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The APA’s PR Problem

Why is the APA hiring a PR company to market DSM-5?


As the news tumbled out last week that the American Psychiatric Association had hired GYMR, an expensive PR company, to help the organization “execute strategies that include image and alliance building, public education campaigns or media relations to harness the formidable forces of Washington and produce successful results for clients” (services that GYMR brags about in its mission statement), it became clearer than ever that the APA has more than an image-problem with DSM-5.

With The Lancet, New England Journal of Medicine, 51 professional organizations, a sizable blogging community, and the manual’s former editor, Allen Frances, all voicing strenuous concern about the manual’s planned revisions and likely content, the hiring of a PR firm to “execute … image-building”—that is, to gloss over serious diagnostic issues and controversies in psychiatry—amounts to a fig leaf, a frantic effort to whitewash the manual’s many flaws and questionable content.

As part of its image-building strategy, the PR company has helped set up a new website, DSM-5 Facts, which claims to “welcome scrutiny, not only of this process but of its results.” But Frances, whom the APA recently tried to brand “a dangerous man” after it hired a further PR consultant who previously had worked for the Department of Defense (you couldn’t make this stuff up), recently published just a preliminary list of the site’s distortions and falsehoods: “Public Relations Fictions Trying to Hide DSM-5 Facts.” The fictions include —

GYMR Fiction: "There are actually relatively few substantial changes to draft disorder criteria."

DSM-5 Fact: Dead wrong—how did GYMR ever come up with this one? My guess is that the DSM-5 changes would affect the diagnosis of tens of millions of people. APA has no way of refuting this estimate since it unaccountably failed to ask the crucial prevalence question in its $3 million field trial.

The list continues:

GYMR Fiction: "There are several proposals in DSM-5 that aim to more accurately describe the symptoms and behaviors of disorders that typically present in children."

DSM-5 Fact: The epidemics of excessive diagnosis in children will be muddled further by DSM-5. The threshold for ADHD is being lowered despite the tripling of rates. Temper Dyregulation (aka DMDD) is being suggested based on just a few years of work by just one research group—despite the risk it will exacerbate the already inappropriate and dangerous use of antipsychotic drugs in kids.

GYMR Fiction: "We have extensive data from the field trials that on average there is a slight decrease in the overall rates of DSM-5 in comparison to DSM-IV disorders."

DSM-5 Fact: This is simply wrong—APA has no such data.

And so on, for another half-dozen or so contested key issues, themselves just scratching the surface of the DSM’s problems.

Given such discrepancies between fact and fiction and the lengths to which the APA is willing to go to try to hide them, is it any wonder blogger Jack Carney could recently post, of the petition against DSM-5, that it is “growing some legs”? The number of signees from around the world now exceeds 13,500. That includes a host of international mental health organizations along with dozens of whole divisions representing the other APA, the American Psychological Association.

One fact remains uncontested: the American Psychiatric Association has given the mental health community until June 15th to voice its objections to the DSM — just under two weeks from now.

If you find the PR marketing of DSM-5 distasteful, even disturbing, given such widespread concern about the likely inclusion of “temper dysregulation,” “premenstrual dysphoric disorder” and (in the appendix to the manual) of “hypersexual disorder,” then you have just under two weeks to let the APA know. You can, for starters, sign the petition here:

As Carney puts it inspiringly, in his post explaining why the petition grew legs in the first place: “Don’t mourn, organize.” Follow me on Twitter: @christophlane