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This update has the URL at the end or you can click on the link to the left. Sign the Open Letter to the DSM-5 Committee and the American Psychiatric Association to change DSM-5.
David Elkins, PhD, President, Division 32, Society for Humanistic Psychology, APA voices concern that the DSM-5, if not changed, may harm vulnerable populations and the field of psychology itself.
Watch David Elkins on this Youtube Video by clicking on link:
Sponsor & Author of the Open Letter below:
As you are aware, the DSM is a central component of the research, education, and practice of most licensed psychologists in the United States. Psychologists are not only consumers and utilizers of the manual, but we are also producers of seminal research on DSM-defined disorder categories and their empirical correlates. Practicing psychologists in both private and public service utilize the DSM to conceptualize, communicate, and support their clinical work.
Though we admire various efforts of the DSM-5 Task Force, especially efforts to update the manual according to new empirical research, we have substantial reservations about a number of the proposed changes that are presented on www.dsm5.org. As we will detail below, we are concerned about the lowering of diagnostic thresholds for multiple disorder categories, about the introduction of disorders that may lead to inappropriate medical treatment of vulnerable populations, and about specific proposals that appear to lack empirical grounding. In addition, we question proposed changes to the definition(s) of mental disorder that deemphasize sociocultural variation while placing more emphasis on biological theory. In light of the growing empirical evidence that neurobiology does not fully account for the emergence of mental distress, as well as new longitudinal studies revealing long-term hazards of standard neurobiological (psychotropic) treatment, we believe that these changes pose substantial risks to patients/clients, practitioners, and the mental health professions in general.
In more detail, our response to DSM-5 is as follows:
Advances Made by the DSM-5 Task Force
Our specific reservations are as follows:
Lowering of Diagnostic Thresholds
We are particularly concerned about:
· “Attenuated Psychosis Syndrome,” which describes experiences common in the general population, and which was developed from a “risk” concept with strikingly low predictive validity for conversion to full psychosis.
We are also gravely concerned about the introduction of disorder categories that risk misuse in particularly vulnerable populations. For example, Mild Neurocognitive Disorder might be diagnosed in elderly with expected cognitive decline, especially in memory functions. Additionally, children and adolescents will be particularly susceptible to receiving a diagnosis of Disruptive Mood Dysregulation Disorder or Attenuated Psychosis Syndrome. Neither of these newly proposed disorders have a solid basis in the clinical research literature, and both may result in treatment with neuroleptics, which, as growing evidence suggests, have particularly dangerous side-effects (see below)—as well as a history of inappropriate prescriptions to vulnerable populations, such as children and the elderly
The DSM-5 has proposed to change the Definition of a Mental Disorder such that DSM-IV’s Feature E: “Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual,” will instead read “[A mental disorder is a behavioral or psychological syndrome or pattern] [t]hat is not primarily a result of social deviance or conflicts with society.” The latter version fails to explicitly state that deviant behavior and primary conflicts between the individual and society are not mental disorders. Instead, the new proposal focuses on whether mental disorder is a “result” of deviance/social conflicts. Taken literally, DSM-5’s version suggests that mental disorder may be the result of these factors so long as they are not “primarily” the cause. In other words, this change will require the clinician to draw on subjective etiological theory to make a judgment about the cause of presenting problems. It will further require the clinician to make a hierarchical decision about the primacy of these causal factors, which will then (partially) determine whether mental disorder is said to be present. Given lack of consensus as to the “primary” causes of mental distress, this proposed change may result in the labeling of sociopolitical deviance as mental disorder.
Revisions to Existing Disorder Groupings
Several new proposals with little empirical basis also warrant hesitation:
New Emphasis on Medico-Physiological Theory
Advances in neuroscience, genetics, and psychophysiology have greatly enhanced our understanding of psychological distress. The neurobiological revolution has been incredibly useful in conceptualizing the conditions with which we work. Yet, even after “the decade of the brain,” not one biological marker (“biomarker”) can reliably substantiate a DSM diagnostic category. In addition, empirical studies of etiology are often inconclusive, at best pointing to a diathesis-stress model with multiple (and multifactorial) determinants and correlates. Despite this fact, proposed changes to certain DSM-5 disorder categories and to the general definition of mental disorder subtly accentuate biological theory. In the absence of compelling evidence, we are concerned that these reconceptualizations of mental disorder as primarily medical phenomena may have scientific, socioeconomic, and forensic consequences.
New emphasis on biological theory can be found in the following DSM-5 proposals:
· The first of DSM-5’s proposed revisions to the Definition of a Mental Disorder transforms DSM-IV’s versatile Criterion D: “A manifestation of a behavioral, psychological, or biological dysfunction in the individual” into a newly collapsed Criterion B: [A behavioral or psychological syndrome] “That reflects an underlying psychobiological dysfunction.” The new definition states that all mental disorders represent underlying biological dysfunction. We believe that there is insufficient empirical evidence for this claim.
· The change in Criterion H under “Other Considerations” for the Definition of a Mental Disorder adds a comparison between medical disorders and mental disorders with no discussion of the differences between the two. Specifically, the qualifying phrase “No definition adequately specifies precise boundaries for the concept of ‘mental disorder’” was changed to “No definition perfectly specifies precise boundaries for the concept of either ’medical disorder’ or ‘mental/psychiatric disorder’.” This effectively transforms a statement meant to clarify the conceptual limitations of mental disorder into a statement equating medical and mental phenomena.
· We are puzzled by the proposals to “De-emphasize medically unexplained symptoms” in Somatic Symptom Disorders (SSDs) and to reclassify Factitious Disorder as an SSD. The SSD Workgroup explains: “…because of the implicit mind-body dualism and the unreliability of assessments of ‘medically unexplained symptoms,’ these symptoms are no longer emphasized as core features of many of these disorders.” We do not agree that hypothesizing a medical explanation for these symptoms will resolve the philosophical problem of Cartesian dualism inherent in the concept of “mental illness.” Further, merging the medico-physical with the psychological eradicates the conceptual and historical basis for somatoform phenomena, which are by definition somatic symptoms that are not traceable to known medical conditions. Though such a redefinition may appear to lend these symptoms a solid medico-physiological foundation, we believe that the lack of empirical evidence for this foundation may lead to practitioner confusion, as might the stated comparison between these disorders and research on cancer, cardiovascular, and respiratory diseases.
· The proposed reclassification of Attention Deficit/Hyperactivity Disorder (ADHD) from Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence to the new grouping “Neurodevelopmental Disorders” seems to suggests that that ADHD has a definitive neurological basis. This change, in combination with the proposal to lower the diagnostic threshold for this category as described above, poses high risk of exacerbating the extant over-medicalization and over-diagnosis of this disorder category.
· A recent publication by the Task Force, The Conceptual Evolution of DSM-5 (Regier, Narrow, Kuhl, & Kupfer, 2011), states that the primary goal of DSM-5 is “to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience.” We believe that the primary goal of DSM-5 should be to keep pace with advances in all types of empirical knowledge (e.g., psychological, social, cultural, etc.).
In sum, we have serious reservations about the proposed content of the future DSM-5, as we believe that the new proposals pose the risk of exacerbating longstanding problems with the current system. Many of our reservations, including some of the problems described above, have already been articulated in the formal response to DSM-5 issued by the British Psychological Society (BPS, 2011) and in the email communication of the American Counseling Association (ACA) to Allen Frances (Frances, 2011b).
American Psychiatric Association (2011). DSM-5 Development. Retrieved from http://www.dsm5.org/Pages/Default.aspx
of subclinical psychotic experiences in the general population. British Journal of Clinical
Psychology, 44, 181-191.
Retrieved from http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=112801
straight: A response to Frances commentary on DSM-V. Psychiatric Times, 26. Retrieved from http://www.psychiatrictimes.com/dsm/content/article/10168/1425806
Sponsored in alliance with:
- British Psychological Society (BPS)
- Danish Psychological Association
- Division of Behavioral Neuroscience and Comparative Psychology (Division 6 of APA)
- Division of Developmental Psychology (Division 7 of APA),
- Division of Clinical Psychology (Division 12 of APA)
- Society of Counseling Psychology (Division 17 of APA)
- Society for Community Research and Action: Division of Community Psychology (Division 27 of APA),
- Division of Psychotherapy (Division 29 of APA),
- Society for the Psychology of Women (Division 35 of APA),
- Division of Psychoanalysis (Division 39 of APA),
- Psychologists in Independent Practice (Division 42 of APA)
- Society for the Psychological Study of Lesbian, Gay, Bisexual, and Transgender Issues (Division 44 of APA),
- The Society for the Psychological Study of Ethnic Minority Issues (Division 45 of APA),
- Executive Committee of Division 48 of the APA
- Society for Group Psychology and Psychotherapy (Division 49 of APA),
- Society for the Psychological Study of Men & Masculinity (Division 51 of APA),
- Division of International Psychology (Division 52 of APA)
- Association for Counselor Education and Supervision (Division of the American Counseling Association)
- Association for Humanistic Counseling (Division of the American Counseling Association)
- The Association for Creativity in Counseling (ACC, Division of the American Counseling Association)
- Association for Adult Development and Aging (AADA, Division of the AMerican Counseling Association),
- Counselors for Social Justice (Division of the American Counseling Association),
- American Rehabilitation Counseling Association (ARCA, Division of the American Counseling Association)
- American College Counseling Association (ACCA)
- American Psychoanalytic Association
- American Family Therapy Academy
- The Association of Black Psychologists
- The Association for Women in Psychology,
- The Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling (ALGBTIC)
- Society of Indian Psychologists
- National Latina/o Psychological Association
- The Society for Personality Assessment,
- The Society for Descriptive Psychology,
- The UK Council for Psychotherapy (UKCP),
- Association for Contextual and Behavioral Science (ACBS)
- Association of Counseling Center Training Agencies
- Psychologists for Social Responsibility
- The Constructivist Psychology Network (CPN),
- The Taos Institute
- Saybrook University
- Zhi Mian International Institute of Existential-Humanistic Psychology
- Institute of Expressive Analysis
- Alliance of Professional Psychology Providers
- Patient Alliance for Neuroendocrineimmune Disorders Organization for Research and Advocacy (PANDORA)
- Council on Illicit Drugs of the National Association for Public Health Policy
- Council of National Psychology Associations for the Advancement of Ethnic Minority Interests
- Psychoanalysis for Social Responsibility (Section IX of Division 39 of APA).
- International Society for Ethical Psychology and Psychiatry