’s DSM-5 Task Force.

Their response to DSM-5 structure and proposals may be of interest to psychiatrists and psychologists affiliated to, or on the boards of our own ME and CFS patient organizations.

The Open Letter to the DSM-5 Task Force can be read here and a copy is appended:

Under the subheading “New Emphasis on Medico-Physiological Theory”, the Open Letter sponsors comment on some aspects of the DSM-5 proposals for the “Somatic Symptom Disorders” categories. The Open Letter also supports concerns set out within the formal response to DSM-5 draft proposals submitted by the British Psychological Society, earlier this year, and more recent concerns published by the American Counseling Association.

A couple of points: both the American Psychological Association, three of whose Divisions are sponsors of this Open Letter, and the American Psychiatric Association use the acronym “APA”. It is the American Psychiatric Association’s DSM-5 Task Force that is developing the DSM-5.

Secondly, although the first release of the DSM-5 draft proposals did have the diagnosis “Factitious Disorder” placed under “Somatic Symptom Disorders (SSDs)”, the most recent (May 2011) DSM-5 draft proposes placing “Factitious Disorder” under the diagnostic chapter “Other Disorders”, not within the SSDs, as the Open Letter, below, states [4], [5].

Suzy Chapman

[1] DSM-5 Development Timeline:

[2] DSM Development website:

[3] Society for Humanistic Psychology:

[4] DSM-5 Draft Proposals, Somatic Symptom Disorders:

[5] DSM-5 Draft Proposals, Other Disorders:

The Open Letter and Petition can be read here:

There’s also a copy on the blog of  Society for Humanistic Psychology


Society for Humanistic Psychology, Division 32 of the American Psychological Association, in alliance with Society for Community Research and Action: Division of Community Psychology (Division 27 of APA) and Society for Group Psychology and Psychotherapy (Division 49 of APA). We invite mental health professionals and mental health organizations to sign on in support of this petition to the DSM5 Task Force of the American Psychiatric Association

To the DSM-5 Task Force and the American Psychiatric Association:

As you are aware, the DSM is a central component of the research, education, and practice of most licensed psychologists in the United States. Psychologists are not only consumers and utilizers of the manual, but we are also producers of seminal research on DSM-defined disorder categories and their empirical correlates. Practicing psychologists in both private and public service utilize the DSM to conceptualize, communicate, and support their clinical work.

For these reasons, we believe that the development and revision of DSM diagnoses should include the contribution of psychologists, not only as select individuals on a committee, but as a professional community. We have therefore decided to offer the below response to DSM-5 development. This document was composed in recognition of, and with sensitivity to, the longstanding and congenial relationship between American psychologists and our psychiatrist colleagues.


Though we admire various efforts of the DSM-5 Task Force, especially efforts to update the manual according to new empirical research, we have substantial reservations about a number of the proposed changes that are presented on As we will detail below, we are concerned about the lowering of diagnostic thresholds for multiple disorder categories, about the introduction of disorders that may lead to inappropriate medical treatment of vulnerable populations, and about specific proposals that appear to lack empirical grounding. In addition, we question proposed changes to the definition(s) of mental disorder that deemphasize sociocultural variation while placing more emphasis on biological theory. In light of the growing empirical evidence that neurobiology does not fully account for the emergence of mental distress, as well as new longitudinal studies revealing long-term hazards of standard neurobiological (psychotropic) treatment, we believe that these changes pose substantial risks to patients/clients, practitioners, and the mental health professions in general.

Given the changes currently taking place in the profession and science of psychiatry, as well as the developing empirical landscape from which psychiatric knowledge is drawn, we believe that it is important to make our opinions known at this particular historical moment. As stated at the conclusion of this letter, we believe that it is time for psychiatry and psychology collaboratively to explore the possibility of developing an alternative approach to the conceptualization of emotional distress. We believe that the risks posed by DSM-5, as outlined below, only highlight the need for a descriptive and empirical approach that is unencumbered by previous deductive and theoretical models.

In more detail, our response to DSM-5 is as follows:

Advances Made by the DSM-5 Task Force

We applaud certain efforts of the DSM-5 Task Force, most notably efforts to resolve the widening gap between the current manual and the growing body of scientific knowledge on psychological distress. In particular, we appreciate the efforts of the Task Force to address limitations to the validity of the current categorical system, including the high rates of comorbidity and Not Otherwise Specified (NOS) diagnoses, as well as the taxonomic failure to establish ‘zones of rarity’ between purported disorder entities (Kendell & Jablensky, 2003). We agree with the APA/DSM-5 Task Force statement that, from a systemic perspective,

The DSM-III categorical diagnoses with operational criteria were a major advance for our field, but they are now holding us back because the system has not kept up with current thinking. Clinicians complain that the current DSM-IV system poorly reflects the clinical realities of their patients. Researchers are skeptical that the existing DSM categories represent a valid basis for scientific investigations, and accumulating evidence supports this skepticism. (Schatzberg, Scully, Kupfer, & Regier, 2009)

As researchers and clinicians, we appreciate the attempt to address these problems. However, we have serious reservations about the proposed means for doing so. Again, we are concerned about the potential consequences of the new manual for patients and consumers; for psychiatrists, psychologists, and other practitioners; and for forensics, health insurance practice, and public policy. Our specific reservations are as follows:

Lowering of Diagnostic Thresholds

The proposal to lower diagnostic thresholds is scientifically premature and holds numerous risks. Diagnostic sensitivity is particularly important given the established limitations and side-effects of popular antipsychotic medications. Increasing the number of people who qualify for a diagnosis may lead to excessive medicalization and stigmatization of transitive, even normative distress. As suggested by the Chair of DSM-IV Task Force Allen Frances (2010), among others, the lowering of diagnostic thresholds poses the epidemiological risk of triggering false-positive epidemics.

We are particularly concerned about:

“Attenuated Psychosis Syndrome,” which describes experiences common in the general population, and which was developed from a “risk” concept with strikingly low predictive validity for conversion to full psychosis.

• The proposed removal of Major Depressive Disorder’s bereavement exclusion, which currently prevents the pathologization of grief, a normal life process.

• The reduction in the number of criteria necessary for the diagnosis of Attention Deficit Disorder, a diagnosis that is already subject to epidemiological inflation.

• The reduction in symptomatic duration and the number of necessary criteria for the diagnosis of Generalized Anxiety Disorder.

Though we also have faith in the perspicacity of clinicians, we believe that expertise in clinical decision-making is not ubiquitous amongst practitioners and, more importantly, cannot prevent epidemiological trends that arise from societal and institutional processes. We believe that the protection of society, including the prevention of false epidemics, should be prioritized above nomenclatural exploration.

Vulnerable Populations

We are also gravely concerned about the introduction of disorder categories that risk misuse in particularly vulnerable populations. For example, Mild Neurocognitive Disorder might be diagnosed in elderly with expected cognitive decline, especially in memory functions. Additionally, children and adolescents will be particularly susceptible to receiving a diagnosis of Disruptive Mood Dysregulation Disorder or Attenuated Psychosis Syndrome. Neither of these newly proposed disorders have a solid basis in the clinical research literature, and both may result in treatment with neuroleptics, which, as growing evidence suggests, have particularly dangerous side-effects (see below)—as well as a history of inappropriate prescriptions to vulnerable populations, such as children and the elderly

Sociocultural Variation

The DSM-5 has proposed to change the Definition of a Mental Disorder such that DSM-IV’s Feature E: “Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual,” will instead read “[A mental disorder is a behavioral or psychological syndrome or pattern] [t]hat is not primarily a result of social deviance or conflicts with society.” The latter version fails to explicitly state that deviant behavior and primary conflicts between the individual and society are not mental disorders. Instead, the new proposal focuses on whether mental disorder is a “result” of deviance/social conflicts. Taken literally, DSM-5’s version suggests that mental disorder may be the result of these factors so long as they are not “primarily” the cause. In other words, this change will require the clinician to draw on subjective etiological theory to make a judgment about the cause of presenting problems. It will further require the clinician to make a hierarchical decision about the primacy of these causal factors, which will then (partially) determine whether mental disorder is said to be present. Given lack of consensus as to the “primary” causes of mental distress, this proposed change may result in the labeling of sociopolitical deviance as mental disorder.

Revisions to Existing Disorder Groupings

Several new proposals with little empirical basis also warrant hesitation:

• As mentioned above, Attenuated Psychosis Syndrome and Disruptive Mood Dysregulation Disorder (DMDD) have questionable diagnostic validity, and the research on these purported disorders is relatively recent and sparse.

• The proposed overhaul of the Personality Disorders is perplexing. It appears to be a complex and idiosyncratic combined categorical-dimensional system that is only loosely based on extant scientific research. It is particularly concerning that a member of the Personality Disorders Workgroup has publicly described the proposals as “a disappointing and confusing mixture of innovation and preservation of the status quo that is inconsistent, lacks coherence, is impractical, and, in places, is incompatible with empirical facts” (Livesley, 2010), and that, similarly, Chair of DSM-III Task Force Robert Spitzer has stated that, of all of the problematic proposals, “Probably the most problematic is the revision of personality disorders, where they’ve made major changes; and the changes are not all supported by any empirical basis.”

• The Conditions Proposed by Outside Sources that are under consideration for DSM-5 contain several unsubstantiated and questionable disorder categories. For example, “Apathy Syndrome,” “Internet Addiction Disorder,” and “Parental Alienation Syndrome” have virtually no basis in the empirical literature.

New Emphasis on Medico-Physiological Theory

Advances in neuroscience, genetics, and psychophysiology have greatly enhanced our understanding of psychological distress. The neurobiological revolution has been incredibly useful in conceptualizing the conditions with which we work. Yet, even after “the decade of the brain,” not one biological marker (“biomarker”) can reliably substantiate a DSM diagnostic category. In addition, empirical studies of etiology are often inconclusive, at best pointing to a diathesis-stress model with multiple (and multifactorial) determinants and correlates. Despite this fact, proposed changes to certain DSM-5 disorder categories and to the general definition of mental disorder subtly accentuate biological theory. In the absence of compelling evidence, we are concerned that these reconceptualizations of mental disorder as primarily medical phenomena may have scientific, socioeconomic, and forensic consequences. New emphasis on biological theory can be found in the following DSM-5 proposals:

• The first of DSM-5’s proposed revisions to the Definition of a Mental Disorder transforms DSM-IV’s versatile Criterion D: “A manifestation of a behavioral, psychological, or biological dysfunction in the individual” into a newly collapsed Criterion B: [A behavioral or psychological syndrome] “That reflects an underlying psychobiological dysfunction.” The new definition states that all mental disorders represent underlying biological dysfunction. We believe that there is insufficient empirical evidence for this claim.

• The change in Criterion H under “Other Considerations” for the Definition of a Mental Disorder adds a comparison between medical disorders and mental disorders with no discussion of the differences between the two. Specifically, the qualifying phrase “No definition adequately specifies precise boundaries for the concept of ‘mental disorder” was changed to “No definition perfectly specifies precise boundaries for the concept of either ’medical disorder’ or ‘mental/psychiatric disorder’.” This effectively transforms a statement meant to clarify the conceptual limitations of mental disorder into a statement equating medical and mental phenomena.

• We are puzzled by the proposals to “De-emphasize medically unexplained symptoms” in Somatic Symptom Disorders (SSDs) and to reclassify Factitious Disorder as an SSD. The SSD Workgroup explains: “…because of the implicit mind-body dualism and the unreliability of assessments of ‘medically unexplained symptoms,’ these symptoms are no longer emphasized as core features of many of these disorders.” We do not agree that hypothesizing a medical explanation for these symptoms will resolve the philosophical problem of Cartesian dualism inherent in the concept of “mental illness.” Further, merging the medico-physical with the psychological eradicates the conceptual and historical basis for somatoform phenomena, which are by definition somatic symptoms that are not traceable to known medical conditions. Though such a redefinition may appear to lend these symptoms a solid medico-physiological foundation, we believe that the lack of empirical evidence for this foundation may lead to practitioner confusion, as might the stated comparison between these disorders and research on cancer, cardiovascular, and respiratory diseases.

• The proposed reclassification of Attention Deficit/Hyperactivity Disorder (ADHD) from Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence to the new grouping “Neurodevelopmental Disorders” seems to suggests that that ADHD has a definitive neurological basis. This change, in combination with the proposal to lower the diagnostic threshold for this category as described above, poses high risk of exacerbating the extant over-medicalization and over-diagnosis of this disorder category.

• A recent publication by the Task Force, The Conceptual Evolution of DSM-5 (Regier, Narrow, Kuhl, & Kupfer, 2011), states that the primary goal of DSM-5 is “to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience.” We believe that the primary goal of DSM-5 should be to keep pace with advances in all types of empirical knowledge (e.g., psychological, social, cultural, etc.).

Taken together, these proposed changes seem to depart from DSM’s 30-year “atheoretical” stance in favor of a pathophysiological model. This move appears to overlook growing disenchantment with strict neurobiological theories of mental disorder (e.g., “chemical imbalance” theories such as the dopamine theory of schizophrenia and the serotonin theory of depression), as well as the general failure of the neo-Kraepelinian model for validating psychiatric illness. Or in the words of the Task Force:

“…epidemiological, neurobiological, cross-cultural, and basic behavioral research conducted since DSM-IV has suggested that demonstrating construct validity for many of these strict diagnostic categories (as envisioned most notably by Robins and Guze) will remain an elusive goal” (Kendler, Kupfer, Narrow, Phillips, & Fawcett, 2009, p. 1).

We thus believe that a move towards biological theory directly contradicts evidence that psychopathology, unlike medical pathology, cannot be reduced to pathognomonic physiological signs or even multiple biomarkers. Further, growing evidence suggests that though psychotropic medications do not necessarily correct putative chemical imbalances, they do pose substantial iatrogenic hazards. For example, the increasingly popular neuroleptic (antipsychotic) medications, though helpful for many people in the short term, pose the long-term risks of obesity, diabetes, movement disorders, cognitive decline, worsening of psychotic symptoms, reduction in brain volume, and shortened lifespan (Ho, Andreasen, Ziebell, Pierson, & Magnotta, 2011; Whitaker, 2002, 2010). Indeed, though neurobiology may not fully explain the etiology of DSM-defined disorders, mounting longitudinal evidence suggests that the brain is dramatically altered over the course of psychiatric treatment.


In sum, we have serious reservations about the proposed content of the future DSM-5, as we believe that the new proposals pose the risk of exacerbating longstanding problems with the current system. Many of our reservations, including some of the problems described above, have already been articulated in the formal response to DSM-5 issued by the British Psychological Society (BPS, 2011) and in the email communication of the American Counseling Association (ACA) to Allen Frances (Frances, 2011b).

In light of the above-listed reservations concerning DSM-5’s proposed changes, we hereby voice agreement with BPS that:

• “…clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.”

• “The putative diagnoses presented in DSM-V are clearly based largely on social norms, with ‘symptoms’ that all rely on subjective judgments, with little confirmatory physical ‘signs’ or evidence of biological causation. The criteria are not value-free, but rather reflect current normative social expectations.”

• “… [taxonomic] systems such as this are based on identifying problems as located within individuals. This misses the relational context of problems and the undeniable social causation of many such problems.”

• There is a need for “a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with ‘normal’ experience” and the fact that strongly evidenced causal factors include “psychosocial factors such as poverty, unemployment and trauma.”

• An ideal empirical system for classification would not be based on past theory but rather would “ begin from the bottom up – starting with specific experiences, problems or ‘symptoms’ or ‘complaints’.”

The present DSM-5 development period may provide a unique opportunity to address these dilemmas, especially given the Task Force’s willingness to reconceptualize the general architecture of psychiatric taxonomy. However, we believe that the proposals presented on are more likely to exacerbate rather than mitigate these longstanding problems. We share BPS’s hopes for a more inductive, descriptive approach in the future, and we join BPS in offering participation and guidance in the revision process.


American Psychiatric Association (2011). DSM-5 Development. Retrieved from

British Psychological Society. (2011) Response to the American Psychiatric Association: DSM-5 development.
Retrieved from

Compton, M. T. (2008). Advances in the early detection and prevention of schizophrenia.
Medscape Psychiatry & Mental Health. Retrieved from

Frances, A. (2010). The first draft of DSM-V. BMJ. Retrieved from

Frances, A. (2011a). DSM-5 approves new fad diagnosis for child psychiatry: Antipsychotic use
likely to rise. Psychiatric Times. Retrieved from

Frances, A. (2011b). Who needs DSM-5? A strong warning comes from professional counselors
[Web log message]. Psychology Today. Retrieved from

Hanssen, M., Bak, M., Bijl, R., Vollebergh, W., & van Os, J. (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology, 44, 181-191.

Ho, B-C., Andreasen, N. C., Ziebell, S., Pierson, R., & Magnotta, V. (2011). Long-term antipsychotic treatment and brain volumes. Archives of General Psychiatry, 68, 128-137.

Johns, L. C., & van Os, J. (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21, 1125-1141.

Kendell, R., & Jablensky, A. (2003). Distinguishing between the validity and utility of psychiatric diagnoses. The American Journal of Psychiatry, 160, 4-11.

Kendler, K., Kupfer, D., Narrow, W., Phillips, K., & Fawcett, J. (2009, October 21). Guidelines
for making changes to DSM-V. Retrieved August 30, 2011, from

Livesley, W. J. (2010). Confusion and incoherence in the classification of Personality Disorder: Commentary on the preliminary proposals for DSM-5. Psychological Injury and Law, 3, 304-313.

Moran, M. (2009). DSM-V developers weigh adding psychosis risk. Psychiatric News Online.
Retrieved from

Regier, D. A., Narrow, W. E., Kuhl, E. A., & Kupfer, D. J. (2011). The conceptual evolution of DSM-5. Arlington, VA: American Psychiatric Publishing.

Schatzberg, A. F., Scully, J. H., Kupfer, D. J., & Regier, D. A. (2009). Setting the record straight: A response to Frances commentary on DSM-V. Psychiatric Times, 26. Retrieved from

Whitaker, R. (2002). Mad in America. Cambridge, MA: Basic Books. Also see

Whitaker, R. (2010). Anatomy of an epidemic. New York, NY: Random House.

Allen Frances and Robert Spitzer on DSM-5 Scientific Review Work Group and DSM-5 Field Trials and deadlines

Allen Frances, MD and Robert Spitzer, MD write to the APA Board of Trustess re DSM-5 Scientific Review Work Group; Frances on DSM-5 Field Trials and deadlines

Post #54 Shortlink:

On 10 December 2009, the American Psychiatric Association (APA) issued a news release announcing a revised timeline for the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The anticipated release date for DSM-5 was being shifted from May 2012 to May 2013.

According to the DSM-5 Development Timeline:

[Timeline superceded by revised Timeline]

But field trials are barely underway.

Allen Frances, MD, currently professor emeritus at Duke, had chaired the DSM-IV Task Force. Frances maintains the blog DSM5 in Distress at Pyschology Today and also writes for Psychiatric Times where he’s been documenting and commenting on the development of DSM-5 since June 2009. Robert Spitzer had chaired the DSM-III Task Force.

Links to two recent commentaries by Allen Frances on DSM-5 deadlines and a joint letter by Frances and Spitzer to the APA Board of Trustees in response to the APA’s appointment of a DSM-5 Scientific Review Work Group, below:

DSM5 in Distress

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

Letter To Board Of Trustees of the American Psychiatric Association sent December 6, 2010

Published on December 13, 2010

We are delighted that you have appointed a DSM-5 Scientific Review Work Group and charged it with assessing the quality of evidence supporting the DSM 5 proposals. This is great news, probably the last hope to weed out proposals that could do great harm to the Association, our field, and to our patients. Our relief and hope are tempered only by several problems with the process as you have established it:

CONTINUED SECRECY: Given all of the negative publicity surrounding the DSM-5 confidentiality agreements, we are amazed to see the following statement in the charge to the Scientific Review committee: “Deliberations and reports to the BOT will be confidential. The existence of the committee (work group) will be public.” Why on earth is this case? What is the possible harm of making this esteemed committee’s final report public? While we can appreciate the need for the committee to be able to deliberate candidly and not feel constrained by the possibility that every aspect of their deliberations will be made public, it is essential that the final report containing the committee’s assessment of the scientific merits of the proposals be made public.

COMPOSITION OF WORK GROUP: The announcement makes an ambitious claim, namely, that this review will be equivalent to an independent NIMH peer review. This desirable standard cannot possibly be met by the DSM-5 Scientific Review Work Group as you have constituted it. The people chosen are all well-respected, but all but two of the committee members have been involved with DSM 5 or its oversight. To have credibility, a review committee must be completely unattached to the work that has already been done on DSM 5. Preferably, APA should contract out the review process to experts in evidence based medicine who would be both fully independent and also able to apply the standards of scientific proof used across all medical specialties. At the very least, the membership of the committee needs to be broadened to guarantee both the reality and the appearance of a truly unbiased and independent review process.

CHARGE: Although labeled a “Scientific Review Work Group”, the charge needs to go beyond just being a scientific review and include a thorough risk/ benefit analysis of all suggestions. That such an analysis is planned in suggested by the statement in the charge that “issues of clinical utility, public health, and potential impact on patients should also be considered.” We applaud this plan to conduct a risk/benefit analysis but are concerned that such a review requires broader experience in primary care, public policy, health economics, and forensics that goes beyond the current composition of the Workgroup. At a minimum, close consultation with such experts should be part of the planned review process.

METHOD: It appears the assessments will be limited to evidence already generated by the work groups, with no check to determine if their reviews have been comprehensive and balanced. Since there was no standard operating procedure in the literature review process, the work group reviews are variable in quality and method. A recheck to ensure that all pertinent references have been included is necessary.

TIMING: This scientific review is occurring unbelievably late in the DSM 5 process- it should have been completed more than a year ago, not after the field trials have already begun. There is little purpose to be doing expensive field testing on proposal likely to be eliminated because of limited scientific support. Every step in the DSM 5 process has missed its deadline, sometimes by a year or more. We are concerned that the momentum of the DSM 5 process and limited time left for its review will result in the rushed inclusion of proposals that are both risky and unsupported by evidence.

All these serious concerns notwithstanding, The DSM 5 Scientific Review Work Group has our very best wishes. It is in a key position to do a great service for our field and for our patients and to save APA from further embarrassment.

Robert Spitzer and Allen Frances

DSM5 in Distress

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

DSM 5 Field Trials-Part 1 Missed Deadlines Have Troubling Consequences
DSM 5 is falling far behind its schedule.

Published on November 15, 2010

This is a sad tale of completely unrealistic timetables, poorly executed work effort, consistently missed deadlines, and what will undoubtedly be a rushed and botched DSM 5. It all started at the annual meeting of the American Psychiatric Association in May 2009, when the DSM 5 leadership blithely announced it was ready to begin field testing in the early summer of 2009…

…It was patently obvious from the moment of its announcements that the new DSM 5 field test timetable was also a product of fantasy that would not be met in the real world. First off, it should have been clear that the field trials could not possibly start on time two months after their announcement. Recruiting the sites, training the personnel, gaining human rights approvals, and pilot testing always take at least six months. Predictably, we are already in mid Nov 2010 and it is still not at all clear when the DSM 5 field tests will actually begin to enroll patients at all its sites.

Read full commentary: DSM 5 Field Trials-Part 1 Missed Deadlines Have Troubling Consequences

DSM5 in Distress

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

The DSM 5 Field Trials, Part 2: Asking The Wrong Question Will Lead To Irrelevant Answers
A waste of talent, time, and money.

Published on November 23, 2010

…Field tests also fail to account for the pressures that will lead to systematic, future misuse-especially the drug company marketing of mental disorders that leads to over-diagnosis.

…What do I mean? DSM 5 has made a number of radical suggestions for change, particularly the inclusion of many new diagnoses at the threshold of normality. These have the potential to reclassify as mentally disordered tens of millions of people currently considered normal. The only relevant questions are the overall rates of these disorders in the general population and the risks of false negative over-diagnosis.

…At the end of the DSM 5 field trials, we will have no idea whatever whether its suggestions will create false epidemics of misidentified pseudo-patients.

Read full commentary: Part 2: Asking The Wrong Question Will Lead To Irrelevant Answers


Implementation of the WHO’s ICD-11 is scheduled for 2014. Earlier this year, I asked ICD Revision to clarify for stakeholders whether any form of Alpha Draft for ICD-11 will be placed in the public domain, when this will be released and in what formats. 

In October, ICD Revision stated via its Facebook site, that there will be no publication of an ICD-11 Alpha Draft for public scrutiny and that a public Beta Draft is still targeted for May 2011.

ICD-11 targets also slipping 

According to the September iCamp2 meeting PowerPoint presentation, Frequent Criticisms and this iCamp2 YouTube, targets for the population of content for the ICD-11 Alpha Draft had not been reached.   

Less that 80% of Terminology Definitions had been uploaded to the iCAT and less than the 20% target for full Content Model completion for the thousands of diseases and disorders classified within ICD had been met at that point. [The Content Model identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters.] Not all Topic Advisory Groups were at a similar developmental stage and ICD-11 Beta Plans were behind schedule.   (See Post #48)

International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders

The APA participates with the WHO in the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders and the DSM-ICD Harmonization Coordination Group.

The International Advisory Group for the Revision of the ICD-10 Chapter for Mental and Behavioural Disorders (currently ICD-10 Chapter V but will be Chapter 5 in ICD-11) was constituted by the WHO with the primary task of advising the WHO on all steps leading to the revision of the mental and behavioural disorders classification in ICD-10, in line with the overall ICD revision process.

The Group is chaired by Steven E Hyman, MD, Harvard University, Cambridge, Massachusetts. Steven E Hyman, MD is also a member of the APA’s DSM-5 Task Force.

There is already a degree of correspondence between DSM-IV and Chapter V of ICD-10. For the next editions, the APA and the WHO have committed as far as possible:

To facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria.

with the objective that

The WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.

The Advisory Group has published no Summary Reports of its meetings since its fourth meeting in December 2008. A fifth meeting of the group was held on 28 – 29 September 2009.  Over a year later, no Summary Report has been published for that meeting. It is uncomfirmed whether any meetings of the Advisory Group were held in 2010.

Topic Advisory Group for Neurology

The lead WHO Secretariat for Topic Advisory Group (TAG) for Neurology is Dr Tarun Dua, Management of Mental and Brain Disorders, Department of Mental Health and Substance Abuse, WHO, Geneva.

The TAG for Neurology is chaired by Raad Shakir, MD, Imperial College London. For further information on TAG Neurology see this page.

DSM-5 in the media and reminder

DSM-5 in the media and a reminder

Post #15 Shortlink:

Draft proposals for the revision of DSM-IV diagnostic categories are scheduled for publication on 10 February with a comment period expected to be open until 20 April.

Information around proposed revisions and draft criteria for DSM-5 categories currently classified under “Somatoform Disorders” will be published on this DSM-5 and ICD-11 Watch page:

DSM-5 draft and comment process

Psychiatric Times  |  Steven A. King, MD, MS  | 07 February 2010

DSM-V and Pain

Dr King is in the private practice of pain medicine in New York and he is also clinical professor of psychiatry at the New York University School of Medicine. 

The Economist  Print edition  |  04 January 2010

Psychiatric diagnosis

That way, madness lies

A new manual for diagnosing diseases of the psyche is about to be unveiled

ON FEBRUARY 10th the world of psychiatry will be asked, metaphorically, to lie on the couch and answer questions about the state it thinks it is in. For that is the day the American Psychiatric Association (APA) plans to release a draft of the fifth version of its Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Mental illness carrying the stigma that it does, and the brain being as little-understood as it is, revising the DSM is always a controversial undertaking. This time, however, some of the questions asked of the process are likely to be particularly probing…

Read on here

Psychiatric Times  |  03 February 2010

CAUTION! Who Should Be the DSM-V Diagnostician?

By H. Steven Moffic, MD

…Much has been written about DSM-V, especially in Psychiatric Times, including concerns about transparency, diagnostic criteria, timing, and the influence of Pharma. The developmental group is now entering the stage of inviting comments from psychiatrists at large. Up until now, I believe virtually nothing has been discussed about who should use it. If we gradually obtain neuroimaging and/or genetic markers to improve diagnosing, it would seem that the diagnostic process will become even more of a medical one, most suitable for psychiatrists…

Read full article here

Authorstream Slide Presentation  |  Dr. Atiqul Haq Mazumder Post Graduate Student Department of Psychiatry BSMMU, Dhaka

Upcoming Changes in DSM-V: Upcoming Changes in DSM-V A Critical Review

Includes transcript of PowerPoint slide text

Three American Psychiatric Association (APA) DSM related pieces

Three American Psychiatric Association (APA) DSM related pieces

Post #10 Shortlink:

Update @ 24 January

Discussion of the Ethan Watters New York Times Magazine article “The Americanization of Mental Illness” here:


Monday, January 11, 2010
The globalization of biopsychiatry

A collaborative weblog covering the intersections of medical anthropology, science and technology studies, cultural psychiatry and bioethics.

with extracts from this Kirmayer and Sartorius article:

Psychosomatic Medicine 69:832-840 (2007)
© 2007 American Psychosomatic Society


Cultural Models and Somatic Syndromes   [Full paper]
Laurence J. Kirmayer, MD and Norman Sartorius, MD, PhD

From the Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada.

Update: 22 January

New Scientist

23 January 2010

Invasion of the mind-snatchers

Western notions of mental illness are one of the US’s most insideous exports – and they are spreading around the world like a contagion, says Ethan Watters

Ethan Watters is a journalist who writes on social trends for publications that include Wired and The New York Times Magazine. His books include Urban Tribes. This essay is based on his latest book, Crazy Like Us: The globalization of the American psyche (Free Press/Simon and Schuster)

The New Yorker

3 January 2010

The Dictionary of Disorder
How one man revolutionized psychiatry

Alix Spiegel

…Robert Spitzer isn’t widely known outside the field of mental health, but he is, without question, one of the most influential psychiatrists of the twentieth century. It was Spitzer who took the Diagnostic and Statistical Manual of Mental Disorders—the official listing of all mental diseases recognized by the American Psychiatric Association (A.P.A.)—and established it as a scientific instrument of enormous power. Because insurance companies now require a DSM diagnosis for reimbursement, the manual is mandatory for any mental-health professional seeking compensation. It’s also used by the court system to help determine insanity, by social-services agencies, schools, prisons, governments, and, occasionally, as a plot device on “The Sopranos.”

Read more: here


New York Times Magazine

The Americanization of Mental Illness

8 January 2010

Ethan Watters

Ethan Watters lives in San Francisco. This essay is adapted from his book “Crazy Like Us: The Globalization of the American Psyche,” which will be published later this month by Free Press.

Dr Sing Lee, referred to in this article is a member of the DSM-5 Work Group for “Somatic Symptom Disorders”.


Psychiatric Times Blogspot

Western Psychiatric Imperialism, or Something Else?

12 January 2010

Ronald Pies responds to the essay in the New York Times Magazine, The Americanization of Mental Illness.

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