Allen Frances, MD

The changes in the newly approved DSM-5 loosen diagnosis and threaten to turn our current diagnostic inflation into diagnostic hyperinflation.

The DSM-5 leadership is trying to put a brave face on its badly failed first stage of field testing and has offered no excuse or explanation for canceling its second and most crucial quality control stage. This field testing fiasco erases whatever was left of the credibility of DSM-5 and APA.

A recent article in the New York Times reports that doctors are prescribing stimulant drugs to compensate for the bad schools their child patients have to attend. Rates of ADHD have tripled in the last 15 years-precisely because many kids are being diagnosed with fake ADHD to make them eligible for medications and/or extra school services.

James Dao reports in the New York Times that the military is considering 2 steps to reduce its startling rate of active duty suicides-which is approaching an unacceptable one suicide every day. Both measures are completely sensible, but neither goes nearly far enough.

Improving our kids performance in school won't come from some vague, quixotic psychological fix. It requires they have better lives and better schools and that means us becoming a fairer society.

With understandable urgency, Secretary of Defense Leon Panetta has made suicide one of his top priorities, instructing commanders at all levels to feel acutely accountable for it. The numbers are startling. On average 1 active duty soldier is killing himself each day--twice the number of combat deaths and twice the civilian rate.

Seventy percent of antidepressants are prescribed by primary care doctors with little training in their proper use, under intense pressure from Big Pharma, drug salespeople, and misled patients, after rushed 7-minute appointments and subject to no systematic auditing. The cash-strapped FDA is beholden to industry for funding. And it gets worse.

"Internet Addiction" may soon spread like wildfire. All the elements favoring fad generation are in place . . . the profusion of alarming books; the breathless articles in magazines and newspapers; extensive TV exposure; ubiquitous blogs; the springing up of unproven treatment programs; the availability of millions of potential patients; and an exuberant trumpeting by newly minted "thought leading" researchers and clinicians. So far, DSM-5 has provided the only restraint.

Psychiatry has no way to predict mass murder and no way to prevent it. There is no indication that psychiatry can change the statistics of violence or the proclivity of the violent.

There is no psychiatric solution for mass murder. What are the warning signs? Is there a way to protect victims? What can we do to prevent an awful tragedy from constantly recurring?

Our current diagnostic system is based more on subjective clinical judgments and less biological psychiatry. There is not one way to develop symptoms of schizophrenia or bipolar disorder or autistim or OCD.

Let’s compare Dr Robert Spitzer's apology to the gay community with the stonewalling that has characterized every step in the development of DSM-5. The American Psychiatric Association has a lot to apologize for-but instead maintains a defensive posture that prevents insight and self-correction.

For the first time in its history, DSM-5 has shown some flexibility and capacity to correct itself. Hopefully, this is just the beginning of what will turn out to be a number of other necessary DSM-5 retreats.

An excellent study has killed two birds with one stone. It is a clear caution against the DSM-5 proposal for a psychosis risk syndrome and it should temper enthusiasm for rushing ahead with "ultra high risk" prevention programs.

My experience indicates that the SVP laws are being implemented in a highly arbitrary and idiosyncratic fashion with judges and juries easily confused by misleading expert testimony.

The diagnostic boundary between Major Depressive Disorder and Bipolar II Disorder is one of the most difficult and also one of the most important in psychiatry.

Up until now, the leadership of the American Psychiatric Association has stubbornly defended the indefensible DSM-5 proposal that would turn normal grief into clinical depression. APA has blithely ignored the contrary scientific evidence

According to this week’s Time Magazine, the American Psychiatric Association has just recruited a new public relations spokesman who previously worked at the Department of Defense.

Of all the misconceived DSM-5 suggestions, the one touching the rawest public nerve is the proposed medicalization of normal grief into a mental disorder.

This letter was sent to the APA Trustees and to the DSM-5 Task Force on February 12, 2012, under the title, “Heads Up And Recommendations.”

Until yesterday, there were only 2 reasons to stick with the projected date of DSM-5 publication (May 2013). The first just dropped out.

My recent blog stimulated 2 interesting responses that illustrate the stark contrast between DSM-5 fantasy and DSM-5 reality. Together they document why publication must be delayed if DSM-5 is to be set right.

My three criticisms of DSM-5 have been: (1) risky suggestions; (2) bad writing; and (3) poor planning and disorganization.

My biggest concern regarding DSM-5 is that it will dramatically increase the rates of mental disorder by cheapening the currency of psychiatric diagnosis . . .The whole purpose of field-testing is to identify and correct problems in the preliminary DSM suggestions before they become set in stone as official guides to diagnostic practice.

This is the title of a disturbing commentary written by the leaders of the DSM-5 Task Force and published in a prominent psychiatric journal.

The designer of the DSM-5 Field Trials has just written a telling commentary in the American Journal of Psychiatry. She makes what I consider to be 2 basic errors that reveal the fundamental worthlessness of these Field Trials and their inability to provide any information that will be useful for DSM-5 decision making.

Accurate diagnosis is absolutely crucial in SVP hearings because the potential outcome is so consequential-involuntary incarceration in a psychiatric hospital that may well last a lifetime. In no other clinical or forensic situation does so much ride on the presence or absence of a psychiatric diagnosis.

The DSM-5 Web site has recently been revised-the term “Pedohebephilia” disappears altogether, but the concept of “Hebephilia” lives on...

ADHD is often inaccurately diagnosed and prematurely treated with medication-especially under the pressure of heavy drug company marketing to physicians and direct advertising to parents and teachers.

This blog is a follow-up to an earlier post. The great news is that there is an active public debate on DSM-5.