DSM-V: A New Animal?

A few interesting tidbits I got from Ken Pope’s digest of a Los Angeles Times article on the current construction of the new Diagnostic and Statistical Manual:

But all agree that the so-called bible of psychiatry is expected to be considerably more nuanced and science-based than the last edition, DSM-IV, published in 1994.

Brain imaging and other technologies, plus new knowledge on biological and genetic causes of many disorders, have almost guaranteed significant alterations in how many mental afflictions are described.

The book will describe disorders in more detail, acknowledge variations that haven’t been viewed as part of “classic” illness and explain how conditions differ based on age, race, gender, culture and physical health, Kupfer said.

What that looks like in practice is anybody’s guess. But what seems clear is that DSM-V is going to be a different sort of animal. Ties to the pharmaceutical industry remains the biggest problem with the work. Here is another excerpt, again courtesy of Ken Pope, that typifies the justifiable concerns that have been raised many, many, many times:

Over the last two decades more medications have become available to treat mental disorders, and some doctors worry that the text may be written in a way that expands the market for drug therapies.

A study published online in the current issue of the journal Psychotherapy and Psychosomatics found that of 20 work group members writing clinical practice guidelines for the treatment of bipolar disorder, schizophrenia and major depression, 18 had at least one financial tie to industry.

A commentary in the May 7 New England Journal of Medicine said that 56% of DSM-V task force and committee members have industry ties.

DSM-V committee members have been asked to abide by conflict-of-interest rules, including agreeing to receive no more than $10,000 annually from industry sources during the period they serve on the committee.

But that isn’t going far enough, said Lisa Cosgrove, lead author of the Psychotherapy and Psychosomatics analysis and an associate professor and clinical psychologist at the University of Massachusetts.

“There are currently work groups where every single person has ties,” Cosgrove said. “It doesn’t seem like genuine progress has been made.”