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DSM-5 stakeholder review and comment exercises
The APA released its first draft proposals for changes to DSM-IV diagnostic categories and criteria on a new APA website, DSM-5 Development, on February 10, 2010. Stakeholder comments were accepted until April 20. Over 8,600 comments were reportedly received by the Task Force and 13 Work Groups.
The second draft was published on May 4, 2011 and the comment period ran until June 15. This was extended for a further month, until July 15. This second draft reportedly received 2,120 responses.
According to Task Force Chair, Dr. David Kupfer, MD, the specific diagnostic categories that received the most feedback during the second public review and feedback exercise were sexual and gender identity disorders, followed closely by somatic symptom disorders and anxiety disorders.
A third and final draft was posted for public review and comment from May 2 – June 15, 2012.
10 December 2009 News Release | Announcing revised publication date, from May 2012 to May 2013
The American Psychiatric Association (APA) published the Diagnostic and Statistical Manual for Mental Disorders Fourth Edition (DSM-IV) in 1994, with a text revision in 2000. The DSM revision process has been underway since 1999. The final, approved version of the next edition, DSM-5, is now anticipated to be published in May 2013.
Diagnostic criteria defined within DSM determine what is considered a mental health disorder and what is not, what medical treatments individuals receive and which treatments medical insurers will authorise funding for. In addition to use in medical settings, DSM is also used by social services agencies, governments, policy makers, courts, prisons, drug regulation agencies, pharmaceutical companies and researchers.
The inclusion or not of a disorder within DSM has revenue implications for pharmaceutical companies seeking licences for new drugs or to expand markets and applications for existing products.
DSM is the primary mental health diagnostic system in the US and is used to a varying extent in other countries. In the UK and some European countries, Chapter V, the Mental and Behavioural Disorders chapter of ICD-10, is also used for diagnosing mental health disorders.
In October 1, 2015, the US will implement ICD-10-CM, a “Clinical Modification” of the WHO’s ICD-10.
The next edition of DSM will shape international research and influence literature in the fields of psychiatry and psychosomatics for many years to come.
In November 2008, in an opinion piece for the Los Angeles Times, Christopher Lane, PhD, Professor of English, Northwestern University, Illinois wrote:
…Not only do mental health professionals use it routinely when treating patients, but the DSM is also a bible of sorts for insurance companies deciding what disorders to cover, as well as for clinicians, courts, prisons, pharmaceutical companies and agencies that regulate drugs. Because large numbers of countries, including the United States, treat the DSM as gospel, it’s no exaggeration to say that minor changes and additions have powerful ripple effects on mental health diagnoses around the world.
In Advances in Psychiatric Treatment, Editor, Joe Bouch wrote:
…Nevertheless, as diagnosis is intended to be one of the strongest assets of a psychiatrist (Tyrer 2009), clinicians need to think about and be involved in the forthcoming revisions and harmonisation of the two major classifications ICD and DSM. Sartorius (pp. 2-9) gives a behind-the-scenes view of the revision process. There are many vested interests: not just clinicians, but governments and NGOs, lawyers, researchers, public health practitioners, Big Pharma and patient groups. Vast sums are at stake – everything from welfare benefits and compensation claims to research budgets. Concerns include the use of national classifications to facilitate political abuse and of diagnostic labels that are seen as stigmatising or are used to stigmatise. Adv. Psychiatr. Treat., Jan 2010; 16: 1.
Planning for this fifth revision began in 1999 with a collaboration between the APA and the US National Institute of Mental Health (NIMH). The revision process is headed up by former NIMH staff and funded by NIMH grants. In 2000, Darrel A Regier, MD, was recruited from the NIMH to serve as research director for the APA and co-ordinator for the development of DSM-5.
The 28 member DSM-5 Task Force set up 13 Work Groups which have been meeting since late 2007 to undertake the revision of DSM-IV. Work Groups also draw on external advisers whose names and affiliations are not being disclosed by APA.
In response to criticism about lack of transparency, APA issued a News Release in May 2008, releasing the names of the appointees to the initial 13 work groups charged with reviewing all existing diagnostic categories in DSM-IV.
The 13 initial DSM-5 Work Groups:
ADHD and Disruptive Behavior Disorders
Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders
Childhood and Adolescent Disorders
Personality and Personality Disorders
Sexual and Gender Identity Disorders
Somatic Symptoms Disorders
These groups have been working towards proposals for the revision of existing disorder criteria, the inclusion of new disorders, or proposing no changes to a disorder or its criteria. Work Groups may also propose revisions to the text accompanying the criteria for each disorder. They may also commission literature reviews and develop research plans for field trials. The Work Groups are composed of more than 120 scientific researchers and clinicians.
As development of DSM-5 progressed, six DSM-5 Study Groups were formed to address cross-cutting issues relevant to all of the disorder work groups:
Individual work groups built on recommendations resulting out of 13 international conferences which were held between 2004 and 2008, conducted by the APA’s American Psychiatric Institute for Research and Education (APIRE) and funded by US National Institute of Health (NIH) grants. According to the APA’s website:
In each conference, participants wrote papers addressing specific diagnostic questions, based on a review of the literature, and from these papers and the conference proceedings, a research agenda was developed on the topic. The results of seven of these conferences have been published to date in peer-reviewed journals or American Psychiatric Publishing, Inc. (APPI) monographs, with the remainder of the publications anticipated in 2008. Findings from all 13 conferences are immediately available to serve as a substantial contribution to the research base for the DSM-V Task Force and Work Groups, and for the WHO as it develops revisions of the International Classification of Diseases.
Summaries of Conferences: DSM-5 Research Planning Conference Summaries and Monographs
Presentations: Presentations on DSM-5 and Related Topics
Publications: Publications from DSM-5 Development
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