In contrast, participants of earlier editions of the DSM were never asked to sign any confidentiality agreement nor were they instructed to hold back from discussing DSM matters with anyone.
Restrictions on the appointment of advisors and consultants. DSM-III, DSM-III-R, and DSM-IV were truly inclusive regarding the appointment of advisors and consultants. To get the widest possible opportunity for input, essentially anyone interested in becoming an advisor was appointed.1 While the policy for appointing DSM-V advisors and consultants has never made been public, it is my understanding that the DSM-V Workgroups have been instructed to submit lists of names of advisors for approval by the DSM leadership—and that many proposed advisor appointments have been turned down. Furthermore, in contrast with earlier DSMs in which consultants were appointed for the duration of the DSM revision process, DSM-V consultants are appointed for 1 year only and expressly for the purpose of consulting on a specific issue or problem. Regardless of whether this change in policy makes sense, it is certainly not an example of DSM-V inclusivity.
Although the motivation for this resistance to make DSM-V more transparent remains a matter of speculation, one clear consequence is that it prevents open debate about the directions that the DSM-V Task Force is taking.
It has been extremely challenging to compose any articles raising any concerns about DSM-V because, short of a single article published in CNS Spectrums7 in which Darrel Regier is interviewed by Norman Sussman about DSM-V, there is nothing in print describing the principles underlying the DSM-V revision. What is known to me comes from off-hand comments by DSM-V participants, from grand rounds and other presentations about DSM-V, or from statements to the media.
For example, I understand that in grand rounds presentations given by Darrel Regier, he reports that the thresholds for making changes in DSM-V will be much lower than they were for DSM-IV and that DSM-V will be more etiologically based than DSM-IV. What is the justification for having a lower threshold for making changes? Is there any evidence that the conservative DSM-IV approach was problematic and that important innovations were impeded in some way?
Regarding DSM-V being more etiological, virtually everything that has come out of the DSM-V research agenda and research planning conferences indicates that there is insufficient empirical evidence to justify making the more etiologically based. What is the basis for this astounding claim? Finally, David Kupfer was quoted in a December 27, 2008, article in the Chicago Tribune, saying that his goal for DSM-V was to reduce the number of diagnoses. The deletion of any diagnosis can have profound implications for researchers, clinicians, and patients—to which diagnoses is he referring and what would be the grounds for deleting them?
The wisdom of such potentially major changes in direction need to be discussed and debated out in the open early in the process, well before drafts of criteria are made available in 2010, so that interested parties can respond and provide potentially important feedback. It is only through such an open revision process that the best and most credible DSM-V can emerge.