What can be done to save DSM-V from itself?
The DSM-V process would not be in its current state if it had been self-correcting and/or open to external suggestions. Influencing its direction now will not be easy, but is certainly not impossible. It will require a sustained external pressure that the research community is well positioned to apply.
Optimism that DSM-V can be saved from itself springs from the fact that external pressure has already resulted in the following improvements, however reluctantly made:
1. Appointment by the American Psychiatric Association (APA) Board of Trustees of an oversight committee to monitor the work on DSM-V
2. Postponement of field trials until after options have been posted and reviewed
3. Reduction of hype about a “paradigm shift”
4. Increased recognition of the value of caution
5. Likely postponement in the DSM-V publication date to May 2013.
There are 3 levers of pressure that the research community can exert to affect a more open, empirically based, and accurate DSM-V.
1. Most immediately, starting in January, individual researchers can each have a valuable correcting role by pointing out the specific problems in their areas that will be caused by the various DSM-V suggestions for change.
2. Within the APA itself, the most relevant components are the Council on Research and Quality and the newly appointed oversight committee, which includes prominent spokespeople for the research community.
3. The APA will be exquisitely sensitive to pressure from the research community—most especially if it comes from NIMH, NIDA, and/or NIAAA, but also from other relevant research-oriented organizations within psychiatry, psychology, and the neurosciences. The APA realizes that it holds the franchise to publish the DSMs only by historical accident, and that this is easily revocable if enough interested organizations lose confidence in its competence and its ability to control its inherent conflict of interest.
Another possible contribution to DSM-V that has excited many psychiatric researchers—but which is certainly premature—is the proposal to go beyond the descriptive method used in the DSM system and instead to attempt to base the classification on the exciting new findings from the revolution in neuroscience.15 This goal would certainly be highly desirable, but, in my view, should not play any current role in creating the DSM-V diagnostic criteria. As an official nomenclature, DSM-V must follow behind research and include only well-established and widely agreed on findings. The next 6 months are certain to be the most important in the development of DSM-V —especially because the field trials will probably not measure impact on rates and are thus likely not to be very informative. Researchers should carefully review DSM-V drafts as they emerge and make their concerns known.