10 Stories on DSM-V

Ken Pope’s listserv has been positively percolating with stories on the revision of DSM-V. It would be a full time job keeping up with the various controversies, but this list provides a bird’s-eye view of the range of concerns. The committee overseeing the revision of DSM-V is taking feedback up until this Friday, June 15, 2012:

1.   Revised Criteria For Mild Cognitive Impairment May Compromise the Diagnosis of Alzheimer Disease Dementia. Article at the Archives of Neurology.

Briefly quoted: “The original diagnosis of MCI6 – 7 was limited to individuals with cognitive impairment in a single domain (memory), thus distinguishing MCI from dementia, but more recently its differentiation from dementia has come to rest solely on the preservation of functional activities.8 – 9 The revised criteria for MCI,2 however, allow considerable latitude as to what represents functional independence and thus blur the categorical distinction between MCI and dementia.”

2.   Researchers Voice Concern Over Proposed Addiction Guideline Changes. From a press release at the University of Connecticut.

Briefly quoted: “Psychiatric epidemiologist Thomas F. Babor, head of the Department of Community Medicine and regional editor of the international journal Addiction, and Dr. Yifrah Kaminer, professor of psychiatry and pediatrics in the Department of Psychiatry and Alcohol Research Center, are concerned that pending changes to the definition of addiction in the Diagnostic and Statistical Manual (DSM) could represent a step backward in diagnosing and treating substance use disorders – and could have major economic and social consequences…. Babor’s reservations about the proposed changes concern the broadening of language defining addiction and the lowering of the threshold of what counts as a substance use disorder. The revisions would expand the number of symptoms of addiction, reduce the number required for a diagnosis and introduce a “behavioral addiction” category – all of which could lead to millions more people being categorized as addicts when they in fact are simply unhealthy users. This could put a strain on already-limited resources in schools, prisons and hospitals, he says.”

3.   A Closer Look at Pending Changes to the Future of Psychiatric Diagnosis. From a news release at the Journal of Nervous and Mental Disease. The special section notes several articles regarding proposed DSM changes.

Briefly quoted: “Many articles within the section present criticisms of DSM-5 proposals. Specifically, several authors worry that the new DSM-5 standards may open up more opportunities for false-positives – a doctor diagnosing a condition when it is not present, or providing medication when it is not needed.” 

Subsection titles include: “Behavioral Addiction V Quo Vadis”, “Hebephilia and the Construction of a Fictitious Diagnosis”, “Should Prolonged Grief Be Reclassified as a Mental Disorder in DSM-5? Reconsidering the Empirical and Conceptual Arguments for Complicated Grief Disorder”,  “Psychotropic Marketing Practices and Problems: Implication for DSM-5”, and “A Critique of the DSM-5 Field Trials.”

4.   Premenstrual Dysphoric Disorder: Why it Doesn’t Belong in DSM-5. Available as a brief podcast.

5.   International Dyslexia Association Requests Reinstatement of the Term “Dyslexia” in American Psychiatric Association’s DSM-5. A news release from the International Dyslexia Association.

Briefly quoted: “However, many view this latest round of revisions — which now omits the term dyslexia — as a significant step backward and worry that this omission will perpetuate lack of recognition and understanding of dyslexia and contribute to delays in diagnosis and treatment.”

6.   Changes to Name, Definition of Mental Retardation Raise Concerns. An article at Education Week.

In the case of the definition of mental retardation, the American Association on Intellectual and Developmental Disabilities said that plans to change mental retardation to “intellectual development disorder” doesn’t match shifts in the United States and abroad to use the term “intellectual disability.

7.   The psychiatric oligarchs who medicalise normality. From a letter to the editor at the British Medical Journal, responding to the article of that title.

8.   Tradition versus empiricism in the current DSM-5 proposal for revising the classification of personality disorders. From an editorial at Criminal Behaviour and Mental Health.

From the abstract: “The DSM-5 proposal is for a confusing, complex and inconsistent system that lacks credibility. A broad overview of the study of personality disorders suggests that the field is having difficulty integrating traditional concepts and modes of practice with empirical findings. The basic theoretical models and concepts underpinning contemporary ideas about classification, aetiology and treatment are largely based on clinical observations. Although these observations often yielded remarkable insights, they were relatively unsystematic and based on small, unrepresentative samples. Evidence and methods are available to construct an innovative and empirically informed classification with high clinical utility that could advance our understanding of the nature and origins of personality disorder. But to implement such a system, one needs the courage and ability both to move beyond traditional assumptions and presuppositions and to ignore political considerations.”

9.   The American Family Therapy Academy released a policy statement about DSM-5. AFTA finds APA non-responsive to feedback.

“AFTA has joined over fifty organizations and thousands of practitioners and researchers worldwide, in writing to the DSM Task Force and the American Psychiatric Association to express these concerns. The response from the American Psychiatric Association has been minimal, at best. None of the organizations or individuals have been invited to participate in the decision making process. We find that the current revision of the DSM continues a long history of ignoring research and excluding vital contributions of non-psychiatric mental health disciplines resulting in invalid diagnostic categories and treatment protocols.”

10.  Criticism Continues to Dog Psychiatric Manual as Deadline Approaches by Greg Miller at the Journal Science. 

“When planning for DSM-5 first began in 1999, its leaders hoped to tap advances in neuroscience and genetics to create a taxonomy of mental illness that better carved nature at its joints (Science, 31 October 2003, p. 808). That didn’t happen to the extent they had hoped. We could not construct a diagnostic classification on the basis of neuroscience findings at this point,” acknowledges David Kupfer, a psychiatrist at the University of Pittsburgh School of Medicine in Pennsylvania and the chair of the DSM-5 committee overseeing the revisions.”

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