James Phillips, MD

With DSM-5 now approved by the APA Board of Trustees—and, to the dismay of this reader, all discussion removed from the DSM-5 Web site—how are we to evaluate the results of the field trials for the end product?

A recent case has caused a flurry of opposing opinions. Not surprisingly, transgender advocacy groups have praised the judge's decision that the inmate in question has an eighth amendment right requiring the state to support and pay for sex reassignment surgery.

With DSM-5 scheduled for publication a little more than a year from now, we may safely assume that, barring unannounced surprises from, say, the APA Scientific Review Committee, what we will see on the DSM-5 Web site is what we will get. With that in mind it’s time to review what we will indeed get.

Both the DSM-5 Web site and Psychiatry News have recently heralded the proposed DSM-5 revision for diagnosis of personality disorders.

Regretfully, if we are to judge the progress of DSM-5 by the incoherence of a recent commentary by the Chair and Vice-chair of the DSM-5 Task Force, we have a lot to worry about.

DSM-II was published in 1968. DSM-5 will be published in 2013. How much progress have we made? I propose that we approach this question with a quiz.

The NIMH Research Domain Criteria (RDoC) project raises many questions about DSM-5 and future DSMs. The first is, does the project play a role in DSM-5? Answer: no. Another question: Will the RDoC play a role in future DSMs? Certainly yes. And further: Will the project cause major revisions in future DSMs? For sure. And finally: What does this say about the status of DSM-5? Let’s consider this.

In my previous blog, The Missing Person in the DSM, I questioned whether the DSM diagnostic manual classifies psychiatric disorders or the individuals suffering from diagnostic disorders—Ms Smith’s bipolar disorder, or Ms Smith, a person with bipolar disorder.

Here’s a question. As you sit across from your patient, what or whom are you treating: Ms Smith’s bipolar illness, or Ms Smith, a person with bipolar illness? The DSM leans toward the first choice.

The DSM does and must involve both science and pragmatism. It must use the science that is available, but it must also make countless judgment calls that are not grounded in solid empirical evidence and surely it makes sense to consider practical consequences in doing the latter.