DSM-5

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

The APA participates with the WHO in the International Advisory Group (AG) for the Revision of ICD-10 Mental and Behavioural Disorders, constituted by the WHO with the primary task of advising WHO on all steps leading to the revision of the mental and behavioural disorders classification in ICD-10 in line with the overall revision process.

The Advisory Group is co-ordinated by Senior Project Officer, Dr Geoffrey M Reed, PhD, seconded to the Department of Mental Health and Substance Abuse, WHO, Geneva, through the IUPsyS (International Union for Psychological Science). Meetings of the Advisory Group are chaired by Steven Hyman, MD, Harvard University, Cambridge, MA, a former Director of the National Institute of Mental Health (NIMH), now a member of the DSM-5 Task Force.

The APA has also participated in a DSM-ICD Harmonization Coordination Group.

The shared objective is “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’s initial period of operation expired in 2009 and the group was reconstituted and reappointed for the next two year period. The appointment of the Harmonization Group and other working groups reporting to the Advisory Group also expired and new working groups were expected to be appointed based on the current needs of the revision.

In late 2009, it was anticipated that harmonization activity would continue to include Steven Hyman, WHO Mental Health Advisory Group Chair; David Kupfer, DSM-5 Task Force Chair; Darrel Regier, DSM-5 Task Force Vice-Chair and Director of the American Psychiatric Institute for Research and Education, and Benedetto Saraceno, Director of Mental Health and Substance Abuse, WHO.

The timeline for DSM-5 has slipped. American Psychiatric Association originally planned to publish DSM-5 in May 2012. But in a press release issued in December 2009, APA announced it was postponing publication for a further year, until May 2013, to allow better linkage with ICD-10-CM and “more time for public review, field trials and revisions.”

According to the APA’s 10 December 2009 News Release:

APA will continue to work with the WHO to harmonize the DSM-5 with the mental and behavioral disorders section of the ICD-11. Given the timing of the release of both DSM-5 and ICD-11 in relation to the ICD-10-CM, the APA will also work with the CDC and CMS to propose a structure for the U.S. ICD-10 CM that is reflective of the DSM-5 and ICD-11 harmonization efforts. This will be done prior to the time when the ICD-10-CM revisions are “frozen” for CMS and insurance companies to prepare for the October 1, 2013, adoption.

Controversies

The DSM revision process has been riddled with controversy. Some of the most vocal critics have been those who had served on Task Forces for previous DSM revisions, with often acerbic exchanges taking place between previous Task Force chairs and APA board members, via the DSM-5 Resource pages of Psychiatric Times.

DSM-5 Task Force has been criticised for lack of transparency; potential conflicts of interest from Task Force and Work Group member financial ties to pharmaceutical companies; lack of diversity and stakeholder representation within the make-up of the Work Groups; the sketchy and infrequent reports issued by the various groups on their progress – only two reports issued in two years; on the APA’s original plan to schedule field trials before proposed changes could be vetted by clinicians and end users (since shelved, with field trials rescheduled to follow the posting of options although the Phase 2 Field Trials have been dropped).

There have been a number of resignations by Work Group members dissatisfied by the process.

Medical and allied health professionals, medical writers, media and interest groups in the US and UK have voiced concerns over the potential inclusion of new and controversial “disorders” and for the medical and social implications of broadening the criteria for some DSM-5 categories, bringing many more patients under a mental health diagnosis.

Allen Frances, MD, who had chaired the Task Force that had oversight of the production of DSM-IV, has called on the APA to delay publication of DSM-5 and to submit its proposals to independent, external (Cochrane) review.

(See also the Coalition for DSM-5 Reform Open Letter and Petition launched by an ad hoc committee of the Society for Humanistic Psychology (Division 32 of the American Pyschological Association).

In December 2009, two days before the announcement of the postponement of publication of DSM-5 to May 2013, New Scientist reported on DSM controversies in Editorial: Time’s up for psychiatry’s bible and Article: Psychiatry’s civil war.

Links for commentary and opinion pieces around the DSM-5 development process are being compiled on this page:

DSM-5 controversies

Controversial issues for the future DSM-V  a manuscript by Sarah Kamens, MA, Fordham University, November 23, 2009, with a Postscript, January 11, 2010, provides a resource for links to criticism and controversy around the DSM-IV revision process and also explores the  concept of a “paradigm shift” in psychiatric diagnosis, through brief discussion of dimensional versus categorical classification.

For further discussion on “Dimensional Assessments” see:

DSM-V: Introduction of Dimensional Assessments  Psychology and Wellbeing May 27, 2009
DSM-V Dimensions, categories and the elephant of impairment  Child Psychology Research Blog  June 19, 2009

Last updated: February 9, 2012

© Copyright 2013 Suzy Chapman

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