DSM-V Controversies

After some members and mental health writers criticized the American Psychiatric Association (APA) for “secrecy” surrounding the development of DSM-V, the Board of Trustees of the APA voted to make public regular DSM-V reports as well as summaries from work group chairs on the Web site at www.dsm5.org.

“We are aware of efforts to portray the DSM-V process as unnecessarily and counterproductively secretive,” said APA president Nada Stotland, MD, MPH, in a November 7 response to a letter to the editor.¹ “On the contrary, it is more open than any previous DSM process. . . . The DSM is a diagnostic manual used in much of the world. Its development must in­clude consideration of the broadest possible range of views and the full range of available or obtainable data.”

“It’s a balancing act between transparency and giving the DSM-V groups space and time to do their work,” said Ronald Burd, MD, speaker of the APA Assembly and a psychiatrist with MeritCare Health System in Fargo, ND. “It is my understanding that prog­ress reports from the groups will be posted on an ongoing basis.”

Dr Stotland acknowledged in her presidential address published in October’s American Journal of Psychiatry that controversy surrounding the DSM-V process has increased in the past few years.

“We are in the midst of a revolution caused by public and legislative concern about the influence of the for-profit sector on the entire field of medicine,” she said. “We have anticipated and addressed questions about conflicts of interest in the DSM process. The abolition of conflict is a myth. . . . what we can do is to be very clear what those interests are.”

Part of the debate emanates from research by Cosgrove and others² who investigated the financial ties to the pharmaceutical industry of 170 panel members who contributed to the diagnostic criteria produced for the DSM-IV and DSM-IV-TR. Of the 170 panel members, 95 (56%) had 1 or more financial associations with companies in the pharmaceutical industry. In 6 of 18 panels, more than 80% of the panel members had financial ties to pharmaceutical companies.

For DSM-V, due out in 2012, the leadership of the APA pledged to take a stringent approach to selecting appointees for the task force, work and study groups, and advisors. The task force includes work group chairs and representatives from the APA, the NIH, and other organizations. They represent a broad spectrum of different fields of science, clinicians, and advocates. The 13 work groups and their subgroups focus on specific categories of mental disorders (eg, mood disorders and neurocognitive disorders), while 5 study groups examine crosscutting issues (eg, diagnostic spectra, assessing impairment, and psychiatric/general medical interface). More than 45 advisors work with the task force and study and work groups to assist with such issues as literature reviews and diagnostic criteria. David Kupfer, MD, of the University of Pittsburgh and Western Psychiatric Institute and Clinic, chairs the task force; and Darrel Regier, MD, MPH, director of APA’s Division of Research and executive director of the American Psychiatric Institute for Research and Education (APIRE), serves as vice chair.

Principles and disclosures
All work group and task force members have been asked to abide by a set of established principles posted on www.dsm5.org.

• Members are to serve without remuneration for their services, with the exception of the DSM-V task force chair).
• They agree to receive no more than $10,000 annually in aggregate from industry sources (excluding unrestricted research grants).
• They must not hold stock or shares worth more than $50,000 in aggregate in pharmaceutical companies/device makers/ biotechnology companies and similar health care–related commercial ventures or receive more than $10,000 annually in aggregate in dividends from such sources. (Exceptions are made for mutual fund shares and similar arrangements.)
• Members agree to abstain from par­­­­­­ticipating in any capacity in industry-sponsored symposia at an APA annual meeting during their task force and/or work group tenure after 2007.