By K. Kimberly McCleary, President & CEO
According to the American Psychiatric Association, “the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States and contains a listing of diagnostic criteria for every psychiatric disorder recognized by the U.S. healthcare system. The current edition, DSM-IV-TR, is used by professionals in a wide array of contexts, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors, as well as by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems). It is used in both clinical settings (inpatient, outpatient, partial hospital, consultation-liaison, clinic, private practice, and primary care) as well as with community populations. In addition to supplying detailed descriptions of diagnostic criteria, DSM is also a necessary tool for collecting and communicating accurate public health statistics about the diagnosis of psychiatric disorders.” (http://www.dsm5.org/about/Pages/Default.aspx)
The DSM is currently being revised through a lengthy and labor-intensive process that began in 1999. “Publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013 will mark one the most anticipated events in the mental health field. As part of the development process, the preliminary draft revisions to the current diagnostic criteria for psychiatric diagnoses are now available for public review. We thank you for your interest in DSM-5 and hope that you use this opportunity not only to learn more about the proposed changes in DSM-5, but also about its history, its impact, and its developers. Please continue to check this site for updates to criteria and for more information about the development process.”
There has been relatively little coverage of the DSM-5 process in the mainstream media. The few reports have focused on the “medicalization” of a growing number of personality disorders and classification of risky sexual behaviors, as described by Shari Roan in a series of articles in the Los Angeles Times. The process has its fans and critics, even within the field of psychiatry. Dr. Allen Frances is the chairman of the DSM-IV Task Force and is quoted in the Los Angeles Times,
“Frances says the many advances in neuroscience, brain imaging and molecular biology have yielded valuable information about the workings of the human brain but not enough to make psychiatric diagnoses. Thus, he said, there is little to be gained by changing the DSM now.
“‘The experts are well-meaning — each suggestion made has the goal of identifying patients currently missed,’ Frances said. But, he added, ‘none of the changes can accurately identify patients who are in real need of help from normal people with everyday problems who would be better left alone.’”
Many organizations that engage with communities potentially affected by proposed DSM changes have activated their constituencies. For instance, criteria for autism spectrum disorders are being reworked, prompting questions from parents, professionals and advocates.
One major change proposed to the DSM-5 involves the creation of a new set of conditions referred to as Somatic Symptom Disorders. “Among the work group’s recommendations is the proposal to rename this category Somatic Symptom Disorders. Because the current terminology for somatoform disorders is confusing and because somatoform disorders, psychological factors affecting medical condition, and factitious disorders all involve presentation of physical symptoms and/or concern about medical illness, the work group suggests renaming this group of disorders Somatic Symptom Disorders.” While chronic fatigue syndrome (CFS) is not named among the conditions being swept into this category, the criteria for diagnosis of SSD and its subtypes may hinder, rather than help, the response individuals with CFS receive from medical and mental health professionals. It has prompted concerns and action from many within the CFS community.
The Solve ME/CFS Initiative submitted its concerns about the first proposal for Complex Somatic Symptom Disorder on April 1, 2010 and responded to a second opportunity to submit comments on the latest revisions to SSD and new subtypes identified by the work group on June 14, 2011. Many other organizations and individuals concerned about these changes have submitted comments as well. Advocate Suzy Chapman has collated comments at her site.
The APA has set June 15, 2011 as the deadline for this round of responses to its latest set of proposals. [Update: The APA has extended the deadline for comments to July 15, 2011.] Registration on the DSM-5 site (www.dsm5.org) is required in order to submit comments, but there are no other requirements such as having a professional affiliation or organizational connection.
K. Kimberly McCleary has served as the Association’s chief staff executive since 1991June 14, 2011