Monday, November 17, 2008

The DSM-5 Debate

Christopher Lane over at the LA Times has an Opinion published in yesterday's issue exposing the debate within the APA (now spilling out) about how transparent to make the process for developing the upcoming DSM-V.
...The bone of contention: whether the next revision of America's psychiatric bible, the "Diagnostic and Statistical Manual of Mental Disorders," should be done openly and transparently so mental health professionals and the public could follow along, or whether the debates should be held in secret.

One of the psychiatrists (former editor Robert Spitzer) wanted transparency; several others, including the president of the American Psychiatric Assn. and the man charged with overseeing the revisions (Darrel Regier), held out for secrecy. Hanging in the balance is whether, four years from now, a set of questionable behaviors with names such as "Apathy Disorder," "Parental Alienation Syndrome," "Premenstrual Dysphoric Disorder," "Compulsive Buying Disorder," "Internet Addiction" and "Relational Disorder" will be considered full-fledged psychiatric illnesses.
Perhaps some think that this is another thing, like making sausage or legislation, that one doesn't want to know how it is made or what goes into it.  Let's hope not.  In fact, Robert Spitzer, who chaired the group which created the third edition of the DSM (the so-called Diagnostic & Statistical Manual contains the gold standard definitions of various mental illnesses and other conditions), sent out an open letter a few months ago calling on the APA to open up the process.  In response, the APA is now publishing Work Group reports and is planning to publish the minutes from the meetings, as well.

The DSMV is expected in 2012.


Novalis said...

I can't grasp the rationale for anything but total transparency in this case; would we want the "input" into the process of anyone who had enough to hide to want to remain anonymous?

Diagnosis is not science in the way of particle physics, but neither ought it to be "anything goes." It is something in between. Perhaps the best analogue would be economic policy, based on empirical data but also shaped by consensual values.

Anonymous said...

I think they should set it up like Wikipedia, so all psychiatrists can contribute.

Might not result in a valid product, but the process would sure be entertaining.

Sounds like a power & control issue.

Midwife with a Knife said...

I want to know about "apathy disorder"... or I sort of want to know, but mostly I'm too lazy to really care. ;) I feel like I'm having an attack of apathy disorder today!

shraddha said...

wow!2012 seems so far way!


Anonymous said...

Maybe psychiatrists would want the process kept secret from the insurance companies. If the insurance companies could hire people to read the rational, mightn't they use that information to disallow some categories? (OK. I don't trust insurance companies to be out for anyone but themselves and I see their self-determined mission to be to pay as few claims as possible.)

Otherwise I'd want to see full disclosure and the Wikipedia format sounds terrific except the diagnoses would change hourly.

Jackie said...

I did my grad school research on the science-policy nexus, how science gets translated into policy. What I found is that additional facts just amplify disagreement in an already polarized discussion. People say
"just have more science--that will solve the problem" but actually time and again, the new facts just confirm the pre-existing beliefs.

So this is a little different, because we're talking about medical stuff, but presumably changes would have to be evidence based. Also, presumably, there are some hot-button topics and some polarization out there in the community? Transparency might end up just amplifying the disagreements by dragging more facts and more people with pre-existing beliefs into the argument. Maybe this is for the best, but I do think there are some instances outside the psychiatric field where a polarized debate just confuses a lot of people (eg dangers of vaccines, chronic lyme disease, etc.).

Anonymous said...

Transparency of information does not necessarily mean that the decision making process is inclusive of all opinions and all people. I think making data available can lead to unforeseen and valuable possibilities.

Bo... said...

Hey, they're putting PMS in there????? Then insurance will have to pay for Midol, heh!

Owner said...

My three shrinks,

I have a question that's somewhat unrelated, but I was wondering whether I could have your opinion on it. I've just recently found out about bug chasing, an underground thing within the gay community where HIV negative men want and seek to get infected. I was wondering whether you know of anything similar in heterosexuals, and also what kind of diagnoses, if any, might be associated with it?

FooFoo5 said...

This would seem a moot argument to me if, in fact, this is a "Statistical" manual, as it claims. I have never forgotten this article prior to the release of DSM-IV, and I would note this comment: "The previous revisions "were more dependent on expert consensus," Dr. First said. "But that's a trap, because the outcome can depend on who's in the room and who argues the loudest." The use of the term "statistical" would suggest to me a formative base of irrefutable data that always includes "deviation" and "anomoly," that would only then qualify "expertise." Instead, we are relying upon selected, appointed "committees" of experts to define a base of data. It would seem the only logical argument for transparency would be a lack of data.

Anonymous said...

Hi, folks ... I can't help but wonder, when I read the list of possible "new" disorders that might be added to the DSM-V, if the profession is going too far in its zeal to label glitches in behaviour. Consider:

"Apathy Disorder" = dog-tired

"Parental Alienation Disorder" = what? Parents pissed off at their children? Children PO'ed at their parents? Parents PO'ed at each other? What?

"Presmenstrual Dysphoric Disorder" = PMS with bloating

"Compulsive Buying Disorder" = being a good consumer, or Retail Therapy

"Internet Addiction" = just another way of trying to fill the void of meaningless in the 21st century

"Relational Disorder" = who *doesn't* have some disorder in their relations from time to time?

With every new edition, the DSM gets fatter, people get crazier, and pharmaceutical companies haul in more profits. How about "Compulsive Diagnostic Disorder" = the need to slap a label on every little blip of human emotional expression that varies from the "norm" -- whatever that is?!

Anonymous said...

adele pace said...

Perhaps "Psychiatrists impulsivity throwing the book (DSM bible) at one another at conventions/revisions".

It has happened. I suppose it is part of civilised professions disagreeing. It depends on how you define civilised I suppose.