I have little confidence that the DSM-V leadership will do the kind of careful risk-benefit analysis of each proposed change that is necessary to avoid damaging unintended consequences.
My concerns arise from the following:
• Their ambition to achieve a paradigm shift when there is no scientific basis for one.
• Their failure to provide clear methodological guidelines on the level of empirical support required for changes.
• Their lack of openness to wide scrutiny and useful criticism.
• Their inability to spot the obvious dangers in most of their current proposals.
• Their failure to set and meet clear timelines.
• The likelihood that time pressure will soon lead to an unconsidered rush of last-minute decisions.
This is the first time I have felt the need to make any comments on DSM-V. Even when the early steps in the DSM-V process seemed excessively ambitious, secretive, and disorganized, I hoped that I could avoid involvement and believed that my successors deserved a clear field. My unduly optimistic assumption was that the initial problems of secrecy and lack of explicitness would self-correct and that excessive ambitions would be moderated by experience. I have decided to write this commentary now only because time is running out and I fear that DSM-V is continuing to veer badly off course and with no prospect of spontaneous internal correction. It is my responsibility to make my worries known before it is too late to act on them.
What is needed now is a profound midterm correction toward greater openness, conservatism, and methodological rigor. I would thus suggest that the trustees of the American Psychiatric Association establish an external review committee to study the progress of the current work on DSM-V and make recommendations for its future direction.
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