DSM5 in Distress

The DSM's impact on mental health practice and research

by Allen Frances, M.D.

Top 10 Indicators Of DSM-5 Openness

In '1984', George Orwell introduced the term 'Newspeak'- the abuse of language by totalitarian bureaucracies to create an upside down, looking glass world of misinformation. He was probably inspired by 'Pravda,' the Soviet Union's propaganda paper that literally means 'truth' in Russian but was famous for publishing everything but. Read More

Follow The Money

The APA budget depends heavily on the huge publishing profits generated by its DSM monopoly. APA needs the money badly. Read More

Public Relations Fictions Trying to Hide DSM 5 Facts

Recently APA recruited a public relations guy from the Department of Defense to respond to my concerns that DSM 5 is way off track. He immediately went on the offensive and (in an interview for Time magazine) made the obvious PR mistake of calling me 'a dangerous man'. Read More

DSM-5 Costs $25 Million Putting APA in a Financial Hole

The American Psychiatric Association just reported a surprisingly large yearly deficit of $350,000. This was caused by reduced publishing profits, poor attendance at its annual meeting, rapidly declining membership, and wasteful spending on DSM-5. APA reserves are now below " the recommended amount for a non-profit (reserves equal to a year’s operating expenses)." Read More

Spitzer Recants: Why Can't APA Admit Mistakes and Correct Them

Ben Carey's front page story in the New York Times movingly recounts Bob Spitzer's apology for an ill-advised study he conducted more than a decade ago.

http://www.nytimes.com/2012/05/19/health/dr-robert-l-spitzer-noted-psychiatrist-apologizes-for-study-on-gay-cure.html?_r=1&emc=eta1 Read More

Psychiatric Mislabeling Is Bad for Your Mental Health

An accurate diagnosis is wonderful thing—a giant step toward explaining what previously seemed unexplainable and starting what is very likely to be an effective treatment. Read More

Newsflash From APA Meeting: DSM 5 Has Flunked Its Reliability Tests

The whole purpose of having a manual of psychiatric diagnosis is to promote diagnostic agreement. Read More

DSM 5 Rejects 'Hebephilia' Except for the Fine Print

The prize for the most wayward of all the DSM 5 work groups must surely go to the sexual disorders group—creators of three remarkably off-beat proposals. Fortunately, they have gradually been forced to abandon their entire wish list because each of the proposals triggered near universal opposition from forensics experts and sexual disorders researchers. Read More

Wonderful News: DSM 5 Finally Begins Its Belated and Necessary Retreat

Sigh of relief. The DSM 5 website announced this morning that two of its most controversial proposals have finally been dropped. We have dodged bullets on Psychosis Risk and Mixed Anxiety Depression. Both are now definitively rejected as official DSM 5 diagnoses and instead are being exiled to the appendix. Read More

Definitive Study Rejects the Diagnosis of "Psychosis Risk"

A British study has succeeded in definitively answering two of the most timely and consequential questions facing psychiatry today: 1) Is it a good idea to include a "psychosis risk syndrome" in DSM 5? and 2) Can early treatment programs prevent psychosis? Read More

Medical Specialists Will Try to Reduce Excessive Diagnostic Testing

An article in the New York Times on April 4 describes a wonderful new initiative that may substantially improve the quality of US health care, while simultaneously also cutting its costs. Nine medical specialties have joined forces in a concerted and long overdue effort to reduce unneeded diagnostic testing and treatment. Read More

Why Social Workers Should Oppose DSM-5

Social workers make up by far the largest single constituency among all the potential users of DSM-5, a plurality of over 200,000 mental health clinicians. Until recently, they have been silent while psychologists, counselors, psychiatrists, the press, and the public have all strongly opposed DSM-5. Things are changing. Read More

My Review Of 28 Sexually Violent Predator Cases

During the past two years, I have been asked by public defenders to review 28 SVP cases, mostly in California, but two each in Iowa and Washington, and one each in illinois and New Hampshire. All had previously been evaluated by two or three psychologists testifying for the prosecution and also by two or three psychologists testifying for the defense. Read More

Risk/Benefit Ratio for Further Expanding Bipolar Disorder

The diagnostic boundary between Major Depressive and Bipolar II Disorder is one of the most difficult and also one of the most important in psychiatry. Difficult (and inherently at least somewhat arbitrary) because the distinction rests completely on how one defines a hypomanic episode. Read More

A Turning Point for DSM 5

Dr Joanne Cacciatore wrote a moving blog opposing the DSM 5 plan. Within days, she had unexpectedly attracted more than 100,000 viewers. Encouraged by the display of overwhelming support, Dr Cacciatore has now written a powerful letter to the APA Trustees. I think her letter could be the crucial turning point in the development of DSM 5. Read More

Am I a Dangerous Man?

According to this week's Time magazine, the American Psychiatric Association has just recruited a new public relations spokesman who previously worked at the Department of Defense. This is an appropriate choice for an association that substitutes a fortress mentality and warrior bluster for substantive discussion. Read More

More Than 65,000 Grievers Must be Heard and Should Be Heeded

Of all the misconceived DSM-5 suggestions, the one touching the rawest public nerve is the proposed medicalization of normal grief into a mental disorder. Fierce opposition has provoked two editorials in Lancet, a front page New York Times story, and incredulous articles in more than 100 journals around the world. Read More

My Third Letter to the APA Trustees

The following letter was sent to the APA Trustees and to the DSM-5 Task Force on February 12, 2012, under the title, Heads Up And Recommendations. Read More

Do We Need a DSM-V?

Here's an editorial (with the above title) taken from the newsletter of the Society of Biological Psychiatry and written by its editor. Read More

ICD-10-CM Delay Removes Excuse for Rushing DSM 5 Into Premature Publication

Until yesterday, there were only two reasons to stick with the projected date of DSM 5 publication (May 2013): 1) the need to coordinate DSM 5 with ICD-10-CM coding, which was scheduled to start Oct 2013; and, 2) the need to protect APA publishing profits in order to meet budget projections. The first reason just dropped out. Read More

DSM 5 to the Barricades on Grief

The storm of opposition to DSM 5 is now focused on its silly and unnecessary proposal to medicalize grief. To paraphrase Voltaire, normal grief is not 'Major', is not 'Depressive,' and is not 'Disorder.' Grief is the normal and necessary human reaction to love and loss, not some phony disease. Read More

Lancet Rejects Grief As a Mental Disorder

The Lancet is probably the most prestigious medical journal in the world. When it speaks, people listen. The New York Times is probably the most prestigious newspaper in the world. Again, when it speaks, people usually listen. The Lancet and The New York Times have both spoken on the DSM-5 foolishness of turning grief into a mental disorder. Read More

DSM 5 Minor Neurocognitive Disorder

Within the next 3-5 years, we will likely have biological tests to accurately diagnose the prodrome of Alzheimer's disease (AD). Much remains to be done in standardizing these tests, determining their appropriate set points and patterns of results, and negotiating the difficult transition from research to general clinical practice. Read More

PTSD, DSM 5, and Forensic Misuse

In preparing DSM IV, we worked hard to avoid causing confusion in forensic settings. Realizing that lawyers read documents in their own special way, we had a panel of forensic psychiatrists go over every word to reduce the risks that DSM IV could be misused in the courts. Read More

Documentation That DSM 5 Publication Must Be Delayed

I wrote last week that DSM 5 is so far behind schedule it can't possibly produce a usable document in time for its planned publication date in May 2013. My blog stimulated two interesting responses that illustrate the stark contrast between DSM 5 fantasy and DSM 5 reality. Read More

Sneaking Hebephilia Into DSM 5

Dr. Ray Blanchard, of the DSM 5 sexual disorders work group, has written a misleading blog that portrays the introduction of 'Hebephilia' into DSM 5 as no more than a minor change. In his rendering, DSM IV already permits the diagnosis of pedophilia if victims are 13 or younger and DSM 5 is just raising the age threshold to 14. No big deal. Read More

APA Should Delay Publication Of DSM 5

My three criticisms of DSM 5 have been: 1) risky suggestions; 2) bad writing; and 3) poor planning and disorganization. I have pretty much failed to have any real impact other than perhaps getting APA to delay publication from May 2012 to May 2013. Read More

Federal Court Denies the Fake Diagnosis of 'Hebephilia'

The current fad of misdiagnosing 'Paraphilia, Not Otherwise Specified'' in Sexually Violent Predator hearings is the most glaring error now occurring at the difficult boundary between psychiatry and the law. Misguided and incompetent psychiatric diagnosis too often has paraded as expert testimony. Read More

Defenses From DSM 5 Get 'Curiouser and Curiouser'

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. Read More

DSM 5 and Diagnostic Inflation

My biggest concern regarding DSM 5 is that it will dramatically increase the rates of mental disorder and cheapen the currency of psychiatric diagnosis. The DSM 5 proposals do this two ways: 1) by reducing thresholds for existing disorders; and, 2) by introducing new high prevalence disorders at the boundary with normality. Read More