Topic Centers

DSM-V

In their response to the commentary by Drs Lisa Cosgrove and Harold Bursztajn in the January 2009 issue of Psychiatric Times (“Toward Credible Conflict of Interest Policies in Clinical Psychiatry,” page 40), David Kupfer and Darrel Regier, the chair and vice-chair, respectively, of the DSM-V Task Force, invite readers to “monitor the most inclusive and transparent developmental process in the 60-year history of DSM at our www.dsm5.org Web site.” As will be demonstrated in this commentary, this remarkable claim about DSM-V inclusiveness and transparency is simply not true.

First, it should be pointed out that (as noted in the beginning of “DSM-V Controversies,” Psychiatric Times, January 2009, page 1), much of the APA’s current policy regarding DSM-V transparency (for example, the APA’s decision to post Task Force reports and summaries of Workgroup activities on the DSM-V Web site) came about only as a direct response to criticism of the DSM process by concerned APA members like me. These were not part of APA’s original plans for the DSM process.

With regard to the truth of the statement that the DSM-V Task Force uses the most inclusive and transparent pro­cess in the history of the DSM, the facts speak for themselves.

Absence of any information setting forth the principles, goals, criteria for change, etc, underlying the DSM-V revision. Although the Task Force has met at least 7 times in 21/2 years, no information has been provided about such DSM-V fundamentals as the principles guiding the re­vision process, criteria for making changes, plans to address criticisms of the DSM-IV definition of mental disorder, considerations regarding the future of the multiaxial system, the methodology guiding the empirical review process (including proposed design of the field trials), etc. This is in marked contrast to the DSM-IV revision process, which commenced with the publication of 4 peer-reviewed papers published in the major psychiatry1,² and psychology journals.^3,4 Those articles were written to help educate the field and the public about the development plans for the DSM-IV.

For example, the first paper, which appeared in the Archives of General Psychiatry in 1989—5 years before the publication of DSM-IV¹—included detailed sections covering the following topics: advisors to the process, methods conferences, criteria for change, review of evidence, and the development of a source book. The only published materials available at the start of the DSM-V process—namely the DSM-V research agenda5 and the monographs summarizing the DSM-V research planning conferences⁶—provide absolutely no information about the plans for the DSM-V process itself.

The imposition of an unprecedented confidentiality agreement. DSM-V participants have been required to sign a confidentiality agreement that prohibits them from divulging any confidential information about the DSM-V revision process. That process is broadly defined as “all work product, unpublished manuscripts and drafts and other prepublication materials, group discussions, internal correspondence, information about the development process and any other written or unwritten information in any form that emanates from or relates to my work with the APA Task Force or Workgroup.” Remarkably, that agreement extends beyond the time of the publication of DSM-V. Even with the exception that allows the participant to discuss DSM matters if “necessary to fulfill the obligations” of his or her appointment, this agreement forces the participant into the awkward position of having to decide whether providing information about the DSM is part of his job. In those likely frequent situations in which providing information is not deemed part of the job, this hardly results in a transparent DSM-V.