Round-up: Recent commentaries by Allen Frances, MD, on a DSM-5 in distress

February 22, 2012 by

Round-up: Recent commentaries by Allen Frances, MD, on a DSM-5 in distress

Post #146 Shortlink: http://wp.me/pKrrB-1X2

Allen Frances’ Blog at Huffington Post

DSM 5 Freezes Out Its Stakeholders

Allen Frances, MD | February 21, 2012

Scary news. The Chair of the DSM 5 Task Force, Dr. David Kupfer, has indicated that 90 percent of the decisions on DSM 5 have already been made.

Why so scary? DSM 5 is the new revision of the psychiatric diagnosis manual, meant to become official in May 2013. It proposes a radical redefinition of the boundary between mental disorder and normality, greatly expanding the former at the expense of the latter. Understandably, this ambitious medicalization of the human condition has generated unprecedented opposition, both from the public and from mental heath professionals. To top it off, the DSM 5 proposals are poorly written, unreliable, and likely to cause the misdiagnosis and the excessive treatment of millions of people.

Under normal circumstances the DSM 5 team would have taken the many criticisms to heart, gone back to the drawing board, and improved the quality and acceptability of their product. After all, the customer is very often right. But this DSM process has been strangely secretive, unable to self-correct, and stubbornly closed to suggestions coming from outside. As a result, current DSM 5 proposals show very little improvement over poorly done first drafts posted in February 2010.

Is there any hope of a last-minute save? I have gathered opinions from three well-informed DSM 5 watchers. They were asked to assess the current state of DSM 5 and offer suggestions about future prospects. The first comment comes from Suzy Chapman, a public advocate, whose website provides the most comprehensive documentary source on the development of DSM 5 and ICD-11. Ms Chapman writes:

DSM 5 consistently misses every one of its deadlines and then fails to update its website with a new schedule. The Timeline was finally revised a couple of weeks ago, but we are still no nearer to a firm date for the final period of invited public comment. We’ve known since November that DSM 5 is stuffed as far as its planned January-February comment period and that Dr Kupfer now reckons “no later than May” – but all the website says is “Spring.” That’s no use to those of us who need to alert patient groups and their professional advisers…

Psychology Today

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

ICD-10-CM Delay Removes Excuse For Rushing DSM 5 Into Premature Publication: Time needed to avoid harmful document

Allen Frances, MD | February 22, 2012

Until yesterday, there were only two reasons to stick with the projected date of DSM 5 publication (May 2013): 1) the need to coordinate DSM 5 with ICD-10-CM coding, which was scheduled to start Oct 2013; and, 2) the need to protect APA publishing profits in order to meet budget projections.

The first reason just dropped out. Health and Human Services (HHS) Secretary Kathleen G. Sebelius has announced that the start date for ICD-10-CM has been postponed. It is not yet clear for how long, but most likely a year (see http://www.dhhs.gov/news/press/2012pres/02/20120216a.html ).

also on Psychiatric Times

Registration required for access

ICD-10-CM Delay Removes Excuse For Rushing DSM-5 Into Premature Publication

and Education Update

Psychology Today

DSM5 in Distress

DSM 5 to the Barricades on Grief

Defending The Indefensible

Allen Frances, MD | February 18, 2012

The storm of opposition to DSM 5 is now focused on its silly and unnecessary proposal to medicalize grief. DSM 5 would encourage the diagnosis of ‘Major Depressive Disorder’ almost immediately after the loss of a loved one—having just 2 weeks of sadness and loss of interest along with reduced appetite, sleep, and energy would earn the MDD label (and all too often an unnecessary and potentially harmful pill treatment). This makes no sense. To paraphrase Voltaire, normal grief is not ‘Major’, is not ‘Depressive,’ and is not ‘Disorder.’ Grief is the normal and necessary human reaction to love and loss, not some phony disease.

All this seems perfectly clear to just about everyone in the world except the small group of people working on DSM 5. The press is now filled with scores of shocked articles stimulated by two damning editorial pieces in the Lancet and a recent prominent article in the New York Times.

The role of public defender of DSM 5 has fallen on John Oldham MD, president of the American Psychiatric Association…

Psychology Today

DSM5 in Distress

Allen Frances, MD | February 17, 2012

Lancet Rejects Grief As a Mental Disorder: Will DSM 5 Finally Drop This Terrible Idea

The Lancet is probably the most prestigious medical journal in the world. When it speaks, people listen. The New York Times is probably the most prestigious newspaper in the world. Again, when it speaks, people usually listen. The Lancet and The New York Times have both spoken on the DSM-5 foolishness of turning grief into a mental disorder. Will DSM-5 finally listen?

Here are some selected quotes from today’s wonderful Lancet editorial
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60248-7/fulltext

Previous DSM editions have highlighted the need to consider, and usually exclude, bereavement before diagnosis of a major depressive disorder. In the draft version of DSM-5 , however, there is no such exclusion for bereavement, which means that feelings of deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness, and no appetite, which continue for more than 2 weeks after the death of a loved one, could be diagnosed as depression, rather than as a normal grief reaction.”

“Medicalising grief, so that treatment is legitimized routinely with antidepressants, for example, is not only dangerously simplistic, but also flawed…”

Psychology Today

DSM5 in Distress

DSM 5 Minor Neurocognitive Disorder: Let’s Wait For Accurate Biological Tests

Allen Frances, MD | February 16, 2012

Within the next 3-5 years, we will likely have biological tests to accurately diagnose the prodrome of Alzheimer’s disease (AD). Much remains to be done in standardizing these tests, determining their appropriate set points and patterns of results, and negotiating the difficult transition from research to general clinical practice. And, given the lack of effective treatment, there are legitimate concerns about the advisability of testing for the individual patient and the enormous societal expense with little tangible benefit. Despite these necessary caveats, there is no doubt that biological testing for prodromal AD will be an important milestone in the clinical application of neuroscience.

How does this impact on the DSM 5 proposal to include a Minor Neurocognitive Disorder as a presumed prodrome to AD…

Psychology Today

DSM5 in Distress

PTSD, DSM 5, and Forensic Misuse: DSM 5 would lead to overdiagnosis in legal cases.

Allen Frances, MD | February 09, 2012

In preparing DSM IV, we worked hard to avoid causing confusion in forensic settings. Realizing that lawyers read documents in their own special way, we had a panel of forensic psychiatrists go over every word to reduce the risks that DSM IV could be misused in the courts. They did an excellent job, but all of us missed one seemingly small mistake– the substitution of an ‘or’ for an ‘and’ in the paraphilia section that lead to serious misunderstandings and the questionably constitutional preventive psychiatric detention of sexual offenders.

DSM 5 is about to make a very different, less crucial, but still consequential forensic mistake. The proposed A criterion for PTSD includes the following wording…

Psychology Today

DSM5 in Distress

Documentation That DSM 5 Publication Must Be Delayed because DSM 5 is so far behind schedule

Allen Frances, MD | February 07, 2012

I wrote last week that DSM 5 is so far behind schedule it can’t possibly produce a usable document in time for its planned publication date in May 2013. My blog stimulated two interesting responses that illustrate the stark contrast between DSM 5 fantasy and DSM 5 reality. Together they document just how far behind its schedule DSM 5 has fallen and illustrate why publication must be delayed if things are to be set right.

The first email came from Suzy Chapman of https://dxrevisionwatch.wordpress.com …

also on Psychiatric Times

Registration required for access

Documentation That DSM-5 Publication Must Be Delayed

Additional coverage of DSM-5 controversies

Sidney Morning Herald

About-turn on treatment of the young

Amy Corderoy | February 20, 2012

CONCERNS about the overmedication of young people and rigid models of diagnosis have led the architect of early intervention in Australian psychiatry, Patrick McGorry, to abandon the idea pre-psychosis should be listed as a new psychiatric disorder.

The former Australian of the Year had previously accepted the inclusion of pre-psychosis – a concept he and colleagues developed – in the international diagnostic manual of mental disorders, or DSM, which is being updated this year.

Professor McGorry has been part of a team researching pre- and early-psychosis, and his work in the latter helped secure a massive $222.4 million Commonwealth funding injection for Early Psychosis Prevention and Intervention Centres across Australia…

Sidney Morning Herald

Suffer the children under new rules

Kathryn Wicks | Opinion | February 20, 2012

Canberra Times

A new chapter for psychiatrists’ bible

Amy Corderoy | February 19, 2012

Madness is being redesigned. The Diagnostic and Statistical Manual of Mental Disorders (DSM) will be updated this year, meaning what counts as a psychiatric disorder will change.

Frances, one of the architects of the current manual, DSM-IV, published in 1994, knows the results of his changes to the definitions of mental illness.

“We were definitely modest, conservative and non-ambitious in our approach to DSM-IV,” he says. “Yet we had three epidemics on our watch…”

Filed under Allen Frances, American Psychiatric Association (APA), Bereavement, Coalition for DSM-5 Reform, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-5 timeline Tagged with , , , , , , , , ,

Science Media Centre DSM-5 press briefing: Comments from research and clinical professionals

February 15, 2012 by

Science Media Centre DSM-5 press briefing: Comments from research and clinical professionals

Post #141 Shortlink: http://wp.me/pKrrB-1TL

On February 9, psychiatrist, Prof Nick Craddock, and psychologist, Prof Peter Kinderman, discussed the implications of proposals for the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) at a Science Media Centre press briefing for invited journalists.

There has been significant UK and international media interest in mental health professionals’ concerns for a range of controversial proposals for DSM-5. Press coverage is being collated in this Dx Revision Watch post:

Media coverage of UK concerns over DSM-5 (Science Media Centre press briefing)

Commentaries from Allen Frances, MD, today, on Huffington Post:

Can the Press Save DSM 5 from Itself? 

“…The intense press scrutiny of DSM 5 is really just beginning. I know of at least 10 additional reporters who are preparing their work now for publication in the near future. And many of the journalists whose articles appeared during these last few weeks intend to stay on this story for the duration — at least until DSM 5 is published, and probably beyond. They understand that DSM 5 is a document of great individual and societal consequence — and that its impact and risks need a thorough public airing…”

and Christopher Lane, Ph.D. on Side Effects at Psychology Today

DSM-5 Controversy Is Now Firmly Transatlantic

Why the APA’s lower diagnostic thresholds are causing widespread concern.

“Proposed draft revisions to the DSM, which the American Psychiatric Association recently made available on its website, are stirring major controversy on both sides of the Atlantic…”  Read on

 

Science Media Centre has very kindly given permission to publish, in full, the comments provided by research and clinical professionals for use by the press:

DSM5: New psychiatry bible broadens definitions of mental illness to include normal quirks of personality

10.02.2012

Round-up comments

Tim Carey, Associate Professor at the Centre for Remote Health and Central Australian Mental Health Service, said:

“The DSM does not assist in understanding psychological distress nor in treating it effectively. It does not “carve nature at its joints” as it were. It is a collection of symptom patterns that have no underlying form or structure. It is akin to an anthology of the constellations in the night sky. While it does not assist in understanding or treating psychological distress, it has generated phenomenal revenues for the APA, expanded the market for pharmaceutical companies, assisted in promulgating and maintaining a disease and illness model of psychological suffering, and constrained the focus of research activity. Are these the activities a humane and scientific society should seek to promote?

“The authors of the DSM themselves acknowledge the inadequacy of the DSM diagnostic system.

“On page xxxi of the latest edition of the DSM it states: ‘there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder. There is also no assumption that all individuals described as having the same mental disorder are alike in all important ways’.

“So, according to the DSM authors, the boundaries demarcating ‘schizophrenia’ (for example) don’t separate ‘schizophrenia’ from ‘depression’ (or social phobia or intermittent explosive disorder or post-traumatic stress disorder or …) or (perhaps most importantly) the boundaries don’t separate ‘schizophrenia’ from ‘no schizophrenia’.

“One would have to ask: if the function of creating particular categories is not to separate these categories from each other or from their absence, what exactly are they for?”

David Pilgrim, Professor of Mental Health Policy, University of Central Lancashire, said:

“It’s hard to avoid the conclusion that DSM-5 will help the interests of the drug companies and the wrong-headed belief of some mental health professionals (mainly most psychiatrists, but sadly all too often others as well). Some patients and many relatives also gain some advantages from diagnosis some of the time because it reduces the reality of the complexity of their experiences and their responsibilities within those existential struggles.

“Madness and misery exist but they come in many shapes and sizes and so they need to be appreciated in their very particular biographical and social contexts. At the individual level this should mean replacing diagnoses with tailored formulations, and for research purposes we should be either looking at single symptoms or shared predicaments of those with mental health problems and their significant others. I worry that we risk treating the experience and conduct of people as if they are botanical specimens waiting to be identified and categorised in rigid boxes – in my opinion that would itself be a form of collective madness for all those complicit in the continuing pseudo-scientific exercise.”

Dr Felicity Callard, Senior Research Fellow, Service User Research Enterprise, Institute of Psychiatry, King’s College London, said:

“The ongoing chaos surrounding the development of DSM-5 has intensified rather than lessened fears that this project is ill-conceived and founded on a weak evidence base. People’s lives can be altered profoundly – and, we should bear in mind, sometimes ruinously – by being given a psychiatric diagnosis. In my opinion, that the architects of DSM-5 are pressing on with such a flawed framework undermines their claim that they wish to produce a DSM that is ‘useful to all health professionals, researchers and patients’.”

Dr Paul Keedwell, Honorary Consultant Psychiatrist and Clinical Lecturer in the Neurobiology of Mood Disorders, Cardiff University, said:

“New findings arising from genetics and brain imaging studies hint at biological mechanisms, and challenge the way we classify disorders: syndromes (like bipolar and unipolar depression) might merge, while others (like “the schizophrenias”) might diverge. However a few more decades will pass before we radically change our existing classifications.

“Where the proposed DSMV is particularly controversial is in its addition of more disorders, like “Apathy Syndrome” and “Disruptive Mood Dysregulation Disorder”, which suggest a worrying trend toward medicalising normal variation in behaviour.

“Every new diagnosis implies a new treatment, suiting vested interests in the health industry. Nothing should enter the final version of DSMV without sound research evidence of the need for professionals to intervene.

“Also, every mental health professional should remember that classification systems are a guide to diagnosis only: they do not necessarily map on to the complex needs of an individual in real practice, and they are definitely not a guide to treatment.”

Allen Frances, Emeritus Professor at Duke University and Chair of the DSM-4 Steering Committee, said:

“DSM 5 will radically and recklessly expand the boundaries of psychiatry by introducing many new diagnoses and lowering the thresholds for existing ones. As an unintended consequence, many millions of people will receive inaccurate diagnosis and inappropriate treatment. Costs include: the side effects and complications of unnecessary medication; the perverse misallocation of scarce mental health resources toward those who don’t really need them (and may actually be harmed) and away from those who do most desperately require help; stigma; a medicalization of normality, individual difference, and criminality; and a reduced sense of personal responsibility. The publication of DSM 5 should be delayed until it can be subjected to a rigorous and independent review, using the methods of evidence based medicine, and meant to ensure that it is both safe and scientifically sound. New diagnoses can be as dangerous as new drugs and require a much more careful and inclusive vetting than has been provided by the American Psychiatric Association. Future revisions of psychiatric diagnosis can no longer be left to the sole responsibility of just one professional organization.”

David Elkins, Professor Emeritus of Psychology, Pepperdine University, Los Angeles, and Chair of the Division 32 Task Force for DSM-5 Reform, said:

“My committee and I remain very concerned the DSM-5, as currently proposed, could result in the widespread misdiagnosis of hundreds of thousands of individuals whose behaviour is within the continuum of normal variation. If this occurs, it means these individuals will be labelled with a mental disorder for life and many will be treated with powerful psychiatric drugs that can have dangerous side effects.

“We are also alarmed that the DSM-5 Task Force seems unresponsive to the concerns of thousands of mental health professionals and dozens of mental health associations from around the world.

“My committee recently asked the DSM-5 Task Force to submit the controversial proposals for review by an outside, independent group of scientists and scholars. Our request was denied.

“My committee launched the Open Letter/Petition Website which has now gathered more than 11, 000 individual signatures and endorsements from more than 40 from mental health associations including 13 other Divisions of the American Psychological Association.”

Dr Kevin Morgan, Senior Lecturer, Department of Psychology, University of Westminster, said:

“The proposed revisions to the diagnosis of schizophrenia i.e. the elimination of subtypes and the use instead of symptom dimensions, is an example of how DSM5 may prove to be more clinically beneficial than the current version of the manual. I wait with great interest to see the final agreed set of changes.”

Til Wykes, Professor of Clinical Psychology and Rehabilitation, Institute of Psychiatry, Kings College London, said:

“The proposals in DSM 5 are likely to shrink the pool of normality to a puddle with more and more people being given a diagnosis of mental illness. This may be driven by a health care system that reimburses only if the individual being treated has a recognised diagnosis – one in the DS manual. Luckily in the UK we have the NHS which treats people on the basis of need, not if they fit a diagnostic system.

“It isn’t just a health care system that is subverted by the spreading of diagnostic labels into normality, research will also be changed. Most research studies that reach the widest readership get published in US journals which will expect these diagnostic labels to have been used.

“We shouldn’t use labels unless we are clear they have some benefit. Saying someone is at risk of a mental illness (in some categories of DSM5) puts a lot of pressure on the individual and their family. When we do not have a good enough prediction mechanism, this is too high a burden.”

Dr David Harper, Reader in Clinical Psychology, University of East London, said:

“The American Psychiatric Association’s revisions of the DSM have become as regular as updates for Microsoft Windows and about as much use. It has facilitated an increasing medicalisation of life (the number of disorders the DSM covers has increased exponentially from its first edition in 1952 to 357 in 2000) and is hugely costly (the text revision of DSM IV made $44m in revenue between 2000 and 2006). The problem is not simply the revisions proposed in DSM 5 but the idea that psychological distress matches its diagnostic categories – people’s experiences of distress cluster in an entirely different manner. This is why most people end up with more than one diagnosis, why the ‘not otherwise specified’ category is massively over-used and why ratings of agreement between psychiatrists continue to be poor. The DSM represents a massive failure of imagination: most clinicians and researchers know the system is flawed but try to convince themselves, despite the evidence, that it aids communication, research and treatment. It does not. The frustrating thing is that there are other viable alternatives – for example, a focus on homogenous experiences of distress would aid research, the use of case formulation would aid treatment. Unfortunately, the pharmaceutical industry can see little profit in either alternative and, instead, continue to swing their considerable weight behind the DSM.”

Richard Bentall, Chair of Clinical Psychology at the University of Bangor, said:

“I share the widespread concerns about the proposed revisions to the DSM diagnostic system. Like earlier editions, this version of the manual is not based on coherent research into the causes or nature of mental illness. For example, it treats ‘schizophrenia’ and ‘bipolar disorder’ as separate conditions despite evidence that this is, at best, an over-simplification. It also looks set to widen some of the diagnostic criteria, for example by removing the grief exclusion from major depression, and by expanding the range of psychotic disorders to include an ‘attenuated psychosis syndrome’ (my own research on this, in press, shows that only about 10% of people meeting the attenuated or prodromal psychosis criteria are likely to go on to develop a full-blown psychotic illness). As there is no obvious scientific added value compared to DSM-IV, and as there are some obvious risks associated with this expansion of diagnostic boundaries, one is bound to ask why there is a need for this revision, or who will benefit from it. It seems likely that the main beneficiaries will be mental health practitioners seeking to justify expanding practices, and pharmaceutical companies looking for new markets for their products.”

Dr Lucy Johnstone, Consultant Clinical Psychologist, Cwm Taf Health Board, Mid Glamorgan, South Wales, said:

“The DSM debate is all about how we understand mental distress. DSM and the proposed revisions are based on the assumption that mental distress is best understood as an illness, mainly caused by genetic or biochemical factors. It is important to realise that, with the exception of a few conditions such as dementia, there is no firm evidence to support this. On the contrary, the strongest evidence is about psychological and social factors such as trauma, loss, poverty and discrimination. In other words, even the more extreme forms of distress are ultimately a response to life problems. We need a paradigm shift in the way we understand mental health problems. DSM cannot be reformed – it is based on fundamentally wrong principles and should be abandoned.”

Dr Warren Mansell, Reader in Psychology & Clinical Psychologist, University of Manchester, said:

“Contemporary research across genetics, neuroscience, psychology and culture all point to the fact that the majority of psychiatric disorders share the same underlying processes and are treated by very similar interventions. Therefore in further emphasising different categories of mental health problems, DSM5 is heading in completely the opposite direction from the most pioneering research across the field of mental health.”

Simon Wessely, Professor of Epidemiological and Liaison Psychiatry at the Institute of Psychiatry, King’s College London:

“We need to be very careful before further broadening the boundaries of illness and disorder. Back in 1840 the Census of the United States included just one category for mental disorder. By 1917 the American Psychiatric Association recognised 59, rising to 128 in 1959, 227 in 1980, and 347 in the last revision. Do we really need all these labels? Probably not. And there is a real danger that shyness will become social phobia, bookish kids labelled as Asperger’s and so on.”

Professor Sue Bailey, President of the Royal College of Psychiatrists, said:

“We recognise the importance of accurate and prompt diagnosis in psychiatry. The classification system used in NHS hospitals and referred to by UK psychiatrists is the World Health Organisation’s International Classification of Disease (ICD). Therefore, the publication of DSM-V will not directly affect diagnosis of mental illness in our health service.”

The British Psychological Society has released a statement on the DSM-5 which can be found here: BPS Statement on DSM-5

* The fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be published in May 2013 by the American Psychiatric Association.

Filed under Allen Frances, American Psychiatric Association (APA), British Psychological Society, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media, DSM-5 Petitions, Science Media Centre Tagged with , , , , , , , , ,

Media coverage of UK concerns over DSM-5

February 9, 2012 by

Media coverage of UK concerns over DSM-5 (Science Media Centre press briefing)

Post #138  Shortlink: http://wp.me/pKrrB-1R8

Update: See also

Science Media Centre DSM-5 press briefing: Comments from research and clinical professionals

Criticism of DSM-5 proposals for grief in this week’s Lancet: Editorial and Essay

Round-up: media coverage following Lancet’s criticism of DSM-5 proposals for grief

On February 9, UK Science Media Centre held a press briefing for invited journalists amid mounting concern from mental health professionals for controversial proposals for the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).

DSM-5 is slated for publication in May 2013.

A third draft of proposed changes to DSM-IV categories and criteria is expected to be posted on the DSM-5 Development site, this May, for a two month long stakeholder review and feedback period.

This final review might be viewed as little more than a public relations exercise given the late stage in the drafting process – according to Task Force chair, David Kupfer, MD, “the revisions are about 90 percent complete.”

Those involved in the press briefing included:

Prof Nick Craddock, MRC Centre for Neuropsychiatric Genetics & Genomics, Cardiff University School of Medicine

Peter Kinderman, Professor of clinical psychology at the University of Liverpool; honorary appointment as consultant clinical psychologist with Merseycare NHS Trust and a former Chair of the British Psychological Society’s Division of Clinical Psychology

Both have research and clinical interests in schizophrenia, bipolar disorder and psychosis.

Psychologists and psychiatrists providing comment on their concerns for potential changes to DSM-IV, included Prof Nick Craddock, Prof Peter Kinderman, Allen Frances, MD, who had chaired the task force that had oversight of the drafting of DSM-IV, Prof Simon Wessely, Prof Richard Bentall, Dr Lucy Johnstone and Prof Til Wykes.

A Reuters News Alert by Kate Kelland, Health and Science Correspondent, issued on February 9, generated considerable interest and has been picked up by dozens of international news sites including Chicago Tribune, Orlando Sentinel, Windsor Star, Psychminded.co.uk, MSNBC, Montreal Gazette, Baltimore Sun and Vancouver Sun.

Professor Peter Kinderman and Dr David Kupfer who chairs the DSM-5 Task Force, debated concerns on Friday’s BBC Radio 4 “Today” programme (link for audio below).

Medical writer, Christopher Lane, author of How Normal Behaviour Became a Sickness, blogged, yesterday, at Side Effects at Psychology Today.

Side Effects
From quirky to serious, trends in psychology and psychiatry.
by Christopher Lane, Ph.D.

DSM-5 Controversy Is Now Firmly Transatlantic

Why the APA’s lower diagnostic thresholds are causing widespread concern.

Proposed draft revisions to the DSM, which the American Psychiatric Association recently made available on its website, are stirring major controversy on both sides of the Atlantic… Read on

John M Grohol, PsyD, editor at PsychCentral, is in a bit of a snit, here.

Comments provided by research and clinical professionals for the Science Media Centre DSM-5 press briefing here: http://wp.me/pKrrB-1TL

For around 100 links for news and media sites that have run DSM-5 stories in the past three weeks or so, open Word file here: Concerns for DSM-5 – Media coverage

Selected UK and international media coverage posted below, as it comes in, most recent at the top:

Insideireland.ie

Shyness: A mental illness?

Sarah Greer | February 13, 2012

British Psychological Society

Is shyness a mental illness?

February 13, 2012

Shyness in a child, and depression following the death of a loved one, could be classed as mental illness under new guidelines. The move could result in millions of people being placed at risk of having a psychiatric disorder, experts have warned.

Guardian

Comment is free

Do we need a diagnostic manual for mental illness?

Profs Richard Bentall and Nick Craddock discuss the controversial revisions to the US Diagnostic and Statistical Manual

Guardian, Comment is free | February 10, 2012

Friday round up…’hypersexual disorder’ is added to the psychiatric bible…

PULSE GP magazine  | February 10, 2012

Financial Times  (Registration may be required)

US mental guidelines attacked

Andrew Jack | February 10, 2012

ABC News

American Psychiatric Association Under Fire for New Disorders

Katie Moisse | February 10, 2012

Shyness, grief and eccentricity could suddenly become mental health disorders if the newest edition of the Diagnostic and Statistical Manual of Mental Disorders goes through as planned. But it won’t if more than 11,000 petitioners, most of whom are mental health professionals, have their way.

The DSM, the 900-page “bible” of psychiatric symptoms published by the American Psychiatric Association, has been around since 1952. But the fifth and latest edition, scheduled for publication in May 2013, has come under attack for “medicalizing” behaviors that some people would consider normal. The 11,000 petitioners are challenging proposed changes they say would label millions more Americans as mentally ill…

Read on

BBC News website and BBC Radio 4 Today programme

http://news.bbc.co.uk/today/hi/today/newsid_9694000/9694926.stm

0831
A new draft of the “psychiatric bible” – DSM5 – has provoked anger for its definitions of behaviours indicative of mental illness. Already, more than 11,000 have signed a petition calling for it to be rewritten and re-thought. David Kupfer who chairs the DSM 5 committee for the American Psychiatric Association, which put the book together, and Peter Kinderman, professor and honorary consultant clinical psychologist with Mersey Care NHS Trust, debate its pros and cons.

Quirk or mental illness?

[Audio interviews with DSM-5 Task Force Chair, David Kupfer, and Prof Peter Kinderman]

The new psychiatric bible, DSM 5, which is the world’s most widely used psychiatric reference book, has been released in draft form. Already, more than 11,000 people have signed a petition calling for it to be rewritten and re-thought. Some claim the new edition broadens the range of behaviours considered indicative of mental illnesses to a point where normal quirks of personality will lead to erroneous diagnoses.

David Kupfer who chairs the DSM 5 committee for the American Psychiatric Association, which put the book together, and Peter Kinderman, professor and honorary Consultant Clinical Psychologist with Mersey Care NHS Trust, debate the pros and cons of the book.

Behind a subscription or pay for access

BMJ News

News
Critics attack DSM-5 for overmedicalising normal human behaviour
BMJ 2012; 344 doi: 10.1136/bmj.e1020 (Published 10 February 2012)
Cite this as: BMJ 2012;344:e1020

News Bullet.in

Grieving, shyness to be called mental illness

Courtesy: Fox News | February 10,  2012

MILLIONS of healthy people – including shy or defiant children, grieving relatives and people with fetishes – may be wrongly labeled mentally ill by a new international diagnostic manual according to a report which appeared in Fox News.

The new classification is expected to figure in the influential Diagnostic and Statistical Manual of Mental Disorders (DSM). According to Fox News, psychologists, psychiatrists and mental health experts said its new categories and “tick-box” diagnosis systems were at best “silly” and at worst “worrying and dangerous…”

Read on

Daily Mail

Shyness in a child and depression after bereavement could be classed as mental illness in controversial new reforms

Jenny Hope | February 9, 2012

Childhood shyness could be reclassified as a mental disorder under controversial new guidelines, warn experts.

They also fear that depression after bereavement and behaviour now seen as eccentric or unconventional will also become ‘medicalised’…

Read on

Telegraph

also Independent.ie

Shyness could be defined as a mental illness

By Donna Bowater | February 10, 2012

SHYNESS, bereavement and eccentric behaviour could be classed as a mental illness under new guidelines, leaving millions of people at risk of being diagnosed as having a psychiatric disorder, experts fear.

Under changes planned to the diagnosis handbook used by doctors in the US, common behavioural traits are likely to be listed as a mental illness, it was reported…

Read on

Independent

Lonely? Shy? Sad? Well now you’re ‘mentally ill’, too

Expanded psychiatric ‘bible’ will see more people needlessly medicated, experts warn

Jeremy Laurance | February, 10 2012

Mild eccentrics, oddball romantics and the lonely, shy and sad could find themselves diagnosed with a mental disorder if proposals to add new conditions to the world’s most widely used psychiatric bible go ahead, experts have warned.

A major revision of the the 1994 Diagnostic and Statistical Manual of Mental Disorders, whose fifth edition is due for publication next year, threatens to extend psychiatric diagnoses to millions of people currently regarded as normal, they say. Among the diagnostic labels are “oppositional defiance disorder” for challenging adolescents, “gambling disorder” for those compelled to have a flutter, and “hypersexual disorder” for those who think about sex at least once every 20 minutes. People crippled by shyness or suffering from loneliness could be diagnosed with “dysthymia”, defined as “feeling depressed for most of the day”.

More worrying, according to some experts, are attempts to redefine crimes as illnesses, such as “paraphilic coercive disorder”, applied to men engaged in sexual relationships involving the use of force. They are more commonly known as rapists…

Read on

Psych Central Blogs

Could Sadness And Shyness Be Mental Illnesses?

Richard Zwolinski, LMHC, CASAC | February 10, 2012

C.R. writes: No. The title of this blog post isn’t a joke. It is based on a series of alarming articles I just read about the new edition of the perennially controversial DSM.
 
In a Reuters piece, Peter Kinderman, a British clinical psychologist and head of the Institute of Psychology at Liverpool University was quoted as saying:
 
“The proposed revision to DSM … will exacerbate the problems that result from trying to fit a medical, diagnostic system to problems that just don’t fit nicely into those boxes,” said Peter Kinderman at a briefing about widespread concerns over the book in London.
 
He said the new edition – known as DSM-5 – “will pathologise a wide range of problems which should never be thought of as mental illnesses”.
 
“Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labeled as mentally ill,” he said. “It’s not humane, it’s not scientific, and it won’t help decide what help a person needs…”
 

Wales Online

Fears that grieving relatives could be labelled mentally ill

Madeleine Brindley Health Editor | February 10, 2012

CHANGES to the American “bible” of mental health disorders could see grieving relatives labelled mentally ill, experts have claimed.

In a backlash to the proposed reforms to the fourth version of the Diagnostic and Statistical Manual of Mental Disorders – known as DSM-5 – thousands of experts have spoken out against the changes…

Read on

Guardian

Psychologists fear US manual will widen mental illness diagnosis
Mental disorders listed in publication that should not exists, warn UK experts

Sarah Boseley Health editor | February 9, 2012

Hundreds of thousands of people will be labelled mentally ill because of behaviour most people would consider normal, if a new edition of what has been termed the psychiatrists’ diagnostic bible goes ahead, experts are warning…

Read on

Reuters | February 9, 2012

Shyness an illness in “dangerous” health book-experts

• Grieving relatives could be classed as ill

• Revisions mean broader diagnoses of mental disorders

• Petition signed by 11,000 health workers calls for halt

By Kate Kelland, Health and Science Correspondent

LONDON, Feb 9 (Reuters) – Millions of healthy people – including shy or defiant children, grieving relatives and people with fetishes – may be wrongly labelled mentally ill by a new international diagnostic manual, specialists said on Thursday.

In a damning analysis of an upcoming revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), psychologists, psychiatrists and mental health experts said its new categories and “tick-box” diagnosis systems were at best “silly” and at worst “worrying and dangerous”.

Some diagnoses – for conditions like “oppositional defiant disorder” and “apathy syndrome” – risk devaluing the seriousness of mental illness and medicalising behaviours most people would consider normal or just mildly eccentric, the experts said.

At the other end of the spectrum, the new DSM, due out next year, could give medical diagnoses for serial rapists and sex abusers – under labels like “paraphilic coercive disorder” – and may allow offenders to escape prison by providing what could be seen as an excuse for their behaviour, they added.

The DSM is published by the American Psychiatric Association (APA) and has descriptions, symptoms and other criteria for diagnosing mental disorders. It is used internationally and is seen as the diagnostic “bible” for mental health medicine.

More than 11,000 health professionals have already signed a petition (at http://dsm5-reform.com ) calling for the development of the fifth edition of the manual to be halted and re-thought.

“The proposed revision to DSM … will exacerbate the problems that result from trying to fit a medical, diagnostic system to problems that just don’t fit nicely into those boxes,” said Peter Kinderman, a clinical psychologist and head of Liverpool University’s Institute of Psychology at a briefing about widespread concerns over the book in London.

He said the new edition – known as DSM-5 – “will pathologise a wide range of problems which should never be thought of as mental illnesses”.

“Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labelled as mentally ill,” he said. “It’s not humane, it’s not scientific, and it won’t help decide what help a person needs.”

RADICAL, RECKLESS, AND INHUMANE

Simon Wessely of the Institute of Psychiatry, King’s College London said a look back at history should make health experts ask themselves: “Do we need all these labels?”

He said the 1840 Census of the United States included just one category for mental disorder, but by 1917 the APA was already recognising 59. That rose to 128 in 1959, to 227 in 1980, and again to around 350 disorders in the fastest revisions of DSM in 1994 and 2000.

Allen Frances, Emeritus professor at Duke University and chair of the committee that oversaw the previous DSM revision, said the proposed DSM-5 would “radically and recklessly expand the boundaries of psychiatry” and result in the “medicalisation of normality, individual difference, and criminality”.

As an unintended consequence, he said an emailed comment, many millions of people will get inappropriate diagnoses and treatments, and already scarce funds would be wasted on giving drugs to people who don’t need them and may be harmed by them.

Nick Craddock of Cardiff University’s department of psychological medicine and neurology, who also spoke at the London briefing, cited depression as a key example of where DSM’s broad categories were going wrong.

Whereas in previous editions, a person who had recently lost a loved one and was suffering low moods would be seen as experiencing a normal human reaction to bereavement, the new DSM criteria would ignore the death, look only at the symptoms, and class the person as having a depressive illness.

Other examples of diagnoses cited by experts as problematic included “gambling disorder”, “internet addiction  disorder” and “oppositional defiant disorder” – a condition in which a child “actively refuses to comply with majority’s requests” and “performs deliberate actions to annoy others”.

“That basically means children who say ‘no’ to their parents more than a certain number of times,” Kinderman said. “On that criteria, many of us would have to say our children are mentally ill.” (Reporting by Kate Kelland; Editing by Andrew Heavens)

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-5 timeline Tagged with , , , , , , ,

APA “Monitor” articles: ICD-11 and DSM-5; Frances, Rajiv Tandon on DSM-5; iCAT Analytics

February 8, 2012 by

1] ICD-11 (with contributions from WHO’s Dr Geoffery Reed) and DSM-5 articles in February edition of American Psychological Association’s “Monitor”

2] Academic article on DSM-5 by Rajiv Tandon, MD, Professor of Psychiatry, University of Florida

3] Allen Frances (who chaired the DSM-IV Task Force), Suzy Chapman and Dr Dayle Jones on DSM-5

4] Paper: Pragmatic Analysis of Crowd-Based Knowledge Production Systems with iCAT Analytics: Visualizing Changes to the ICD-11 Ontology

 

Post #137 Shortlink: http://wp.me/pKrrB-1QW

1] Two articles in the February edition of the American Psychological Association’s “Monitor”:

American Psychological Association

Monitor

Feature, February 2012, Vol 43, No. 2

Improving disorder classification, worldwide

Rebecca A. Clay  |  February 2012

With the help of psychologists, the next version of the International Classification of Diseases will have a more behavioral perspective.

Print version: page 40

What’s the world’s most widely used classification system for mental disorders? If you guessed the Diagnostic and Statistical Manual of Mental Disorders (DSM), you would be wrong.

According to a study of nearly 5,000 psychiatrists in 44 countries sponsored by the World Health Organization (WHO) and the World Psychiatric Association, more than 70 percent of the world’s psychiatrists use WHO’s International Classification of Diseases (ICD) most in day-to-day practice while just 23 percent turn to the DSM. The same pattern is found among psychologists globally, according to preliminary results from a similar survey of international psychologists conducted by WHO and the International Union of Psychological Science.

“The ICD is the global standard for health information,” says psychologist Geoffrey M. Reed, PhD, senior project officer in WHO’s Department of Mental Health and Substance Abuse. “It’s developed as a tool for the public good; it’s not the property of a particular profession or particular professional organization.”

Now WHO is revising the ICD, with the ICD-11 due to be approved in 2015. With unprecedented input from psychologists, the revised version’s section on mental and behavioral disorders is expected to be more psychologist-friendly than ever—something that’s especially welcome given concerns being raised about the DSM’s own ongoing revision process. (See “Protesting proposed changes to the DSM”.) And coming changes in the United States will mean that psychologists will soon need to get as familiar with the ICD as their colleagues around the world…

…”Since the rest of the world will be adopting the ICD-11 when it is released in 2015, the CDC will likely make annual updates to gradually bring the ICD-10-CM into line with the ICD-11 to avoid another abrupt shift. But the differences between the DSM and the ICD may grow even greater over time, says Reed, depending on the outcomes of the ICD and DSM revision processes.”

For more information about the ICD revision, visit the World Health Organization.

Rebecca A. Clay is a writer in Washington, D.C.

Read full article here

American Psychological Association

Monitor

February 2012, Vol 43, No. 2

Print version: page 42

Protesting proposed changes to the DSM

When President David N. Elkins, PhD, and two colleagues within APA’s Div. 32 (Society for Humanistic Psychology) heard about the proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), they were alarmed. But what could three people do?

Plenty, as it turns out.

Although their original aim was simply to educate the division’s members, Elkins, Secretary Brent Dean Robbins, PhD, and student representative Sara R. Kamens soon decided to share their concerns in an open letter to the American Psychiatric Association. Thinking it would pack more punch with a few more signatures, they posted it online last October.

The response astounded them. “Within two days, we had more than 1,500 signatures,” says Elkins. So far, more than 10,000 individuals and 40 mental health organizations have signed on, and media outlets as diverse as Nature, USA Today and Forbes have covered the controversy. APA, which has no official position on the controversy, urges its members to get involved in the debate (see APA’s statement in the January Monitor, page 10).

The open letter outlines three major concerns with the proposed draft of the DSM-5, set for publication in 2013…

Read full article here

2] Article by Rajiv Tandon, MD, Professor of Psychiatry, University of Florida:

Current Psychiatry

Vol. 11, No. 02 / February 2012

Getting ready for DSM-5: Part 1

The process, challenges, and status of constructing the next diagnostic manual

Rajiv Tandon, MD  |  February 2012
Professor of Psychiatry, University of Florida, Gainesville, FL

Discuss this article at www.facebook.com/CurrentPsychiatry

Work on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—scheduled to be published in May 2013—has been ongoing for more than a decade. Momentous advances in genetics and brain imaging since publication of DSM-IV in 1994 have generated optimism that an improved understanding of the neurobiologic underpinnings of psychiatric disorders might lead to a paradigm shift from the current descriptive classification system to a more scientific etiopathophysiological system similar to that used by other medical specialities.1

Some fear that any changes to our current classification system may be premature and could make an already complex system even more unwieldy.2 Scores of articles about the content and process of DSM-5 and several critiques and commentaries on the topic have been published. The American Psychiatric Association (APA) has made the DSM-5 process transparent by posting frequent updates to the DSM-5 Development Web site (www.dsm5.org), seeking feedback from the psychiatric community and the public, and presenting progress reports by members of the DSM-5 Task Force at scientific meetings.

There have been few discussions on the implications of DSM-5 from the practicing clinician’s vantage point, which I seek to present in this series of articles, the remainder of which will be published here, at CurrentPsychiatry.com…

Read on here

 

3] Allen Frances, MD, in Psychology Today and Psychiatric Times

Registration required for access to article on Psychiatric Times

DSM5 in Distress

PTSD, DSM 5, and Forensic Misuse
DSM 5 would lead to overdiagnosis in legal cases.

Allen Frances, MD | February 9, 2012

————————————————————

Documentation That DSM-5 Publication Must Be Delayed
because DSM 5 is so far behind schedule

Allen Frances, MD | February 7, 2012

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

Last week, I wrote that DSM-5 is so far behind schedule it can’t possibly produce a usable document in time for its planned publication date in May 2013.¹ My blog stimulated 2 interesting responses that illustrate the stark contrast between DSM-5 fantasy and DSM-5 reality. Together they document why publication must be delayed if DSM-5 is to be set right. The first email came from Suzy Chapman of Dx Revision Watch https://dxrevisionwatch.wordpress.com

Re DSM-5 delays, here is a telling statement made by Dr Darrel Regier, its Vice Chair, on March 9, 2010: “We have just released draft criteria on a website on February 10th at dsm5.org. And we’ll be having a field trial starting in July of this year. We’ll then have another revision based on field trial results going into a second revision or second field trial in July of 2011. As a result, we will not have our final recommendations for the DSM-V probably until early 2011.”  She continues,

Please note the dates. Dr Regier’s promised timetable has been missed by more than a year—we still don’t have final recommendations.

Dayle Jones, PhD, is head of the Task Force of the American Counseling Association that monitors DSM-5. She sent in a timeline comparing DSM-5 promised deadlines with actual delivery dates:

The DSM-5 academic/large clinic field trials were designed to have two phases. Phase 1 was first scheduled to begin in June 2009, but had to be postponed for a year because the criteria sets were not ready. The timetable for field trial completion was unrealistic from the start and not surprisingly the end dates have been repeatedly postponed from early 2010 to early 2011, and we’re now already into 2012 with no end in sight. Phase 2, originally scheduled for September 2011 to February 2012, was to re-test those diagnoses that did poorly in Phase 1 and had to be revised. The phase 2 trials were quietly canceled. We still don’t have results from the phase 1 field trials, but the APA leadership has warned us that we must accept reliabilities that are barely better than chance. Without the second stage, uncorrected problem diagnoses will be included in DSM-5.

The separate clinician field trial has been an even worse disaster. Clinicians were originally scheduled to be trained by August 2010, enrolling patients no later than late November 2010, and ending by February, 2011. Training was finally completed 18 months late in December 2011, which means the earliest these trials could possibly end is June 2012—well after most DSM-5 final decisions will have been made. Furthermore, of the over 5000 clinicians who registered to participate, only 70 (1.4%) have begun enrolling patients for the field trial. My guess is that like academic/large clinic Phase 2 field trial, poor planning and disorganization will force cancellation.

Dr Jones concludes,

In my opinion, there is no process and not enough time left to ensure that DSM-5 will attain high enough quality to be used by counselors. Fortunately, we can always bypass it by using ICD-10-CM.

Sobering stuff. Its constant procrastination has at last caught up with DSM-5. Having fallen so far behind schedule, DSM-5 abruptly dropped the second stage of field-testing—without public comment or justification or discussion of what would be the effects on quality and reliability. In fact, the second stage of the field trials was perhaps the most crucial step in the entire DSM-5 process—a last chance for sorely needed quality control to bring a lagging DSM-5 up to acceptable standards. The DSM-5 proposals that were weak performers in the first stage were supposed to be rewritten and retested in the second to ensure that they deserved to be included in the manual.

The American Psychiatric Association (APA) is now stuck with the most unpalatable of choices—protecting the quality of DSM-5 versus protecting the publishing profits to be gained by premature publication. Given all the delays, it can’t possibly do both—a quality DSM-5 cannot be delivered in May 2013.

All along, it was predictable (and predicted), that DSM-5 disorganization would lead to a mad, careless dash at the end. The DSM’s have become far too important to be done in this slapdash way—the high cost to users and the public of this rush to print is unacceptable. Unless publication is delayed, APA will be offering us official DSM-5 criteria that are poorly written, inadequately tested, and of low reliability. The proper alternative is clear: APA should delay publication of DSM-5 until it can get the job done right. Public trust should always trump publishing profits.

Let’s close with a worrying and all too illustrative quote from Dr Regier, just posted by Scientific American.² When asked if revisions to criteria in DSM-5 could be completed by the end of this year, he said “there is plenty of time.” I beg to differ—there is not nearly enough time if the changes are to be done based on a much needed independent scientific review and are to be tested adequately in Phase 2 of the field trial. Without these necessary steps DSM-5 will be flying blind toward the land of unintended consequences.

References
1. Frances A. APA should delay publication of DSM-5. January 31, 2012. Psychiatr Times. http://www.psychiatrictimes.com/blog/frances/content/article/10168/2024394

2. Jabr F. Redefining autism: will new DSM-5 Criteria for ASD exclude some people? January 30, 2012. Sci Am. http://www.scientificamerican.com/article.cfm?id=autism-new-criteria  Accessed February 7, 2012.

 

4] Paper: Pragmatic Analysis of Crowd-Based Knowledge Production Systems with iCAT Analytics: Visualizing Changes to the ICD-11 Ontology

     Pragmatic Analysis – iCAT Analytics 2012

Pragmatic Analysis of Crowd-Based Knowledge Production Systems with iCAT Analytics: Visualizing Changes to the ICD-11 Ontology

http://kmi.tugraz.at/staff/markus/documents/2012_AAAI_iCATAnalytics.pdf

Jan P¨oschko and Markus Strohmaier, Knowledge Management Institute, Graz University of Technology, Inffeldgasse 21a/II, 8010 Graz, Austria

Tania Tudorache and Natalya F. Noy and Mark A. Musen, Stanford Center for Biomedical Informatics Research, 1265 Welch Road, Stanford, CA 94305-5479, USA

Abstract

While in the past taxonomic and ontological knowledge was traditionally produced by small groups of co-located experts, today the production of such knowledge has a radically different shape and form. For example, potentially thousands of health professionals, scientists, and ontology experts will collaboratively construct, evaluate and  maintain the most recent version of the International Classification of Diseases (ICD-11), a large ontology of diseases and causes of deaths managed by the World Health Organization. In this work, we present a novel web-based tool-iCAT Analytics-that allows to investigate systematically crowd-based processes in knowledge-production systems. To enable such investigation, the tool supports interactive exploration of pragmatic aspects of ontology engineering such as how a given ontology evolved and the nature of changes, discussions and interactions that took place during its production process. While iCAT Analytics was motivated by ICD-11, it could potentially be applied to any crowd-based ontology-engineering project. We give an introduction to the features of iCAT Analytics and present some insights specifically for ICD-11.

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 field trials, iCAT, ICD-11 Tagged with , , , , , , , , ,

DSM-5 media round up: Grief, autism spectrum disorder, Paraphilias Sub workgroup, medical ethics

January 26, 2012 by

DSM-5 media round up: Grief, autism spectrum disorder, Paraphilias Sub workgroup, medical ethics

Post #133 Shortlink: http://wp.me/pKrrB-1J8

The Coffee Klatch

Allen Frances talked to The Coffee Klatch Parents strand on January 25, 2012
 
Audio
 
Dr Allen Frances Chair of the DSM-IV Task Force returns to discuss the confusion and concerns over the soon to be released DSMV.  How will the changes impact your child?  What do the changes mean for your childs accommodations? Why are so many additions and revisions causing so much controversy?  

New York Times

When does a broken heart become a diagnosis?

Grief Could Join List of Disorders

Benedict Carey | January 24, 2012

In a bitter skirmish over the definition of depression, a new report contends that a proposed change to the diagnosis would characterize grieving as a disorder and greatly increase the number of people treated for it.

The criteria for depression are being reviewed by the American Psychiatric Association, which is finishing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., the first since 1994. The manual is the standard reference for the field, shaping treatment and insurance decisions, and its revisions will affect the lives of millions of people for years to come.

In coming months, as the manual is finalized, outside experts will intensify scrutiny of its finer points, many of which are deeply contentious in the field. A controversy erupted last week over the proposed tightening of the definition of autism, possibly sharply reducing the number of people who receive the diagnosis. Psychiatrists say current efforts to revise the manual are shaping up as the most contentious ever…

Full article

Psychiatric News

APA Responds to N.Y. Times Article on Proposed DSM Change

Psychiatric News Alert | January 25, 2012

…The proposed elimination of the bereavement exclusion—which like all proposals for DSM-5 is still being reviewed—is the subject of an article in the New York Times today citing researchers at Columbia who claim that removing the exclusion would medicalize normal grief.

But Jan Fawcett, M.D., chair of the work group, told Psychiatric News that people who develop the symptoms and the level of impairment associated with major depression should have access to treatment. And he wondered: Is there any difference between depression that occurs in response to grief and that which occurs in response to any other life stress? “Where do you draw the line?” he asked…

Full article

Bloomberg News

Psychiatric Group Push to Redefine Mental Illness Sparks Revolt

Elizabeth Lopatto | January 24, 2012

An effort that promises to broaden the definitions of mental illnesses is spurring a revolt among health-care professionals in the U.S. and the U.K…

…The October letter and the June criticism by the British Psychological Association, have a spirited exchange that resulted this month in the critics calling for an independent scientific review of the more controversial diagnosis changes.

“It really isn’t possible to identify what kind of outside group would have the expertise and range of discipline and disorders we’re covering to do that kind of outside review,” Regier said by telephone. Still, he said the panel members are interested in the criticisms of their proposals and “we’re not taking them lightly.”

Full article here

Response from Allen Frances, MD

DSM5 in Distress

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

Defenses From DSM 5 Get ‘Curiouser and Curiouser’
Trying to defend the indefensible

Allen Frances, MD | January 24, 2012

Elizabeth Lopatto has written an excellent piece in today’s Bloomberg News summarizing concerns that DSM 5 will expand the boundaries of psychiatry, increase the already existing diagnostic inflation, and promote the excessive use of medications to treat life problems that don’t really require them.

The Vice Chair of the DSM 5 Task Force tries to defend DSM 5 but with statements that have a strange Alice-in-Wonderland out-of-touch-with-reality quality…

Full article

Allen Frances on Huffington Post

Don’t Confuse Grief with Depression | January 27, 2012

The Autism Controversy Revisited | January 22, 2012

Why Are Kids Suddenly So Sick? | January 20, 2012

Preventive Psychiatry Can Be Bad for Our Health | January 19, 2012

America Is Over Diagnosed and Over Medicated | January 09, 2012

Lifespan News

The Impact Of Deleting Five Personality Disorders In The New DSM-5

January 24, 2012

“When it comes to revising the official diagnostic classification system, the guiding principle should be that criteria should not be changed in the absence of research demonstrating that the new approach is superior to the old in either validity or clinical utility, preferably both,” Zimmerman states. “Despite assurances that only data-driven modification would be made, with each new edition of the DSM, we have witnessed repeated instances of changes being made in the absence of sufficient data demonstrating the new criteria is superior…”

…Zimmerman comments, “The findings of the present study highlight our concerns about adopting changes in the diagnostic manual without adequate empirical evaluation beforehand. To be sure, there are problems with the classification of personality disorders, however, the identification of a problem is only the first step of a process resulting in a change to diagnostic criteria.”

He concludes, “The classification of personality disorders would not be improved if the new criteria or diagnostic material were more clinically useful but less reliable and valid.”

Full article

Sexual Abuse: A Journal of Research and Treatment

A Guest Blog by DSM-5 Paraphilias Subworkgroup Chair Dr. Ray Blanchard on Proposed Criteria for Pedophilic Disorder

Ray Blanchard PhD | January, 24 2012

NOTE: This guest blog comes to you authored by Ray Blanchard, Ph.D., who is an Adjunct Professor, Department of Psychiatry, University of Toronto and an Affiliate Scientist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. He is also the Chair of the Paraphilias Subworkgroup for the DSM-5 Work Group on Sexual and Gender Identity Disorders and was the 2010 recipient of ATSA’s Significant Achievement Award.

The Proposal to Add Intense or Preferential Sexual Interest in Early Pubescent Children to the DSM-5 Diagnosis of Pedophilic Disorder

Ray Blanchard, Ph.D.

The proposal of the DSM-5 Work Group on Sexual and Gender Identity Disorders to extend the definition of Pedophilic Disorder to include preferential attraction to children in the early stages of puberty has prompted an extraordinarily vigorous and often misleading rhetorical campaign by its opponents. Although debate on this topic may be healthy, deliberate distortion and disinformation are not. I am therefore writing this piece to give an accurate account of the Work Group’s reasons for this proposal. All of the arguments in it have previously been made in conference presentations, in print documents (usually authored by members of the Paraphilias Subworkgroup of the Work Group on Sexual and Gender Identity Disorders), and in on-line sources (http://www.dsm5.org/). This piece simply puts these arguments together in one convenient and readily accessible place.

Full article

 

DSM-5 proposals and autism spectrum disorder (ASD)

A good deal published over the last week around DSM-5 proposals and autism spectrum disorder (ASD) which can be pulled up via Google News. Selected items:

American Psychiatric Association put out this News Release (Release No. 12.03) on January 20, 2012:

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

ARLINGTON, Va. (Jan. 20, 2012)—The American Psychiatric Association (APA) has proposed new diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for autism. While final decisions are still months away, the recommendations reflect the work of dozens of the nation’s top scientific and research minds and are supported by more than a decade of intensive study and analysis. The proposal by the DSM-5 Neurodevelopmental Work Group recommends a new category called autism spectrum disorder which would incorporate several previously separate diagnoses, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified.

The proposal asserts that symptoms of these four disorders represent a continuum from mild to severe, rather than a simple yes or no diagnosis to a specific disorder. The proposed diagnostic criteria for autism spectrum disorder specify a range of severity as well as describe the individual’s overall developmental status–in social communication and other relevant cognitive and motor behaviors.

Dr. James Scully, Medical Director of the American Psychiatric Association said, “The proposed criteria will lead to more accurate diagnosis and will help physicians and therapists design better treatment interventions for children who suffer from autism spectrum disorder.”

The draft DSM-5 criteria will provide a more useful dimensional assessment to improve the sensitivity and specificity of the criteria. This change will help clinicians more accurately diagnose people with relevant symptoms and behaviors by recognizing the differences from person to person, rather than providing general labels that tend not to be consistently applied across different clinics and centers.

Proposed DSM-5 criteria are being tested in real-life clinical settings known as field trials. Field testing of the proposed criteria for autism spectrum disorder does not indicate that there will be any change in the number of patients receiving care for autism spectrum disorders in treatment centers–just more accurate diagnoses that can lead to more focused treatment.

Criteria proposed for DSM-5 are posted on the DSM-5 website and will be open for additional public comment this spring. More information on the process for developing DSM-5 is also available on the website. Final publication of DSM-5 is planned for May 2013.

DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric Association (APA) will publish DSM-5 in 2013, culminating a 14-year revision process. For more information, go to www.dsm5.org .

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention, and research of mental illnesses including substance use disorders. Visit the APA  at www.psych.org, www.psychiatryonline.org, and www.HealthyMinds.org.

and published this Alert on Psychiatric News website:

Autism Spectrum Disorder Proposed for DSM-5 Would Cover Those With Asperger’s

January 20, 2012

After much study, the DSM-5 Neurodevelopemental Disorders Work Group has concluded that there is no evidence to support continued separation of autism spectrum disorder (ASD) diagnoses, Susan Swedo, M.D., the work group chair, told Psychiatric News. “That is why we’ll be recommending that DSM-5 utilize a single diagnosis—ASD.”

The move to a single diagnosis of autism spectrum disorder would eliminate Asperger’s disorder and pervasive developmental disorder-not otherwise specified as separate diagnoses. They are included in DSM-IV. The possible elimination of Asperger’s has proven controversial, as evidenced by an article in the New York Times yesterday suggesting that the proposed change would narrow the definition and exclude people in need of a diagnosis and treatment. But in fact, adults or children diagnosed with Asperger’s according to DSM-IV criteria would meet criteria for autism spectrum disorder, with “specifiers” that help clinicians identify patients who have individual differences…

Full News Alert

New York Times

From Benedict Carey for NYT:

New Definition of Autism Will Exclude Many, Study Suggests

Benedict Carey | January 19, 2012

Proposed changes in the definition of autism would sharply reduce the skyrocketing rate at which the disorder is diagnosed and might make it harder for many people who would no longer meet the criteria to get health, educational and social services, a new analysis suggests.

The definition is now being reassessed by an expert panel appointed by the American Psychiatric Association, which is completing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, the first major revision in 17 years. The D.S.M., as the manual is known, is the standard reference for mental disorders, driving research, treatment and insurance decisions. Most experts expect that the new manual will narrow the criteria for autism; the question is how sharply…

Amy Harmon contributed reporting.

Full article

From Amy Harmon for NYT:

A Specialists’ Debate on Autism Has Many Worried Observers

Amy Harmon | January 20, 2012

Full article

A debate among medical professionals over how to define autism has spilled over into the public domain, stirring anger and fear among many parents and advocates of those with the neurological disorder, even as some argue that the diagnosis has been too loosely applied.

A study reported on Thursday found that proposed revisions to the American Psychiatric Association’s definition would exclude about three-quarters of those now diagnosed with milder forms of autism called Asperger syndrome or “pervasive developmental disorder, not otherwise specified,” also known as P.D.D.-N.O.S. These are people who have difficulties with social interaction but do not share the most severe impairments of children with classic autism.

From Deborah Brauser for Medscape Medical News

From Medscape Medical News > Psychiatry

Concern Over Changes to Autism Criteria Unfounded, Says APA

Deborah Brauser | January 25, 2012

January 25, 2012 — Concerns that proposed changes to autism criteria in the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) will exclude many individuals from diagnosis and treatment are unfounded, says the American Psychiatric Association (APA)…

Full article

Dr. William Narrow Gives Update on DSM-5

William Narrow, M.D., provides an update on the progress of DSM-5.

3:02 mins | Uploaded January 17, 2012

Dr William Narrow is DSM-5 Research Director

Virtual Mentor

American Medical Association Journal of Ethics

December 2011, Volume 13, Number 12: 873-879.

STATE OF THE ART AND SCIENCE

Patient-Centered Revisions to the DSM-5

Emily A. Kuhl, PhD, David J. Kupfer, MD, and Darrel A. Regier, MD, MPH

The forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 [1]) will mark the first time in nearly 2 decades that the field has overhauled the way mental illnesses are diagnosed and classified. Anticipation of the DSM-5 has been high, and recent discussions about changes likely to be adopted have focused largely on the manual’s increased integration of scientific and clinical evidence in support of proposed revisions [2, 3]. An equally important, though perhaps less frequently heard, voice in this dialogue concerns the potential ethical consequences of the DSM-5’s draft revisions.

The therapeutic alliance between psychiatrist and patient is unique and requires constant vigilance on ethical matters of self-harm or harm to others, confidentiality, legal aspects of diagnosis and treatment (e.g., competency), patient autonomy, involvement of third parties, dual agency and dual relationships, and patient stigma. This last issue is of particular concern; perhaps more so than in any other area of medicine, stigma has become a routine aspect of the lived experience for many people with mental illnesses.

PDF or Open here on Dx Revision Watch Patient-Centred Revisions to the DSM-5

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-V Tagged with , , , , , , , , ,

DSM 5 and Diagnostic Inflation: Reply To Misleading Comments From Task Force: Allen Frances

January 24, 2012 by

Post #132 Shortlink: http://wp.me/pKrrB-1IP

Allen Frances, MD, who chaired the Task Force that had oversight of the development of DSM-IV, is currently professor emeritus, Duke University.

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

DSM 5 and Diagnostic Inflation
Reply To Misleading Comments From The Task Force

Allen Frances, MD | January 23, 2012

My biggest concern regarding DSM-5 is that it will dramatically increase the rates of mental disorder by cheapening the currency of psychiatric diagnosis—arbitrarily and carelessly reducing thresholds for existing disorders and introducing new disorders with high prevalence. This would create millions of newly mislabeled “patients,” resulting in unnecessary and potentially harmful treatment, stigma, and wasteful misallocation of scarce resources…

Read on

also at

Psychiatric Times

DSM-5 and Diagnostic Inflation: Reply to the DSM-5 Task Force
Allen Frances, MD | January 23, 2012

Free registration required to access Psychiatric Times article.

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 field trials, DSM-5 in the media, DSM-V Tagged with , , , , , , , , ,

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