DSM-5: A Year End Summary


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

There have been three positive developments:
1. The appointment of a Work Group reporting to the APA Board of Trustees (BOT) charged with independently reviewing the scientific evidence supporting DSM-5 proposals. Too bad it is not really independent and that the report will be confidential.
2. The increasing activity of the Assembly provides a sorely needed governance check to fill the void created by an almost total  absence of BOT leadership.
3. The example set by John Livesley of the Personality Disorders Work Group in courageously publishing a dissent that details the foolishness of its proposals. Perhaps others working on DSM-5 will follow his lead and open a much needed public discussion of other potentially harmful DSM proposals.    

The rest of the DSM-5 news continues to be extremely worrisome.
1. Aside from being off point, the DSM-5 field trials have fallen far behind schedule. Originally meant to start in July 2009, then rescheduled to begin in July of 2010, the project is still not fully off the ground. An impossibly complicated design guarantees further inevitable delays. Poor planning and disorganized execution will inevitably lead to rushed attempts to cut corners to meet the irrevocable May 2013 publication deadline. The field trials will almost surely turn out to have been a colossal waste of time, money, and effort.
2. The BOT remains passive and spends almost no time or thought on DSM-5, somehow not understanding how crucial it is for the APA and for our patients.
3. For mysterious reasons, the posting of all the latest DSM-5 criteria sets has been delayed.   
4. The reconciliation of DSM-5 codes with the ICD-10-CM codes has been left to the last minute and is being done carelessly.
5. The leadership did finally appoint a group charged with writing the DSM-5 text. But the effort is off to a very late start and has a decentralized structure unlikely to produce a consistent and well organized document. In the preparation of DSM-IV, I found text writing by far the most time consuming, demanding, and onerous task. I fear that DSM-5 may not have the time and expertise to write a readable manual.

All in all, another year that has largely been wasted. Time is running out.

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