DSM-5 Round up: January #2

DSM-5 Round up: January #2

Post #220 Shortlink: http://wp.me/pKrrB-2Ce

Round up of recent media coverage of DSM-5 issues from US and UK spanning January 18 to January 28:

Scientific American

The Newest Edition of Psychiatry’s “Bible,” the DSM-5, Is Complete

The APA has finished revising the DSM and will publish the manual’s fifth edition in May 2013. Here’s what to expect

Ferris Jabr | January 28, 2013

For more than 11 years, the American Psychiatric Association (APA) has been laboring to revise the current version of its best-selling guidebook, the Diagnostic and Statistical Manual of Mental Disorders (DSM) (see “Psychiatry’s Bible Gets an Overhaul” in Scientific American MIND). Although the DSM is often called the bible of psychiatry, it is not sacred scripture to all clinicians—many regard it more as a helpful corollary to their own expertise. Still, insurance companies in the U.S. often require an official DSM diagnosis before they help cover the costs of medication or therapy, and researchers find it easier to get funding if they are studying a disorder officially recognized by the manual. This past December the APA announced that it has completed the lengthy revision process and will publish the new edition—the DSM-5—in May 2013, after some last (presumably minor) rounds of editing and proofreading. Below are the APA’s final decisions about some of the most controversial new disorders as well as hotly debated changes to existing ones, including a few surprises not anticipated by close observers of the revision process…

Update: New material above

New York Times | New Old Age Blogs | Medical Issues

Time to Recognize Mild Cognitive Disorder?

Paula Span| January 25, 2013

Dr. Allen Frances, chairman of the task force that developed the previous Diagnostic and Statistical Manual of Mental Disorders, predicts inclusion of Mild Neurocognitive Disorder in the new version will lead to “wild overdiagnosis.”

The Diagnostic and Statistical Manual of Mental Disorders, published and periodically updated by the American Psychiatric Association, is one of those documents few laypeople ever read, but many of us are affected by…

Medscape Medical News Psychiatry

No Impact of DSM-5 Criteria on Alcohol Disorder Prevalence

Deborah Brauser | January 25, 2013

Although criteria used to assess serious alcohol problems will be revised in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), these changes will not likely affect the prevalence of these disorders, new research suggests…

Huffington Post Blogs | Allen Frances, MD

Why Will DSM-5 Cost $199 a Copy?

Allen Frances, MD | January 25, 2013

DSM-5 has just announced its price — an incredible $199 (and the paperback is also no bargain at a hefty $149). Compare this to $25 for a DSM III in 1980; $65 for a DSM IV in 1994; and $84 for a DSM-IV-TR in 2000. The price tag on a copy of DSM is escalating at more than twice the rate of inflation.

What’s going on?

Huffington Post Blogs | Allen Frances, MD

Terrible News: DSM-5 Refuses to Reduce Overdiagnosis of ‘Somatic Symptom Disorder’

Allen Frances, MD | January 18, 2013

Many of you will have read a previous blog prepared by Suzy Chapman and me that contained alarming information about the new DSM-5 diagnosis “somatic symptom disorder” (SSD).

DSM-5 defines SSD so over-inclusively that it will mislabel one in six people with cancer and heart disease, one in four with irritable bowel syndrom and fibromyalgia, and one in 14 who are not even medically ill.

I hoped to be able to influence the DSM-5 work group to correct this in two ways: 1) by suggesting improvements in the wording of the SSD criteria set that would reduce mislabeling, and 2) by letting them know how much opposition they would face from concerned professionals and an outraged public if DSM-5 failed to slam on the brakes while there was still time…

New York Times | New Old Age Blogs | Medical Issues

Grief Over New Depression Diagnosis

Paula Span | January 24, 2013, 6:40 am

The next edition of the Diagnostic and Statistical Manual of Mental Disorders will not only abandon the Roman numerals, but will also leave grief considerations out of diagnoses for depression.
When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue…

TIME | Alcohol

Revisions to Mental Health Manual May Turn Binge Drinkers into ‘Mild’ Alcoholics

Maia Szalavitz | January 23, 2013

Are you an alcoholic— or just a problem drinker? It may not matter, according to the latest version of the DSM, psychiatry’s diagnostic manual.

And now, in a new study of the different levels of alcohol misuse, scientists say the changes made to the DSM-5 may not even represent a significant improvement in the diagnosis of alcoholism. In fact, the revised definition collapses the medical distinction between problem drinking and alcoholism, potentially leading college binge drinkers to be mislabeled as possible lifelong alcoholics. The changes take effect in May, when the DSM-5 will be released…

EurekAlert! Press Release | January 22, 2013

Will Proposed DSM-5 Changes to Assessment of Alcohol Problems Do Any Better?

Proposed changes to the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will affect the criteria used to assess alcohol problems. One change would collapse the two diagnoses of alcohol abuse (AA) and alcohol dependence (AD) into a single diagnosis called alcohol use disorder (AUD). A second change would remove “legal problems,” and a third would add a criterion of “craving.” A study of the potential consequences of these changes has found they are unlikely to significantly change the prevalence of diagnoses…

Medpage Today

Psych Group Posts Glimpses of Final DSM-5

John Gever, Senior Editor, MedPage Today | January 21, 2013

Peeks into the final DSM-5, the controversial new edition of the American Psychiatric Association’s diagnostic manual, are now available from the group prior to the guide’s official May 22 debut…

British Psychological Society

Professor Peter Kinderman writes on DSM-5 for the BBC News website

January 18, 2013

People diagnosed with a mental illness need help and understanding, not labels and medication. That is the message of an article published on the BBC News Health pages today by Professor Peter Kinderman from the University of Liverpool, a former chair of our Division of Clinical Psychology…

[BBC News Health report below]

BBC News Health

‘Grief and anxiety are not mental illnesses’

Peter Kinderman, Professor of Clinical Psychology | January 18, 2013

The forthcoming edition of an American psychiatric manual will increase the number of people in the general population diagnosed with a mental illness – but what they need is help and understanding, not labels and medication.

Many people experience a profound and long-lasting grieving process following the death of a loved one. Many soldiers returning from conflict suffer from trauma. Many of us are shy and anxious in social situations or unmotivated and pessimistic if we’re unemployed or dislike our jobs…

Psychiatric Times

DSM-5 Field Trials: What Was Learned

James Phillips, MD | January, 8 2013

With DSM-5 now approved by the APA Board of Trustees—and, to the dismay of this reader, all discussion removed from the DSM-5 Web site—how are we to evaluate the results of the field trials for the end product? I suggest beginning with the short piece published in Psychiatric News, “What We Learned from DSM-5 Field Trials.”1 Authors David Kupfer and Helena Kraemer wrote, “We ultimately tested the criteria for 23 disorders. The question we asked was a straightforward one: In the hands of regular clinicians, assessing typically symptomatic patients in no different way than they would during everyday practice, was a particular disorder reliable?”

DSM-5 Round up: January #1

DSM-5 Round up: January #1

Post #218 Shortlink: http://wp.me/pKrrB-2Bs

American Journal of Psychiatry

Editorials | January 01, 2013

The Initial Field Trials of DSM-5: New Blooms and Old Thorns

Robert Freedman, M.D.; David A. Lewis, M.D.; Robert Michels, M.D.; Daniel S. Pine, M.D.; Susan K. Schultz, M.D.; Carol A. Tamminga, M.D.; Glen O. Gabbard, M.D.; Susan Shur-Fen Gau, M.D., Ph.D.; Daniel C. Javitt, M.D., Ph.D.; Maria A. Oquendo, M.D., Ph.D.; Patrick E. Shrout, Ph.D.; Eduard Vieta, M.D., Ph.D.; Joel Yager, M.D.

Am J Psychiatry 2013;170:1-5. 10.1176/appi.ajp.2012.12091189

View Author and Article Information
Copyright © 2013 by the American Psychiatric Association


“A rose is a rose is a rose” (1). For psychiatric diagnosis, we still interpret this line as Robins and Guze did for their Research Diagnostic Criteria—that reliability is the first test of validity for diagnosis (2). To develop an evidence-based psychiatry, the Robins and Guze strategy (i.e., empirically validated criteria for the recognizable signs and symptoms of illness) was adopted by DSM-III and DSM-IV. The initial reliability results from the DSM-5 Field Trials are now reported in three articles in this issue (3–5). As for all previous DSM editions, the methods used to assess reliability reflect current standards for psychiatric investigation (3). Independent interviews by two different clinicians trained in the diagnoses, each prompted by a computerized checklist, assessment of agreement across different academic centers, and a pre-established statistical plan are now employed for the first time in the DSM Field Trials. As for most new endeavors, the end results are mixed, with both positive and disappointing findings…

Full free text

Washington Post

Antidepressants to treat grief? Psychiatry panelists with ties to drug industry say yes

Peter Whoriskey | December 27, 2012

It was a simple experiment in healing the bereaved: Twenty-two patients who had recently lost a spouse were given a widely used antidepressant.

The drug, marketed as Wellbutrin, improved “major depressive symptoms occurring shortly after the loss of a loved one,” the report in the Journal of Clinical Psychiatry concluded.

When, though, should the bereaved be medicated? For years, the official handbook of psychiatry, issued by the American Psychiatric Association, advised against diagnosing major depression when the distress is “better accounted for by bereavement.” Such grief, experts said, was better left to nature.

But that may be changing…

Medscape Medical News > Psychiatry

APA Answers Criticism of Pharma-Influenced Bias in DSM-5

Deborah Brauser | January 4, 2013

The American Psychiatric Association (APA) has fired back a strong response to a recent article by the Washington Post questioning the possibility of pharmaceutical industry influence on decisions regarding the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)…

Ed: Note for watchers of DSM-5’s Timeline. Although the Timeline has the final texts schedule for submission to the publishers by December 2012, in his commentary below, Dr Frances discloses that DSM-5 will go to press at the end of January. The new edition of DSM is slated for release at the APA’s 166th Annual Meeting, May 18-22, 2013, San Francisco.

Psychology Today

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

Last Plea to DSM 5: Save Grief From the Drug Companies
Let us respect the dignity of love and loss.

Allen J. Frances, M.D. | January 3, 2013

Psychiatric News
Psychiatric News | January 04, 2013
Volume 48 Number 1 page 7-7
American Psychiatric Association
Professional News

Eating-Disorders Guideline Still Current and Valid, Panel Finds

Mark Moran | January 4, 2013

A review of the 2006 APA practice guideline on eating disorders finds that it is substantially current and is not affected by changes in diagnostic criteria in DSM-5.

Huffington Post

‘Eating Disorders Not Otherwise Specified’: What’s Changing With EDNOS In DSM-5?

Catherine Pearson | January 4, 2013

It took Autumn Whitefield-Madrano more than 20 years to seek treatment for her eating disorder. The writer was 9 when she started having symptoms, primarily binging, and 33 when she finally got help. When she did, the diagnosis surprised her. Whitefield-Madrano had EDNOS, or an “Eating Disorder Not Otherwise Specified…”

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

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

Post #144 Shortlink: http://wp.me/pKrrB-1V2

Previous Post #143:

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


Christopher Lane, Ph.D.:  Good Grief: The APA Plans to Give the Bereaved Two Weeks to Conclude Their Mourning, Britain’s “Lancet” calls the proposal “dangerously simplistic and flawed.”

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




Libby Purves, columnist and author, lost a son in his late teens to suicide.

The Times

Why must grief be a sign of mental illness?

Libby Purves | February 20, 2012

Treating the bereaved for depression after two weeks typifies our urge to medicalise everyday experience…

Content behind sub or paywall



From Medscape Medical News > Psychiatry

Lancet Weighs in on DSM-5 Bereavement Exclusion

Megan Brooks | February 16, 2012

February 16, 2012 — An editorial that appears in this week’s Lancet expresses concerns about the proposed elimination of the bereavement exclusion to major depression in the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association (APA)…

Read on


Daily Mail

Lancet urges doctors to treat grief with empathy, not pills

Lauren Paxman | February 17, 2012

‘Grief is not a mental illness that should be treated with pills’: Doctors hit back at creeping medicalisation of life events

Treatment of grief with antidepressants is ‘dangerously simplistic’, experts say

Backlash follows the American Psychiatric Association’s reclassification of grief as a mental illness. In an unsigned editorial in the influential medical journal The Lancet, experts argue that grief does not require psychiatrists and that ‘legitimising’ the treatment of grief with antidepressants ‘is not only dangerously simplistic, but also flawed.’ 

Read on


ABC News Radio

February 17, 2012

Grief: Normal, Not A Mental Illness

(NEW YORK) — Grief following the death of a loved one isn’t a mental illness that requires psychiatrists and antidepressants, according to editors of The Lancet, who oppose “medicalizing” an often-healing response to overwhelming loss.

Routinely legitimizing the treatment of grief with antidepressants “is not only dangerously simplistic, but also flawed,” says the unsigned lead editorial appearing in Friday’s edition of the influential international medical journal. “Grief is not an illness; it is more usefully thought of as part of being human and a normal response to the death of a loved one.”

Read On


The Australian

Individual difference suffers in the neverending explosion of mental illness

Frank Furedi | February 18, 2012

YOU may be suffering from a mental illness that you never realised existed. The American Psychiatric Association has just published a draft version of the updated edition of its Diagnostic and Statistical Manual. According to this diagnostic bible, called DSM-5, shyness in children and confusion over gender is likely to be labelled as a mental disorder.

Read on for subscribers




Good Grief! Psychiatry’s Struggle to Define Mental Illness Goes Awry

A proposed new definition of depression would include normal bereavement. Why that’s a bad idea.

Maia Szalavitz | @maiasz | February 17, 2012

The editors of the forthcoming fifth edition of the Diagnostic and Statistical Manual — psychiatry’s diagnostic handbook — are having a hard time. They’ve been attacked by autism advocacy groups for proposing to eliminate the Asperger’s diagnosis. They’ve been slammed for adding a diagnosis, or “prediagnosis,” for people determined to be “at high risk” of developing schizophrenia. And, now, they’re being pummeled for introducing a provision to diagnose grief as depression…

Read on



Grief is not an illness, warns The Lancet

Stephen Adams Medical Correspondent | February 17, 2012

Bereaved relatives overcome by grief should not be given pills and treated as if they are clinically depressed, a leading medical journal warns today (Fri).

“Grief is not an illness”, say the journal’s editors in an impassioned editorial, which argues that “medicalising” such a normal human emotion is “not only dangerously simplistic, but also flawed”.

Doctors tempted to prescribe pills “would do better to offer time, compassion, remembrance and empathy”, they write.

The editors are worried by moves which appear to categorise extreme emotions as problems that need fixing.

Their fears have been prompted by the publication of a new draft version of the psychiatrists’ ‘bible’, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, known as DSM-5…

Read on


Inside Ireland

The Lancet: Grief is not an illness

Sarah Greer | February 17, 2012

A leading medical journal has today warned that bereaved relatives should not be given pills and treated as if they are clinically depressed.

“Grief is not an illness,” the journal’s editors say. They argue that ‘medicalising’ such a normal human emotion is ‘not only dangerously simplistic, but also flawed’, and say doctors who are tempted to prescribe pills ‘would do better to offer time, compassion, remembrance and empathy’.

The editors are worried by moves which appear to categorise extreme emotions as problems that need fixing…

Read on


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

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

Post #143 Shortlink: http://wp.me/pKrrB-1Um


Christopher Lane Ph.D. has blogged at Side Effects at Psychology Today

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

Good Grief: The APA Plans to Give the Bereaved Two Weeks to Conclude Their Mourning

Britain’s “Lancet” calls the proposal “dangerously simplistic and flawed.”

Published on February 17, 2012 by Christopher Lane, Ph.D. in Side Effects

Allan Frances, MD, former chair of DSM-IV Task Force has blogged in DSM5 in Distress at Psychology Today

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

Lancet Rejects Grief As a Mental Disorder

Will DSM 5 Finally Drop This Terrible Idea

Published on February 17, 2012 by Allen J. Frances, M.D. in DSM5 in Distress


This week in the Lancet

The lead Editorial in this week’s Lancet expresses concerns about specific proposals for the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

The misclassification of grief as a mental illness

An Editorial expresses concerns about the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). While previous editions of DSM have highlighted the need to consider, and usually exclude, bereavement before diagnosis of a major depressive disorder, the current draft of this fifth edition fails to do that. In this week’s The Art of Medicine Arthur Kleinma reflects on his own personal experiences of grief and continues the discussion on the classification of grief as a mental illness. Finally, a Comment asks if attenuated psychosis syndrome should be included in DSM-5.

Lancet Editorial: Grief is not an illness and should not be routinely treated with antidepressants (Full text)

The Lancet, Volume 379, Issue 9816, Page 589, 18 February 2012 doi:10.1016/S0140-6736(12)60248-7 

Also includes reference to ICD-11:

“WHO’s International Classification of Diseases, currently under revision as ICD-11, is debating a proposal to include “prolonged grief disorder”, but it will be another 18 months before that definition will be clear.” Editorial, The Lancet, Page 589, 18 February 2012

Essay: Culture, bereavement, and psychiatry (Full text)

The Lancet, Volume 379, Issue 9816, Pages 608 – 609, 18 February 2012 doi:10.1016/S0140-6736(12)60258-X

Comment: Should attenuated psychosis syndrome be included in DSM-5? (Subscription or payment required)

The Lancet, Volume 379, Issue 9816, Pages 591 – 592, 18 February 2012 doi:10.1016/S0140-6736(11)61507-9

Previous Lancet article on DSM-5

The first flight of DSM-5 | Niall Boyce

The Lancet, Volume 377, Issue 9780, Pages 1816 – 1817, 28 May 2011 doi:10.1016/S0140-6736(11)60743-5

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

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
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.orgwww.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.


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.

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