Statement of Concern about the Reliability, Validity, and Safety of DSM-5 from the International Response Committee:We, the undersigned, are concerned that the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5):
SEE SOME OF COMMITTEE SPEAKING AT OLD TRAFFORD : https://www.bps.org.uk/decpjune28
- Includes many diagnostic categories with questionable reliability, which may lead to misleading assumptions about their scientific validity;
The DSM-5 development process was --especially at first-- one effort to conduct that review. In the words of DSM-5 Task Force members (Regier, Narrow, Kuhl, & Kupfer, 2009), "As we began the DSM-V developmental process in 1999, a major concern was to address a range of issues that had emerged over the previous 30 years," including "the basic definition of a mental disorder" (para. 7). There was hope for a "paradigm shift" in psychiatric diagnosis (Kupfer, First, & Regier, 2002, p. xix), and even though that aspiration has since been pushed to the back-burner (Kendler et al., 2009), the new manual will be published with markedly liberal revisions to DSMs III and IV.
The DSM-5 field trials (conducted in one phase, due the cancellation of plans for a second phase revealed an unexpected change from the previous two editions of the manual: reliability estimates for many major disorder categories had dropped well below not only those for DSM-III/IV-designed disorders, but also below commonly accepted standards (see Frances, 2012c). Furthermore, primary care doctors (family physicians and general practitioners) were not included in the field trials (American Psychiatric Association, 2011), despite the fact that they provide the majority of mental health treatment (Wang et al., 2007) and prescribe the majority of psychiatric medications (Mark, Levit, & Buck, 2009).
A primary tenet of empirical research holds that reliability is a necessary precondition for validity, as scientists cannot make stable claims about a concept that fluctuates empirically or lacks consensus among observers. Thus, before achieving common reliability standards, it is premature and untenable to introduce the DSM-5 revisions into hospitals, clinics, and general practice. Clinical research, likewise, should seek to establish psychometric stability before proceeding on the assumption that DSM-5 diagnostic categories are valid empirical entities. Epidemiological investigations may suffer from inconclusive findings and lack of continuity with research conducted using previous diagnostic definitions.
- Did not receive a much-needed and widely requested external scientific review;
On January 9, 2012, the Open Letter Committee of the Society for Humanistic Psychology (Division 32 of the American Psychological Association) called for an external scientific review of the DSM-5 proposals by an independent group of researchers who are not affiliated with DSM-5 or the American Psychiatric Association (the full text can be found here: http://dsm5-reform.com/the-open-letter-committee-calls-for-independent-review-of-dsm-5/). This request was made in light of widespread reservation about the scientific status and safety of DSM-5 among mental health professionals and patient advocacy groups. An open letter to the DSM-5 Task Force and the American Psychiatric Association detailing these concerns (http://www.ipetitions.com/petition/dsm5/) was endorsed by more than 14,000 individuals and over 50 professional organizations, including 16 divisions of the American Psychological Association.
- May compromise patient safety through the implementation of lowered diagnostic thresholds and the introduction of new diagnostic categories that do not have sufficient empirical backing;
DSM-5 also introduces new disorders that did not appear in earlier editions of the manual. Among them: Premenstrual Dysphoric Disorder, Disruptive Mood Dysregulation Disorder, Somatic Symptom Disorder, and Mild Neurocognitive Disorder. These new diagnoses have generated significant controversy as a result of their questionable research backing and their potential for application to vulnerable populations, including children, the elderly, and persons with chronic medical illnesses. Some of the feared consequences of these new categories are as follows:
- Somatic Symptom Disorder (a modification of the Somatoform Disorders in DSM-IV-TR) includes a new stipulation that will allow for the diagnosis of mental disorder in persons with chronic medical illness complaining of excessive pain. As a result, doctors may prematurely jump to the conclusion that "it's all in the head" (Frances, 2012b, para. 3).
- Disruptive Mood Dysregulation Disorder may be diagnosed in children and adolescents displaying significant mood swings (temper tantrums), which may be developmentally normal and resolve without treatment. Although the new category was invented with the aim of precluding the controversial practice of diagnosing Pediatric Bipolar Disorder, the latter diagnosis never existed in previous editions of the manual due to its questionable validity.
- Mild Neurocognitive Disorder appears to describe normal cognitive decline that may be expected in elderly populations. Over-diagnosis of mental disorder and psychiatric treatment in the elderly --especially elderly populations in nursing homes-- is already a nationwide problem in the US and other countries.
- Premenstrual Dysphoric Disorder transforms severe PMS into a psychiatric disorder. In the past, similar proposals have been excluded from previous editions of the DSM due to substantial controversy and attention from women's rights groups because of the risk of pathologizing women's experience.
Our duty in the medical and helping professions is, first and foremost, to do no harm. Thus, as mental health practitioners and researchers, we are greatly concerned about the introduction of empirically questionable diagnostic concepts into psychiatric and general medical practice.
- Is the result of a process that gives the impression of putting institutional needs ahead of public welfare.
Additional concerns about the DSM-5 development process include hiring of a pubic relations firm (GYMR) to influence public opinion about the manual through a PR website (http://dsmfacts.org/), the lack of external scientific evaluation of the proposals, and the lack of a formal forensic review.
Because of the above, we fear that DSM-5:
- May result in the mislabeling of mental illness in people who would fare better without a psychiatric diagnosis;
- May result in unnecessary and potentially harmful treatment, particularly with psychiatric medication;
- May divert precious mental health resources away from those who most need them.
Committee MembersRichard Bentall; Professor of Clinical Psychology, University of Liverpool, UK
Mary Boyle; Emeritus Professor of Clinical Psychology, University of East London, UK
Pat Bracken; Consultant Psychiatrist and Clinical Director of Mental Health Services, West Cork, Eire
Joanne Cacciatore; Assistant Professor; Arizona State University School of Social Work, USA
Tim Carey; Associate Professor, Flinders University, Australia
David Castle; Professor of Psychiatry, University of Melbourne, Australia
Jack Carney; Licenced Psychologist, Alabama, USA
Anne Cooke; Clinical Psychologist, Canterbury Christ Church University, UK
Jacqui Dillon; Chair; Hearing Voices Network, UK
Suman Fernando; Honorary Professor in the Faculty of Social Sciences and Humanities, London Metropolitan University, London, formerly consultant psychiatrist, UK
Daniel Fisher; Consultant Psychiatrist, National Empowerment Centre, USA
Dave Harper; Reader in Clinical Psychology, University of East London, UK
Louis Hoffman; Continuing Education Coordinator, Society for Humanistic Psychology, USA
Lucy Johnstone; Clinical Psychologist, Bristol UK
Dayle Jones; Associate Professor, University of Central Florida, USA
Sarah Kamens; Society for Humanistic Psychology, USA
Peter Kinderman; Professor of Clinical Psychology, University of Liverpool, UK
Patrick Landman; Psychiatrist and Psychoanalyst; Paris, France
Eleanor Longden; Psychologist, London UK
Jason McCarty; Psychotherapist, British Columbia, Canada
Nancy McWilliams; Psychologist and Psychoanalyst, Rutgers University, USA
Gordon Milson; Clinical Psychologist, Manchester, UK
Bradley Olsen; President-Elect, Division 48 of American Psychological Association; President, Psychologists for Social Responsibility, Chicago, USA
Ana Padilla; University College London, London UK
Richard Pemberton; Chair, British Psychological Society Division of Clinical Psychology, UK
Dave Pilgrim; Professor of Health and Social Policy, University of Liverpool, UK
John Read; Professor of Clinical Psychology, University of Auckland, NZ
Melissa Raven; Research Fellow, Flinders University, Australia
Brent Robbins; President, Society for Humanistic Psychology, Div32 American Psychological Association, USA
Dave Traxson ; Educational Psychologist, Worcestershire, UK.
email: firstname.lastname@example.org; twitter: @davetraxson + Linkedin
Sara Tai; Senior Lecturer in Clinical Psychology, University of Manchester, UK
Phil Thomas; Honorary Visiting Professor, University of Bradford, formerly consultant psychiatrist, UK
Sam Thompson; University of East London, UK
Sami Timimi; Consultant Psychiatrist, UK
Steve Trenchard; Chair of ISPS UK (International Society for Psychological and Social Approaches to Psychosis)
Martin Whitely; MLA, Parliament of Western Australia, Australia
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