DSM5 in Distress

Dr Frances, you've said in your previous blog post (DSM5: An Open Process Or Bust, 12 April) that "Today is the last day for public comment on these drafts." and The period allotted for public comment has been far too short and ends arbitrarily and prematurely today."

I've left a comment to that post querying these statements because there is nothing on the APA's new DSM-5 webpages that I can see which suggests any changes to the closure date for submission of comments in the public review process. No news releases have been issued by the APA that I am aware of and there are no new notices on the site or on the APA's various Twitter and Facebook sites since 9 April, when the DSM-5 Facebook site posted a reminder of the closure date.

Could I ask that you clarify, please, whether the information you have received around the closure date has been revised in the last few days?

I would not want to see professionals in the field and other stakeholders discouraged from submitting comments if it were the case that no changes have been made to the closure date of Tuesday, 20 April.

Suzy Chapman, UK patient advocate

April 20 is the correct date. The next opportunity for public review will not be until May of 2011-so this would be a final week of opportunity to help influence the process before it may be too late. Also, thanks for your previous comments which were very helpful.

Your post citing both "cheerleading" for a specific diagnosis and the potential influence of "outside forces" on the process struck a bit of a chord with me. It also seems strange to me that a potential increase in any royalties related to psychological testing hasn't been talked about or really disclosed overtly in the disclosure statements in regards to a potential "outside force."

For example, 2 of the members of the personality disorders workgroup who have authored sections of the personality disorders portion of the website at dsm5.org also have authored personality tests. Not surprisingly, many of the names of the new system of personality disorder traits (facets) proposed closely resemble the names of the scales on the tests they authored. Which begs the question: Can you author (and "sell"/collect royalties from) a personality assessment and then instruct the field on how personality should be assessed in DSM-5? Would anyone be surprised if the answer is "use our tests?" Approximately 17 of the traits/facets proposed for DSM-5 are nearly word for word with the subscales of these two authors two personality assessments despite many of these names not being used on a more popular test. I hate to be the jaded one to suggest that "outside influences" like potential royalties earned from psychological test publishers could *potentially* influence the "cheerleading," but it at least seems strange that there is no disclosure related to any potential gain that these workgroup members might experience should a new trait/facet system turn out to look a lot like their tests. I blogged more about this recently at http://www.worldwidementalhealth.com/blog with a much longer, detailed posting.

Great comment! I have no specific knowledge whether financial considerations are involved-but I would certainly doubt it. In my experience, mistakes made by DSM5 work groups come from naivete and an inability to see the forest for the trees. The personality disorders section seems particularly out of touch with clinical need, but my guess this is not financially driven and rather comes from researchers just not understanding how cumbersome and inappropriate are their suggestions. I'll blog on this soon. Nonetheless, even the appearance of conflict of interest is damaging. It would be valuable for you to call this to their attention and do whatever else you can to help stop these completely impractical suggestions.

Thanks for your comments, they make good sense

Thank you for the VERY informative information on DSM5. I have been frequenting website and trying to gain an understanding of how this "Holy Grail" is designed and written. The one thing that strikes me is that the workgroups seem to be composed of strictly psychiatric researchers. I am not suggesting that this is wrongheaded; researchers are the backbone of this work. HOWEVER...I believe that it wouldn't hurt to include more, 1) psychologists; 2) clinicians (people who actually WORK with the people the DSM5 will affect; and 3) WOMEN

I am a student, and not yet as informed as many of you here; and maybe that's a good thing.

I lost all faith in the DSM process back in 1973. What a fiasco! And the reverberations are still being felt by everyone. The process was deliberately corrupt and caused so much harm to so many people suffering from deviant sexual compulsions. The world changed because of the corruption, and the doctors who swore to do no harm are still committing crimes today. The misinformed public has now become the silent majority in collusion with the errant "doctors of psychiatry." I wish scientists/psychiatrists would correct the process, correct the errors and restore some sanity to the mental health field.