Psychiatry’s diagnostic manual feuding continues

The storm over the new version of the diagnostic manual for psychiatrists shows no signs of dying down as a committee member has publicly resigned over concerns that new diagnoses are being created without proper regard to the scientific evidence.

The 5th edition of the Diagnostic and Statistical Manual for Mental disorders, known as the DSM-V, is due out in 2012. It is hotly anticipated because it defines mental illness for the USA and much of the world.

The Carlat Psychiatry Blog reports that Dr. Jane Costello, a member of the Work Group on Disorders in Childhood and Adolescence, recently resigned in protest at what she suggests are unrealistic aims and a disregard of the research evidence. A copy of her resignation letter has already found its way online.

Carlat also reports that Allen Frances and Robert Spitzer, both chiefs of the committee for past versions of the manual, have amplified their recent criticisms in a leaked letter by writing to the American Psychiatric Association Board of Trustee to denounce the DSM-V leadership as having “lost contact with the field” and urging that “It is your responsibility to save DSM-V from itself before it is too late”.

As Frances’ last public criticism was greeted by a strongly worded and surprisingly personal response, this may be the beginning of a drawn out public battle.

Link to Carlat Psychiatry Blog on latest DSM feuding.

3 thoughts on “Psychiatry’s diagnostic manual feuding continues”

  1. Vaughn, you are so awesome. Please keep up Mindhacks. Please, please, please!
    I’ve followed this blog on and off for years now. So many great stories. I trust you to search through the neuroscience and medical community for great stories.
    I’ve shared this DSM fiasco with my friends. Remember JAMA editor Catherine DeAngelis called Jonathan Leo a “nobody and nothing” for his criticism of undisclosed financial connections?
    So many DSM committee members are financially connected to PhRMA. It’s such a rich community. It boggles the mind…

  2. The Diagnostics and Statistical Manual (DSM), the Shrink’s bible, has been around for over 50 years. Within this manual, there are now possibly nearly 300 mental disorders.
    As a dictionary of suspected mental illnesses, many redefined diagnoses are added to this manual with each edition, and how such disorders are classified and assessed.
    On occasion, a mental disorder is deleted from the DSM, such as homosexuality in the early 1970s. Its purpose, this manual, is to assist mental health professionals to diagnose and classify mental disorders.
    How a group sponsored by for profit pharmaceutical industry corporations that promote psychotropic drugs for various mental issues that may or may not fully exist make the determinations that they do while maintaining objectivity is a phenomenon.
    Published and designed by the American Psychiatric Association (APA), the DSM is also used, I understand, for seeking mental diagnostic criteria to assure reimbursement.
    The DSM is organized in part by the following:
    I- Mental disorders
    II- mental conditions
    III- Physical disorders/syndromes, medical conditions (co-morbidity)
    IV- Mental disorder suspected etiology
    V- Pediatric assessments
    The APA has historically directed the creation of each edition of the DSM, and assigns selected task force members to create this manual. This situation has proven to be controversial.
    The next DSM involves 27 people. About 80 percent of these individuals are male, and only 4 members are not medical doctors. Most have had relationships with the NIH, and about 25 percent of these task force members have had relationships with the WHO.
    Historically, at least a third of task force members have had, or do, have often monetary pharmaceutical industry ties in some way.
    This makes sense, as about one third of the APAs total financing is from the pharmaceutical industry.
    The APA required this task force for the next DSM edition to sign non-disclosure agreements- which is rather absurd and pointless. Lack of transparency equals lack of credibility because of these agreements of the content of the next DSM. It opposes any recovery model necessary regarding such disorders, I believe.
    The DSM should be evaluated by another unrelated task force or a peer review of sorts to assure objectivity. This is particularly of concern presently, as many more are diagnosed with mental dysfunctions presently at a concerning rate- with very young children in particular.
    Dan Abshear

  3. Vaughn,
    I discovered this blog this past year while at college and it constantly provides valuable, fascinating, and up-to-date information. Thanks for your contributions. I’ve started my own humble little blog at if you want to check it out.
    Take care,

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