DSM

The DSM-5 Scientific Review Group was the last hope for an eleventh hour DSM-5 save. This hope recently died.

DSM-II was published in 1968. DSM-5 will be published in 2013. How much progress have we made? I propose that we approach this question with a quiz.

Humans have just these 2 ways of sorting things--giving them a name or a giving them a number. We have been naming things since the days of Adam.

I just received a very important email from Dr Dayle Jones who chairs the DSM-5 Task Force of the American Counseling Association (ACA). The ACA has provided a much needed wake-up call for the American Psychiatric Association.

The proposal to include "coercive paraphilia" as an official diagnosis in the main body of DSM-5 has been rejected. This sends an important message to everyone involved in approving psychiatric commitment under Sexually Violent Predator (SVP) statutes.

DSM-IV, published in 1994, did not include a cannabis withdrawal disorder diagnosis. DSM-IV-TR clearly stated the reason for the omission: “Symptoms of possible cannabis withdrawal . . . have been described in association with the use of very high doses, but their clinical significance is uncertain.”1

Aside from its reckless proposals for dangerous new diagnoses, the most characteristic thing about DSM-5 has been its remarkably poor planning and its consistently missed deadlines.

The NIMH Research Domain Criteria (RDoC) project raises many questions about DSM-5 and future DSMs.

The thing to remember that there is not a pill for every worry or life problem and that pills can sometimes make things worse.

Writers of diagnostic criteria should consider their work and all its implications. What about adding a new disorder? What might that do to epidemiological capture? Depending on the characteristics of the diagnostic criteria set, many possibilities exist.

In previous blogs and papers, I have done my level best to skewer the misuse of the misdiagnosis "Paraphilia NOS." I regard it as no more than a flimsy justification, concocted to allow the psychiatric incarceration of rapists who would otherwise have to be released from prison to the street.

I was asked three interesting questions by a psychologist with 15 years experience evaluating sexually violent predators. She has testified often--both for the prosecution and for the defense in the hearings that determine the legitimacy of involuntary psychiatric commitment under SVP statutes.

There have been four ringing rejections of the concept of paraphilic rape--in DSM-III, in DSM-IIIR, in DSM-IV, and in a 1999 APA Task Force report. The circumstances surrounding the latter three decisions are fairly well known, the first less so.

In a recent Psychiatric Times blog, Allen Frances engaged a debate with Andrew Hinderliter over the question of change in the diagnostic categories of DSM-5.

One of the impulse-control disorders, Intermittend Explosive Disorder includes serious acts of aggression against person or property that are completely out of proportion to any provocation.

Charles Moser, PhD, MD, has forwarded an interesting suggestion to solve the problem of weak diagnoses that have received a free ride through previous revisions of DSM. His is a middle way intended to steer between the contrasting risks of continuing questionable diagnoses and the risks of eliminating them.

A DSM critic, Andrew Hinderliter sent this perceptive email questioning the wisdom of the most fundamental decision we made in preparing DSM IV-- ie, our goal of keeping the system stable.

In my previous blog, The Missing Person in the DSM, I questioned whether the DSM diagnostic manual classifies psychiatric disorders or the individuals suffering from diagnostic disorders-Ms Smith’s bipolar disorder, or Ms Smith, a person with bipolar disorder.

A large new study from Australia found that DSM-5 would cause a sky-rocketing 60% increase in the rate of alcohol use disorders.

Gary Greenberg, PhD is a psychotherapist, author, teacher, and historian of psychiatric diagnosis. His writings are characterized by penetrating insight, elegant wordsmithing, entertaining story telling, and a dig-deep, no-holds-barred search for underlying meaning.

There have been three positive developments. The rest of the DSM-5 news continues to be extremely worrisome, and time is running out.

Last week, I had a brief, but heated debate with a friend who is on the DSM-5 Task Force. He is strongly supporting a proposed new diagnosis for DSM-5 that I oppose just as strongly.

The New York Times of Dec 20,2010 carried an alarming story. It seems that during the past decade, college students have suddenly become much more mentally ill.

Recently, the Substance Use Disorder Work group of the DSM-5 announced the inclusion of “craving” in the diagnostic criteria for all substance use disorders despite its lack of empirical support from the very analyses conducted by that Workgroup. In addition, no detailed literature review supports the decision to make “craving” a core symptom of Substance Use Disorder syndromes.

Many people associated with DSM-5 have privately expressed their serious doubts to me, but felt muzzled into public silence by constraining confidentiality agreements and loyalty to the process.