December 2, 2012
Media coverage: American Pyschiatric Association Board of Trustees approves final DSM-5 diagnostic criteria
Post #213 Shortlink: http://wp.me/pKrrB-2xF
See also Post #212 for APA News Release (12.01.12) and Message from APA President, Dilip Jeste, M.D.
Additional media coverage and commentary will be added to the top of this post as it comes to my attention.
Updates to Media coverage
Huffington Post blog
Dilip V. Jeste, M.D.
President of the American Psychiatric Association
Dilip V. Jeste, MD | December 11, 2012
Ronald W. Pies, MD | December 11, 2012
New York Times
Benedict Carey | December 10, 2012
Sharon Kirkey | Postmedia News |December 9, 2012
Rosie Mestel | December 9, 2012
Elements Behavioral Health
December 8, 2012
With contribution from Sharon Kirkey
Audio of interview with Jerome Wakefield plus transcript
December 5, 2012
December 5, 2012
By Laurie Martin, Web Editor | December 6, 2012
Will the new diagnostic manual for psychiatrists go too far in labeling kids dysfunctional?
David Dobbs| December 7, 2012
It won’t be published until May, but the American Psychiatric Association’s Diagnostic Statistical Manual, Fifth Edition, or DSM-5—an updating of the field’s highly influential and pleasingly profitable handbook—is already in deep trouble. Every decade or so, DSM publishes a major edition, and often the changes stir controversy. But the alterations the APA announced for DSM-5 this week sparked unusually ferocious attacks from critics, many of them highly prominent psychiatrists. They say the manual fails to check a clear trend toward overdiagnosis and overmedication—and that a few new or expanded diagnoses defy both common sense and empirical evidence. This medicine is not going down well…
British Psychological Society (BPS)
Psychology Today Blogs
The People’s Professor
Psychology 360: A brain-behavior buffet, heavy to lite, A to Z by Frank Farley, Ph.D.
A new open global movement emerges to re-think and re-design diagnosis
Published on December 3, 2012 by Frank Farley, Ph.D. in The People’s Professor
…Our Committee’s strategy at this point is to reboot the whole program of diagnosis, to re-examine the very fundaments of the concept of diagnosis, and to assess what might be involved in creating an alternative approach to those presently available, creating a blueprint, if you will.
Any new or evolved approach would have to meet, in my view, more rigorous scientific criteria, responding to what I call “The Seven Sins of Psychiatric/Psychological science,” (Farley, 2012), incorporate the cultural/social/relationship/humanistic side of our lives, and involve all the principal disciplinary and professional stakeholders in the U.S and internationally. Given the relentless criticisms of the DSM over several decades and the failure to take some of these serious criticisms into account, our Committee (which now consists of myself and Jon Raskin as co-chairs, and members Dean Brent Robbins, Donna Rockwell, Krishna Kumar, Sarah Kamens, and student consultant Erinn Chalene Cosby) has decided to convene with international collaboration an International Ongoing/Online Summit on Diagnosis (or similar title). Among other things we anticipate bringing together scholars and practioners globally and from across the various fields involved in diagnosis to address the Olympian task of an improved approach or approaches to what we have now. We feel the psychological health and well-being of every distressed individual requires a valid and humane approach to diagnosis, and the Zeitgeist is ready…
Medscape Medical News > Psychiatry
Deborah Brauser | December 3, 2012
Experts and organizations are weighing in on this weekend’s decision by the American Psychiatric Association (APA) Board of Trustees to approve the final diagnostic criteria for the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)…
CBS/AP/ December 3, 2012, 10:38 AM
Alice G. Walton, Contributor | December 3, 2012
Family Practice News, Practice Trends
Mary Ellen Schneider | Family Practice News Digital Network | December 3, 2012
Autism & Asperger
Lee Wilkinson | December 3, 2012
Greg Miller | December 3, 2012
Health News Review
Posted by Gary Schwitzer in Disease mongering, Evidence-based medicine | December 03, 2012
From quirky to serious, trends in psychology and psychiatry
Christopher Lane, Ph.D. | December 2, 2012
A Disaster for Childhood Diagnoses
The Board of Trustees of the American Psychiatric Association tried yesterday to project confidence in the next edition of its problem-plagued manual, assuring Americans that radical changes to the DSM “passed” all necessary hurdles and represented a “major milestone” for American psychiatry.
But DSM-5 is now certain to include highly controversial changes, including approval of Attenuated Psychosis Syndrome and Disruptive Mood Dysregulation Disorder—proposals that sparked widespread concern and skepticism when first circulated…
Medscape Medical News > Psychiatry
Caroline Cassels | December 2, 2012
The final diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has been approved by the leadership of the American Psychiatric Association (APA).
In an official communiqué released December 1 at 3:31 pm Eastern Time, the APA announced that its Board of Trustees approved the manual’s proposed criterial…
Claudia M Gold | December 2, 2012
Because DSM V the newest version of the Diagnostic and Statistical manual, sometimes referred to as the “bible of psychiatry” set to come out in May 2013, makes no mention of relationships, the relational perspective is that it is a flawed instrument. The whole discussion about what categories should and should not be included is off the mark. Nonetheless, as it currently dictates who will and who will not receive treatment, it is a force to be reckoned with…
Psychology Today Blogs
DSM5 in Distress
Allen J Frances MD | December 2, 2012
This is the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry. The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM 5 containing many changes that seem clearly unsafe and scientifically unsound. My best advice to clinicians, to the press, and to the general public – be skeptical and don’t follow DSM 5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication. Just ignore the ten changes that make no sense.
Brief background. DSM 5 got off to a bad start and was never able to establish sure footing. Its leaders initially articulated a premature and unrealizable goal- to produce a paradigm shift in psychiatry. Excessive ambition combined with disorganized execution led inevitably to many ill conceived and risky proposals.
These were vigorously opposed. More than fifty mental health professional associations petitioned for an outside review of DSM 5 to provide an independent judgment of its supporting evidence and to evaluate the balance between its risks and benefits. Professional journals, the press, and the public also weighed in- expressing widespread astonishment about decisions that sometimes seemed not only to lack scientific support but also to defy common sense.
DSM 5 has neither been able to self correct nor willing to heed the advice of outsiders. It has instead created a mostly closed shop- circling the wagons and deaf to the repeated and widespread warnings that it would lead to massive misdiagnosis. Fortunately, some of its most egregiously risky and unsupportable proposals were eventually dropped under great external pressure (most notably ‘psychosis risk’, mixed anxiety/depression, internet and sex addiction, rape as a mental disorder, ‘hebephilia’, cumbersome personality ratings, and sharply lowered thresholds for many existing disorders). But APA stubbornly refused to sponsor any independent review and has given final approval to the ten reckless and untested ideas that are summarized below.
The history of psychiatry is littered with fad diagnoses that in retrospect did far more harm than good. Yesterday’s APA approval makes it likely that DSM 5 will start a half or dozen or more new fads which will be detrimental to the misdiagnosed individuals and costly to our society.
The motives of the people working on DSM 5 have often been questioned. They have been accused of having a financial conflict of interest because some have (minimal) drug company ties and also because so many of the DSM 5 changes will enhance Pharma profits by adding to our already existing societal overdose of carelessly prescribed psychiatric medicine. But I know the people working on DSM 5 and know this charge to be both unfair and untrue. Indeed, they have made some very bad decisions, but they did so with pure hearts and not because they wanted to help the drug companies. Their’s is an intellectual, not financial, conflict of interest that results from the natural tendency of highly specialized experts to over value their pet ideas, to want to expand their own areas of research interest, and to be oblivious to the distortions that occur in translating DSM 5 to real life clinical practice (particularly in primary care where 80% of psychiatric drugs are prescribed).
The APA’s deep dependence on the publishing profits generated by the DSM 5 business enterprise creates a far less pure motivation. There is an inherent and influential conflict of interest between the DSM 5 public trust and DSM 5 as a best seller. When its deadlines were consistently missed due to poor planning and disorganized implementation, APA chose quietly to cancel the DSM 5 field testing step that was meant to provide it with a badly needed opportunity for quality control. The current draft has been approved and is now being rushed prematurely to press with incomplete field testing for one reason only- so that DSM 5 publishing profits can fill the big hole in APA’s projected budget and return dividends on the exorbitant cost of 25 million dollars that has been charged to DSM 5 preparation.
This is no way to prepare or to approve a diagnostic system. Psychiatric diagnosis has become too important in selecting treatments, determining eligibility for benefits and services, allocating resources, guiding legal judgments, creating stigma, and influencing personal expectations to be left in the hands of an APA that has proven itself incapable of producing a safe, sound, and widely accepted manual.
New diagnoses in psychiatry are more dangerous than new drugs because they influence whether or not millions of people are placed on drugs- often by primary care doctors after brief visits. Before their introduction, new diagnoses deserve the same level of attention to safety that we devote to new drugs. APA is not competent to do this.
So, here is my list of DSM 5’s ten most potentially harmful changes. I would suggest that clinicians not follow these at all (or, at the very least, use them with extreme caution and attention to their risks); that potential patients be deeply skeptical, especially if the proposed diagnosis is being used as a rationale for prescribing medication for you or for your child; and that payers question whether some of these are suitable for reimbursement. My goal is to minimize the harm that may otherwise be done by unnecessary obedience to unwise and arbitrary DSM 5 decisions.
1) Disruptive Mood Dysregulation Disorder: DSM 5 will turn temper tantrums into a mental disorder- a puzzling decision based on the work of only one research group. We have no idea whatever how this untested new diagnosis will play out in real life practice settings, but my fear is that it will exacerbate, not relieve, the already excessive and inappropriate use of medication in young children. During the past two decades, child psychiatry has already provoked three fads- a tripling of Attention Deficit Disorder, a more than twenty-times increase in Autistic Disorder, and a forty-times increase in childhood Bipolar Disorder. The field should have felt chastened by this sorry track record and should engage itself now in the crucial task of educating practitioners and the public about the difficulty of accurately diagnosing children and the risks of over- medicating them. DSM 5 should not be adding a new disorder likely to result in a new fad and even more inappropriate medication use in vulnerable children.
2) Normal grief will become Major Depressive Disorder, thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one and substituting pills and superficial medical rituals for the deep consolations of family, friends, religion, and the resiliency that comes with time and the acceptance of the limitations of life.
3) The everyday forgetting characteristic of old age will now be misdiagnosed as Minor Neurocognitive Disorder, creating a huge false positive population of people who are not at special risk for dementia. Since there is no effective treatment for this ‘condition’ (or for dementia), the label provides absolutely no benefit (while creating great anxiety) even for those at true risk for later developing dementia. It is a dead loss for the many who will be mislabeled.
4) DSM 5 will likely trigger a fad of Adult Attention Deficit Disorder leading to widespread misuse of stimulant drugs for performance enhancement and recreation and contributing to the already large illegal secondary market in diverted prescription drugs.
5) Excessive eating 12 times in 3 months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM 5 has instead turned it into a psychiatric illness called Binge Eating Disorder.
6) The changes in the DSM 5 definition of Autism will result in lowered rates- 10% according to estimates by the DSM 5 work group, perhaps 50% according to outside research groups. This reduction can be seen as beneficial in the sense that the diagnosis of Autism will be more accurate and specific- but advocates understandably fear a disruption in needed school services. Here the DSM 5 problem is not so much a bad decision, but the misleading promises that it will have no impact on rates of disorder or of service delivery. School services should be tied more to educational need, less to a controversial psychiatric diagnosis created for clinical (not educational) purposes and whose rate is so sensitive to small changes in definition and assessment.
7) First time substance abusers will be lumped in definitionally in with hard core addicts despite their very different treatment needs and prognosis and the stigma this will cause.
8) DSM 5 has created a slippery slope by introducing the concept of Behavioral Addictions that eventually can spread to make a mental disorder of everything we like to do a lot. Watch out for careless overdiagnosis of internet and sex addiction and the development of lucrative treatment programs to exploit these new markets.
9) DSM 5 obscures the already fuzzy boundary been Generalized Anxiety Disorder and the worries of everyday life. Small changes in definition can create millions of anxious new ‘patients’ and expand the already widespread practice of inappropriately prescribing addicting anti-anxiety medications.
10) DSM 5 has opened the gate even further to the already existing problem of misdiagnosis of PTSD in forensic settings.
DSM 5 has dropped its pretension to being a paradigm shift in psychiatric diagnosis and instead (in a dramatic 180 degree turn) now makes the equally misleading claim that it is a conservative document that will have minimal impact on the rates of psychiatric diagnosis and in the consequent provision of inappropriate treatment. This is an untenable claim that DSM 5 cannot possibly support because, for completely unfathomable reasons, it never took the simple and inexpensive step of actually studying the impact of DSM on rates in real world settings.
Except for autism, all the DSM 5 changes loosen diagnosis and threaten to turn our current diagnostic inflation into diagnostic hyperinflation. Painful experience with previous DSM’s teaches that if anything in the diagnostic system can be misused and turned into a fad, it will be. Many millions of people with normal grief, gluttony, distractibility, worries, reactions to stress, the temper tantrums of childhood, the forgetting of old age, and ‘behavioral addictions’ will soon be mislabeled as psychiatrically sick and given inappropriate treatment.
People with real psychiatric problems that can be reliably diagnosed and effectively treated are already badly shortchanged. DSM 5 will make this worse by diverting attention and scarce resources away from the really ill and toward people with the everyday problems of life who will be harmed, not helped, when they are mislabeled as mentally ill.
Our patients deserve better, society deserves better, and the mental health professions deserve better. Caring for the mentally ill is a noble and effective profession. But we have to know our limits and stay within them.
DSM 5 violates the most sacred (and most frequently ignored) tenet in medicine- First Do No Harm! That’s why this is such a sad moment.
December 3, 2012
DSM-5, latest revision of Diagnostic and Statistical Manual, merges Asperger’s with autism and widens dyslexia category
Asperger’s syndrome is to be dropped from the psychiatrists’ Diagnostic and Statistical Manual (DSM) of Mental Disorders, the American publication that is one of the most influential references for the profession around the world.
The term “Asperger’s disorder” will not appear in the DSM-5, the latest revision of the manual, and instead its symptoms will come under the newly added “autism spectrum disorder”, which is already used widely. That umbrella diagnosis will include children with severe autism, who often do not talk or interact, as well as those with milder forms…
Dan Box | December 3, 2012
THE diagnosis of Asperger’s syndrome is being dropped from the world-leading US medical manual of psychiatric conditions, in a decision that could affect the support and funding available to thousands of Australian families.
The decision is among the first major revisions to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders since 1994…
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Lindsey Tanner | December 1, 2012
CHICAGO — For the first time in almost two decades the nation’s psychiatrists are changing the guidebook they use to diagnose mental disorders. Among the most controversial proposed changes: Dropping certain familiar terms like Asperger’s disorder and dyslexia and calling frequent, severe temper tantrums a mental illness.
The board of trustees for the American Psychiatric Association voted Saturday in suburban Washington, D.C., on scores of revisions that have been in the works for several years. Details will come next May when the group’s fifth diagnostic manual is published.
The trustees made the final decision on what proposals made the cut; recommendations came from experts in several task force groups assigned to evaluate different mental illnesses…
John Gever, Senior Editor | December 1, 2012
The American Psychiatric Association’s board of trustees has approved the fifth edition of its influential diagnostic manual, dubbed DSM-5, the group announced Saturday.
The board vote is the last step before the manual is formally released at the APA’s annual meeting next May. The association’s Diagnostic and Statistical Manual of Mental Disorders was last revised in 1994; that edition is known colloquially as DSM-IV…
Tina Burgess | December 1, 2012
On Saturday, Dec. 1, 2012, the board of trustees of the American Psychiatric Association voted in Washington, D.C., that the term “dyslexia” will be eliminated from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
According to Saturday’s The Seattle Times report, “Board members were tightlipped about the update, but its impact will be huge, affecting millions of children and adults worldwide.”
Eliminating the term “dyslexia” from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has major implications for students with dyslexia…
Psychiatric association approves changes to diagnostic manualCNN International
Miriam Falco, CNN Medical Managing Editor | December 2, 2012
(CNN) — Starting next year, the process of diagnosing autism may see drastic changes following the revision of the official guide to classifying psychiatric illnesses.
After years of reviewing and refining criteria used by psychiatrists and other experts to diagnose mental health disorders, the American Psychiatric Association board of trustees on Saturday approved major changes to the manual, better known as DSM-5…
Dallas Morning News
Associated Press The Dallas Morning News
Published: 02 December 2012 12:59 AM
CHICAGO — The now familiar term “Asperger’s disorder” is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But “dyslexia” and other learning disorders remain.
The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation’s psychiatrists. Changes were approved Saturday.
Full details of all the revisions will come next May when the American Psychiatric Association’s new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education….
Wall Street Journal
Melinda Beck | December 1, 2012
Asperger’s syndrome is out and hoarding is in, and starting next year, psychiatrists may diagnose some children with a new “disruptive mood dysregulation disorder” if they have severe tantrums three or more times a week for more than a year.
After more than a decade of discussion and often heated debate, the Board of Trustees of the American Psychiatric Association voted Saturday in Arlington, Va., to approve the fifth edition of the group’s “Diagnostic and Statistical Manual for Mental Disorders” or DSM-5, the official guide to classifying psychiatric illnesses.
The changes – the first major revisions since 1994 — could…
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Sharon Jayson | December 2, 212
Manual also is important for the health insurance industry in deciding what treatments to cover.
7:58 PM EST December 1. 2012 – Asperger’s is out, but binge eating and hoarding are in as official mental disorders in the latest version of the diagnostic bible published by the American Psychiatric Association, following a vote Saturday by that group’s board…
Bloomberg Businessweek – News from Business
Elizabeth Lopatto | December 2, 2012
The vote yesterday by the American Psychiatric Association was alternately called “a disaster” by Allen Frances, who led work on the previous version, and a “conservative document” by David Kupfer, who led the panel that presented the latest edition…
Detroit Free Press
Lyndsey Tanner | December 2, 2012
The board of trustees for the American Psychiatric Association voted Saturday in suburban Washington, D.C., on scores of revisions that have been in the works for several years. Details will come in May, when the group’s fifth diagnostic manual is published…
Gina Putt | December 1, 2012
The American Psychiatric Association’s timeline calls for the ”Final Revisions by the APA Task Force; Final Approval by APA Board of Trustees; Submission to American Psychiatric Publishing, Inc..” in December of 2012. This edition, the fifth, attempts to further…
Alix Spiegel | November 30, 2012
…The APA refuses to say anything about what’s in and what’s out, and they’ve also told people associated with the DSM-5 that they shouldn’t speak specifically, so it’s very hard to know. But some of the changes that were published last year on the APA website…
From Ben Carey, NYT, November 26
Benedict Carey | November 26, 2012 | 355 Comments
This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine: personality disorders.
Personality disorders occupy a troublesome niche in psychiatry. The 10 recognized syndromes are fairly well represented on the self-help shelves of bookstores and include such well-known types as narcissistic personality disorder, avoidant personality disorder, as well as dependent and histrionic personalities.
But when full-blown, the disorders are difficult to characterize and treat, and doctors seldom do careful evaluations, missing or downplaying behavior patterns that underlie problems like depression and anxiety in millions of people.
The new proposal — part of the psychiatric association’s effort of many years to update its influential diagnostic manual — is intended to clarify these diagnoses and better integrate them into clinical practice, to extend and improve treatment. But the effort has run into so much opposition that it will probably be relegated to the back of the manual, if it’s allowed in at all…
Clinical Psychiatry News
By: MICHAEL BRODSKY, M.D., Clinical Psychiatry News Digital Network
If substantive changes to the DSM-5 framework do not occur before publication, clinicians will be called upon to evaluate personality using dimensional measures in addition to the personality diagnostic categories familiar to psychiatrists from the DSM-IV.
In this article, I want to consider the personality dimension of neuroticism, a construct with a long tradition of research and considerable evidence of both internal and external validity (Am. Psychol. 2009;64:241-56). Recent epidemiologic findings suggest that scores along this dimension may carry important clinical implications for mental and physical health…