Article: Coalition4ME/CFS Puts Out Call For Action on DSM-5 Proposal
- Thread starter Phoenix Rising Team
- Start date
@ Andrew
Let me know if would you like your submission added to the others at:
http://wp.me/PKrrB-19a
@ to everyone
You now have until midnight Monday, July 18 to send comments in via email to: dsm5@psych.org
(Do not try to use the DSM-5 Development site to send in comments as there is a fault with the WYSIWYG editor displaying on the site which is why the APA is requesting that comments are sent directly to them by email - so that makes it easier.)
Mark your comments "For the attention of the Work Group for Somatic Symptom Disorders"
Let me know if would you like your submission added to the others at:
http://wp.me/PKrrB-19a
@ to everyone
You now have until midnight Monday, July 18 to send comments in via email to: dsm5@psych.org
(Do not try to use the DSM-5 Development site to send in comments as there is a fault with the WYSIWYG editor displaying on the site which is why the APA is requesting that comments are sent directly to them by email - so that makes it easier.)
Mark your comments "For the attention of the Work Group for Somatic Symptom Disorders"
Dr Alan Gurwitt, M.D., President, Massachusetts CFIDS/ME & FM Association (Retired adult and child psychiatrist, Distinguished Fellow of the American Psychiatric Association) has contacted me today, to say that he has sent the following brief response to the APA. Last year's submissions by the Massachusetts CFIDS/ME & FM Association can be read here National advocacy efforts state concerns about revisions to DSM-V
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RE: DSM5 and Myalgic Encephalopathy (also known as CFS)
There is great apprehension that the proven medical illness, Chronic Fatigue Syndrome (CFS), also better known as Myalgic Encephalopathy or Myalgic Encephalitis (ME) will again be mistakenly thrown into a psychiatric categorization by your revisions of somatic disorders. Great harm has been done for over 25 years by sloppy psychiatric diagnostic procedures and nosology. With an prevalence rate of 0.42 % of adults, this serious medical illness has been too often misdiagnosed. There is no excuse for the ignorance of the diagnostic criteria for ME/CFS (see the Canadian Consensus Criteria from 2003, currently being updated). Please pay attention to this issue
Alan Gurwitt, M.D., Distinguished Fellow of the APA
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RE: DSM5 and Myalgic Encephalopathy (also known as CFS)
There is great apprehension that the proven medical illness, Chronic Fatigue Syndrome (CFS), also better known as Myalgic Encephalopathy or Myalgic Encephalitis (ME) will again be mistakenly thrown into a psychiatric categorization by your revisions of somatic disorders. Great harm has been done for over 25 years by sloppy psychiatric diagnostic procedures and nosology. With an prevalence rate of 0.42 % of adults, this serious medical illness has been too often misdiagnosed. There is no excuse for the ignorance of the diagnostic criteria for ME/CFS (see the Canadian Consensus Criteria from 2003, currently being updated). Please pay attention to this issue
Alan Gurwitt, M.D., Distinguished Fellow of the APA
Sounds good. Please add it.
BTW, if/when depression comes up for review, we might want to write about that as well.
Thank you, Andrew, I'll add yours this evening as "US patient, Andrew" (unless you'd prefer to be styled in some other way).
Re: depression, all categories in DSM-IV are under revision and the Depressive Disorders proposals are here:
http://www.dsm5.org/proposedrevision/Pages/DepressiveDisorders.aspx
I've just spotted this notice on the DSM-5 Development site (directly beneath the notice in red text about the website glitch and extension to midnight, Monday July 18):
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Only 2000 odd this time. I considered that the reason for the additional four week extension was likely to be a low response rate, this time, compared with the first stakeholder review.
Let's hope that a significant proportion of those 2000 were expressions of concern for the proposals of the SSD Work Group.
We still have one more day and > 4500 members on these forums.
If you haven't already submitted please, please, submit tomorrow, however brief.
http://www.dsm5.org/Pages/Default.aspx
The 2nd period for submitting comments and suggestions to the web site regarding the proposed diagnostic criteria revisions, and the newly proposed organizational structure for DSM-5 took place from May 4th-July 15th. We are appreciative of your ongoing interest in contributing to this process. During our first comment period, we received over 8600 comments from you, our viewers. We encourage you to spend time on this site to investigate the myriad ways your comments helped shape some of the recent updates to the proposed diagnostic criteria. During this second comment period, we have received over 2000 comments and our work groups are actively reviewing your input. Thank you for taking the time to provide your insights, experiences, and expertise toward these important issues.
The 2nd period for submitting comments and suggestions to the web site regarding the proposed diagnostic criteria revisions, and the newly proposed organizational structure for DSM-5 took place from May 4th-July 15th. We are appreciative of your ongoing interest in contributing to this process. During our first comment period, we received over 8600 comments from you, our viewers. We encourage you to spend time on this site to investigate the myriad ways your comments helped shape some of the recent updates to the proposed diagnostic criteria. During this second comment period, we have received over 2000 comments and our work groups are actively reviewing your input. Thank you for taking the time to provide your insights, experiences, and expertise toward these important issues.
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Only 2000 odd this time. I considered that the reason for the additional four week extension was likely to be a low response rate, this time, compared with the first stakeholder review.
Let's hope that a significant proportion of those 2000 were expressions of concern for the proposals of the SSD Work Group.
We still have one more day and > 4500 members on these forums.
If you haven't already submitted please, please, submit tomorrow, however brief.
Samuel Wales has sent me a copy of his submission for inclusion on my site. Sam blogs at http://thekafkapandemic.blogspot.com/
A recent post of Samuel's that I know many have enjoyed:
http://thekafkapandemic.blogspot.com/2011/07/modest-and-possibly-lucrative-proposal.html
"A modest and possibly lucrative proposal".
Submission to DSM-5
Date: Mon, 18 Jul 2011
To: dsm5@psych.org
To the DSM-5 Task Force and particularly to the members of the "Somatic Symptom Disorder Work Group".
A recent post of Samuel's that I know many have enjoyed:
http://thekafkapandemic.blogspot.com/2011/07/modest-and-possibly-lucrative-proposal.html
"A modest and possibly lucrative proposal".
Submission to DSM-5
Date: Mon, 18 Jul 2011
To: dsm5@psych.org
To the DSM-5 Task Force and particularly to the members of the "Somatic Symptom Disorder Work Group".
1. According to media reports, Senator Grassley's investigations of certain members of your profession have raised questions about conflict of interest. Rightly or wrongly, many currently consider the profession to be in disrepute.
A new category is being proposed. If it is made official, there is a high probability that unwanted questions will rightly or wrongly be raised about conflict of interest.
There is an increased risk, rightly or wrongly, of investigations, lawsuits, or unwanted media attention concerning the Task Force, the Work Group, and their individual members.
2. My concern in this matter pertains to the high potential of the measures under consideration to increase suffering and death from misdiagnosed physical diseases. Others have written on this topic expressing a similar concern. I agree with the points I have seen and urge you to treat these matters with maximum seriousness. Human lives are at stake.
A new category is being proposed. If it is made official, there is a high probability that unwanted questions will rightly or wrongly be raised about conflict of interest.
There is an increased risk, rightly or wrongly, of investigations, lawsuits, or unwanted media attention concerning the Task Force, the Work Group, and their individual members.
2. My concern in this matter pertains to the high potential of the measures under consideration to increase suffering and death from misdiagnosed physical diseases. Others have written on this topic expressing a similar concern. I agree with the points I have seen and urge you to treat these matters with maximum seriousness. Human lives are at stake.
Samuel Wales
Open Letter and Petition to DSM-5 Task Force by Society for Humanistic Psychology
There are a number of (not currently active) existing threads on the DSM-5 SSD proposals issue. So as not to fragment previous discussions and information, I am resurrecting a previous thread.
A version of this post has also been published on the Co-Cure mailing list:
From Suzy Chapman for http://dxrevisionwatch.wordpress.com
October 23, 2011
Open Letter and Petition to DSM-5 Task Force by Society for Humanistic Psychology (Division 32 of the American Psychological Association)
This time last year, folk would mail me saying - I don't know why you bother monitoring DSM-5 and ICD-11, XMRV is going to render the DSM-5 proposals meaningless.
Well that was then, and this is now. And in a couple of months' time we'll be anticipating the third and final public review and feedback on the APA's draft proposals for changes to categories and criteria for the revision of DSM-IV.
During the first feedback exercise, over 8,600 comments rolled in; during the second comment period (which was extended by an additional four weeks), over 2000 comments were received.
According to the current DSM-5 Timeline:
According to the DSM-5 Development home page:
So assuming the APA's schedule remains on target, US and international patient organizations and advocates need to start preparing well in advance of the New Year for how best to engage our own medical and allied professionals in this process and encourage their input.
Because of increased family and business commitments following my husband's recent major surgery, I shall not be in a position to undertake very much in the way of awareness raising or contacting patient organizations and professionals, early next year, when revised draft proposals are expected to be published.
As soon as revised proposals are posted on the DSM-5 Development site, I shall put out alerts on my websites, via Co-Cure and on other platforms and I shall be contacting UK patient organizations, as I have done for the previous two public review exercises.
But I hope that other advocates and groups, in the US and internationally, will work to take this forward and ensure that as many international patient organizations, ME clinicians and researchers, like those who collaborated on the new ME-ICC, and allied professionals are made aware of the proposals of the "Somatic Symptom Disorders" Work Group and the implications for ME, CFS, FM, IBS, CI, CS and GWS patient groups, and are encouraged to submit comments as professional stakeholders.
Today I was alerted to an Open Letter and petition sponsored by the Society for Humanistic Psychology, Division 32 of the American Psychological Association, in alliance with the Society for Community Research and Action: Division of Community Psychology (Division 27 of APA) and the Society for Group Psychology and Psychotherapy (Division 49 of APA) [3].
These American Psychological Association bodies are inviting mental health professionals and mental health organizations to sign up in support of an open letter to the American Psychiatric Association's DSM-5 Task Force. Their response to DSM-5 structure and proposals may be of interest to psychiatrists and psychologists affiliated to, or on the boards of our own ME and CFS patient organizations.
The Open Letter to the DSM-5 Task Force can be read here and a copy is also appended: http://www.ipetitions.com/petition/dsm5/
Under the subheading "New Emphasis on Medico-Physiological Theory", the petition sponsors comment on some aspects of the DSM-5 proposals for the "Somatic Symptom Disorders" categories. The Open Letter also supports concerns set out within the formal response to DSM-5 draft proposals submitted by the British Psychological Society, earlier this year, and more recent concerns published by the American Counseling Association.
A couple of points: both the American Psychological Association, whose bodies are sponsors of this Open Letter, and the American Psychiatric Association use the acronym "APA". It is the American Psychiatric Association's DSM-5 Task Force that is developing the DSM-5.
Secondly, although the first release of draft DSM-5 proposals did have "Factitious Disorder" placed with "Somatic Symptom Disorders (SSDs)", the most recent (May 2011) DSM-5 draft proposes placing "Factitious Disorder" within "Other Disorders", not within the SSDs, as the Open Letter states [4], [5].
[1] DSM-5 Development Timeline: http://www.dsm5.org/about/Pages/Timeline.aspx
[2] DSM Development website: http://www.dsm5.org/Pages/Default.aspx
[3] Society for Humanistic Psychology: http://www.apadivisions.org/division-32/index.aspx
[4] DSM-5 Draft Proposals, Somatic Symptom Disorders: http://www.dsm5.org/proposedrevision/Pages/SomaticSymptomDisorders.aspx
[5] DSM-5 Draft Proposals, Other Disorders: http://www.dsm5.org/proposedrevision/Pages/OtherDisorders.aspx
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http://www.ipetitions.com/petition/dsm5/
Open Letter to the DSM-5: Society for Humanistic Psychology, Division 32 of the American Psychological Association
Signaturies: http://www.ipetitions.com/petition/dsm5/signatures
Sponsor
Society for Humanistic Psychology, Division 32 of the American Psychological Association, in alliance with Society for Community Research and Action: Division of Community Psychology (Division 27 of APA) and Society for Group Psychology and Psychotherapy (Division 49 of APA). We invite mental health professionals and mental health organizations to sign on in support of this petition to the DSM5 Task Force of the American Psychiatric Association
To the DSM-5 Task Force and the American Psychiatric Association:
As you are aware, the DSM is a central component of the research, education, and practice of most licensed psychologists in the United States. Psychologists are not only consumers and utilizers of the manual, but we are also producers of seminal research on DSM-defined disorder categories and their empirical correlates. Practicing psychologists in both private and public service utilize the DSM to conceptualize, communicate, and support their clinical work.
For these reasons, we believe that the development and revision of DSM diagnoses should include the contribution of psychologists, not only as select individuals on a committee, but as a professional community. We have therefore decided to offer the below response to DSM-5 development. This document was composed in recognition of, and with sensitivity to, the longstanding and congenial relationship between American psychologists and our psychiatrist colleagues.
Overview
Though we admire various efforts of the DSM-5 Task Force, especially efforts to update the manual according to new empirical research, we have substantial reservations about a number of the proposed changes that are presented on www.dsm5.org. As we will detail below, we are concerned about the lowering of diagnostic thresholds for multiple disorder categories, about the introduction of disorders that may lead to inappropriate medical treatment of vulnerable populations, and about specific proposals that appear to lack empirical grounding. In addition, we question proposed changes to the definition(s) of mental disorder that deemphasize sociocultural variation while placing more emphasis on biological theory. In light of the growing empirical evidence that neurobiology does not fully account for the emergence of mental distress, as well as new longitudinal studies revealing long-term hazards of standard neurobiological (psychotropic) treatment, we believe that these changes pose substantial risks to patients/clients, practitioners, and the mental health professions in general.
Given the changes currently taking place in the profession and science of psychiatry, as well as the developing empirical landscape from which psychiatric knowledge is drawn, we believe that it is important to make our opinions known at this particular historical moment. As stated at the conclusion of this letter, we believe that it is time for psychiatry and psychology collaboratively to explore the possibility of developing an alternative approach to the conceptualization of emotional distress. We believe that the risks posed by DSM-5, as outlined below, only highlight the need for a descriptive and empirical approach that is unencumbered by previous deductive and theoretical models.
In more detail, our response to DSM-5 is as follows:
Advances Made by the DSM-5 Task Force
We applaud certain efforts of the DSM-5 Task Force, most notably efforts to resolve the widening gap between the current manual and the growing body of scientific knowledge on psychological distress. In particular, we appreciate the efforts of the Task Force to address limitations to the validity of the current categorical system, including the high rates of comorbidity and Not Otherwise Specified (NOS) diagnoses, as well as the taxonomic failure to establish zones of rarity between purported disorder entities (Kendell & Jablensky, 2003). We agree with the APA/DSM-5 Task Force statement that, from a systemic perspective,
The DSM-III categorical diagnoses with operational criteria were a major advance for our field, but they are now holding us back because the system has not kept up with current thinking. Clinicians complain that the current DSM-IV system poorly reflects the clinical realities of their patients. Researchers are skeptical that the existing DSM categories represent a valid basis for scientific investigations, and accumulating evidence supports this skepticism. (Schatzberg, Scully, Kupfer, & Regier, 2009)
As researchers and clinicians, we appreciate the attempt to address these problems. However, we have serious reservations about the proposed means for doing so. Again, we are concerned about the potential consequences of the new manual for patients and consumers; for psychiatrists, psychologists, and other practitioners; and for forensics, health insurance practice, and public policy. Our specific reservations are as follows:
Lowering of Diagnostic Thresholds
The proposal to lower diagnostic thresholds is scientifically premature and holds numerous risks. Diagnostic sensitivity is particularly important given the established limitations and side-effects of popular antipsychotic medications. Increasing the number of people who qualify for a diagnosis may lead to excessive medicalization and stigmatization of transitive, even normative distress. As suggested by the Chair of DSM-IV Task Force Allen Frances (2010), among others, the lowering of diagnostic thresholds poses the epidemiological risk of triggering false-positive epidemics.
We are particularly concerned about:
Attenuated Psychosis Syndrome, which describes experiences common in the general population, and which was developed from a risk concept with strikingly low predictive validity for conversion to full psychosis.
The proposed removal of Major Depressive Disorders bereavement exclusion, which currently prevents the pathologization of grief, a normal life process.
The reduction in the number of criteria necessary for the diagnosis of Attention Deficit Disorder, a diagnosis that is already subject to epidemiological inflation.
The reduction in symptomatic duration and the number of necessary criteria for the diagnosis of Generalized Anxiety Disorder.
Though we also have faith in the perspicacity of clinicians, we believe that expertise in clinical decision-making is not ubiquitous amongst practitioners and, more importantly, cannot prevent epidemiological trends that arise from societal and institutional processes. We believe that the protection of society, including the prevention of false epidemics, should be prioritized above nomenclatural exploration.
Vulnerable Populations
We are also gravely concerned about the introduction of disorder categories that risk misuse in particularly vulnerable populations. For example, Mild Neurocognitive Disorder might be diagnosed in elderly with expected cognitive decline, especially in memory functions. Additionally, children and adolescents will be particularly susceptible to receiving a diagnosis of Disruptive Mood Dysregulation Disorder or Attenuated Psychosis Syndrome. Neither of these newly proposed disorders have a solid basis in the clinical research literature, and both may result in treatment with neuroleptics, which, as growing evidence suggests, have particularly dangerous side-effects (see below)as well as a history of inappropriate prescriptions to vulnerable populations, such as children and the elderly
Sociocultural Variation
The DSM-5 has proposed to change the Definition of a Mental Disorder such that DSM-IVs Feature E: Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, will instead read [A mental disorder is a behavioral or psychological syndrome or pattern] [t]hat is not primarily a result of social deviance or conflicts with society. The latter version fails to explicitly state that deviant behavior and primary conflicts between the individual and society are not mental disorders. Instead, the new proposal focuses on whether mental disorder is a result of deviance/social conflicts. Taken literally, DSM-5s version suggests that mental disorder may be the result of these factors so long as they are not primarily the cause. In other words, this change will require the clinician to draw on subjective etiological theory to make a judgment about the cause of presenting problems. It will further require the clinician to make a hierarchical decision about the primacy of these causal factors, which will then (partially) determine whether mental disorder is said to be present. Given lack of consensus as to the primary causes of mental distress, this proposed change may result in the labeling of sociopolitical deviance as mental disorder.
Revisions to Existing Disorder Groupings
Several new proposals with little empirical basis also warrant hesitation:
As mentioned above, Attenuated Psychosis Syndrome and Disruptive Mood Dysregulation Disorder (DMDD) have questionable diagnostic validity, and the research on these purported disorders is relatively recent and sparse.
The proposed overhaul of the Personality Disorders is perplexing. It appears to be a complex and idiosyncratic combined categorical-dimensional system that is only loosely based on extant scientific research. It is particularly concerning that a member of the Personality Disorders Workgroup has publicly described the proposals as a disappointing and confusing mixture of innovation and preservation of the status quo that is inconsistent, lacks coherence, is impractical, and, in places, is incompatible with empirical facts (Livesley, 2010), and that, similarly, Chair of DSM-III Task Force Robert Spitzer has stated that, of all of the problematic proposals, Probably the most problematic is the revision of personality disorders, where theyve made major changes; and the changes are not all supported by any empirical basis.
The Conditions Proposed by Outside Sources that are under consideration for DSM-5 contain several unsubstantiated and questionable disorder categories. For example, Apathy Syndrome, Internet Addiction Disorder, and Parental Alienation Syndrome have virtually no basis in the empirical literature.
New Emphasis on Medico-Physiological Theory
Advances in neuroscience, genetics, and psychophysiology have greatly enhanced our understanding of psychological distress. The neurobiological revolution has been incredibly useful in conceptualizing the conditions with which we work. Yet, even after the decade of the brain, not one biological marker (biomarker) can reliably substantiate a DSM diagnostic category. In addition, empirical studies of etiology are often inconclusive, at best pointing to a diathesis-stress model with multiple (and multifactorial) determinants and correlates. Despite this fact, proposed changes to certain DSM-5 disorder categories and to the general definition of mental disorder subtly accentuate biological theory. In the absence of compelling evidence, we are concerned that these reconceptualizations of mental disorder as primarily medical phenomena may have scientific, socioeconomic, and forensic consequences. New emphasis on biological theory can be found in the following DSM-5 proposals:
The first of DSM-5s proposed revisions to the Definition of a Mental Disorder transforms DSM-IVs versatile Criterion D: A manifestation of a behavioral, psychological, or biological dysfunction in the individual into a newly collapsed Criterion B: [A behavioral or psychological syndrome] That reflects an underlying psychobiological dysfunction. The new definition states that all mental disorders represent underlying biological dysfunction. We believe that there is insufficient empirical evidence for this claim.
The change in Criterion H under Other Considerations for the Definition of a Mental Disorder adds a comparison between medical disorders and mental disorders with no discussion of the differences between the two. Specifically, the qualifying phrase No definition adequately specifies precise boundaries for the concept of mental disorder was changed to No definition perfectly specifies precise boundaries for the concept of either medical disorder or mental/psychiatric disorder. This effectively transforms a statement meant to clarify the conceptual limitations of mental disorder into a statement equating medical and mental phenomena.
We are puzzled by the proposals to De-emphasize medically unexplained symptoms in Somatic Symptom Disorders (SSDs) and to reclassify Factitious Disorder as an SSD. The SSD Workgroup explains: because of the implicit mind-body dualism and the unreliability of assessments of medically unexplained symptoms, these symptoms are no longer emphasized as core features of many of these disorders. We do not agree that hypothesizing a medical explanation for these symptoms will resolve the philosophical problem of Cartesian dualism inherent in the concept of mental illness. Further, merging the medico-physical with the psychological eradicates the conceptual and historical basis for somatoform phenomena, which are by definition somatic symptoms that are not traceable to known medical conditions. Though such a redefinition may appear to lend these symptoms a solid medico-physiological foundation, we believe that the lack of empirical evidence for this foundation may lead to practitioner confusion, as might the stated comparison between these disorders and research on cancer, cardiovascular, and respiratory diseases.
The proposed reclassification of Attention Deficit/Hyperactivity Disorder (ADHD) from Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence to the new grouping Neurodevelopmental Disorders seems to suggests that that ADHD has a definitive neurological basis. This change, in combination with the proposal to lower the diagnostic threshold for this category as described above, poses high risk of exacerbating the extant over-medicalization and over-diagnosis of this disorder category.
A recent publication by the Task Force, The Conceptual Evolution of DSM-5 (Regier, Narrow, Kuhl, & Kupfer, 2011), states that the primary goal of DSM-5 is to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience. We believe that the primary goal of DSM-5 should be to keep pace with advances in all types of empirical knowledge (e.g., psychological, social, cultural, etc.).
Taken together, these proposed changes seem to depart from DSMs 30-year atheoretical stance in favor of a pathophysiological model. This move appears to overlook growing disenchantment with strict neurobiological theories of mental disorder (e.g., chemical imbalance theories such as the dopamine theory of schizophrenia and the serotonin theory of depression), as well as the general failure of the neo-Kraepelinian model for validating psychiatric illness. Or in the words of the Task Force:
epidemiological, neurobiological, cross-cultural, and basic behavioral research conducted since DSM-IV has suggested that demonstrating construct validity for many of these strict diagnostic categories (as envisioned most notably by Robins and Guze) will remain an elusive goal (Kendler, Kupfer, Narrow, Phillips, & Fawcett, 2009, p. 1).
We thus believe that a move towards biological theory directly contradicts evidence that psychopathology, unlike medical pathology, cannot be reduced to pathognomonic physiological signs or even multiple biomarkers. Further, growing evidence suggests that though psychotropic medications do not necessarily correct putative chemical imbalances, they do pose substantial iatrogenic hazards. For example, the increasingly popular neuroleptic (antipsychotic) medications, though helpful for many people in the short term, pose the long-term risks of obesity, diabetes, movement disorders, cognitive decline, worsening of psychotic symptoms, reduction in brain volume, and shortened lifespan (Ho, Andreasen, Ziebell, Pierson, & Magnotta, 2011; Whitaker, 2002, 2010). Indeed, though neurobiology may not fully explain the etiology of DSM-defined disorders, mounting longitudinal evidence suggests that the brain is dramatically altered over the course of psychiatric treatment.
Conclusions
In sum, we have serious reservations about the proposed content of the future DSM-5, as we believe that the new proposals pose the risk of exacerbating longstanding problems with the current system. Many of our reservations, including some of the problems described above, have already been articulated in the formal response to DSM-5 issued by the British Psychological Society (BPS, 2011) and in the email communication of the American Counseling Association (ACA) to Allen Frances (Frances, 2011b).
In light of the above-listed reservations concerning DSM-5s proposed changes, we hereby voice agreement with BPS that:
clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.
The putative diagnoses presented in DSM-V are clearly based largely on social norms, with 'symptoms' that all rely on subjective judgments, with little confirmatory physical 'signs' or evidence of biological causation. The criteria are not value-free, but rather reflect current normative social expectations.
[taxonomic] systems such as this are based on identifying problems as located within individuals. This misses the relational context of problems and the undeniable social causation of many such problems.
There is a need for a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience and the fact that strongly evidenced causal factors include psychosocial factors such as poverty, unemployment and trauma.
An ideal empirical system for classification would not be based on past theory but rather would begin from the bottom up starting with specific experiences, problems or symptoms or complaints.
The present DSM-5 development period may provide a unique opportunity to address these dilemmas, especially given the Task Forces willingness to reconceptualize the general architecture of psychiatric taxonomy. However, we believe that the proposals presented on www.dsm5.org are more likely to exacerbate rather than mitigate these longstanding problems. We share BPSs hopes for a more inductive, descriptive approach in the future, and we join BPS in offering participation and guidance in the revision process.
References
American Psychiatric Association (2011). DSM-5 Development. Retrieved from http://www.dsm5.org/Pages/Default.aspx
British Psychological Society. (2011) Response to the American Psychiatric Association: DSM-5 development.
Retrieved from http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5 2011 - BPS response.pdf
Compton, M. T. (2008). Advances in the early detection and prevention of schizophrenia.
Medscape Psychiatry & Mental Health. Retrieved from http://www.medscape.org/viewarticle/575910
Frances, A. (2010). The first draft of DSM-V. BMJ. Retrieved from http://www.bmj.com/content/340/bmj.c1168.full
Frances, A. (2011a). DSM-5 approves new fad diagnosis for child psychiatry: Antipsychotic use
likely to rise. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/display/article/10168/1912195
Frances, A. (2011b). Who needs DSM-5? A strong warning comes from professional counselors
[Web log message]. Psychology Today. Retrieved from http://www.psychologytoday.com/blog/dsm5-in-distress/201106/who-needs-dsm-5
Hanssen, M., Bak, M., Bijl, R., Vollebergh, W., & van Os, J. (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology, 44, 181-191.
Ho, B-C., Andreasen, N. C., Ziebell, S., Pierson, R., & Magnotta, V. (2011). Long-term antipsychotic treatment and brain volumes. Archives of General Psychiatry, 68, 128-137.
Johns, L. C., & van Os, J. (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21, 1125-1141.
Kendell, R., & Jablensky, A. (2003). Distinguishing between the validity and utility of psychiatric diagnoses. The American Journal of Psychiatry, 160, 4-11.
Kendler, K., Kupfer, D., Narrow, W., Phillips, K., & Fawcett, J. (2009, October 21). Guidelines
for making changes to DSM-V. Retrieved August 30, 2011, from
http://www.dsm5.org/ProgressReports/Documents/Guidelines-for-Making-Changes-to-DSM_1.pdf
Livesley, W. J. (2010). Confusion and incoherence in the classification of Personality Disorder: Commentary on the preliminary proposals for DSM-5. Psychological Injury and Law, 3, 304-313.
Moran, M. (2009). DSM-V developers weigh adding psychosis risk. Psychiatric News Online.
Retrieved from http://pn.psychiatryonline.org/content/44/16/5.1.full
Regier, D. A., Narrow, W. E., Kuhl, E. A., & Kupfer, D. J. (2011). The conceptual evolution of DSM-5. Arlington, VA: American Psychiatric Publishing.
Schatzberg, A. F., Scully, J. H., Kupfer, D. J., & Regier, D. A. (2009). Setting the record straight: A response to Frances commentary on DSM-V. Psychiatric Times, 26. Retrieved from http://www.psychiatrictimes.com/dsm/content/article/10168/1425806
Whitaker, R. (2002). Mad in America. Cambridge, MA: Basic Books. Also see http://www.madinamerica.com/madinamerica.com/Schizophrenia.html
Whitaker, R. (2010). Anatomy of an epidemic. New York, NY: Random House.
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Suzy Chapman
_____________________
me.agenda@virgin.net
http://dxrevisionwatch.wordpress.com
http://meagenda.wordpress.com
http://www.facebook.com/MEagenda
http://twitter.com/MEagenda
There are a number of (not currently active) existing threads on the DSM-5 SSD proposals issue. So as not to fragment previous discussions and information, I am resurrecting a previous thread.
A version of this post has also been published on the Co-Cure mailing list:
From Suzy Chapman for http://dxrevisionwatch.wordpress.com
October 23, 2011
Open Letter and Petition to DSM-5 Task Force by Society for Humanistic Psychology (Division 32 of the American Psychological Association)
This time last year, folk would mail me saying - I don't know why you bother monitoring DSM-5 and ICD-11, XMRV is going to render the DSM-5 proposals meaningless.
Well that was then, and this is now. And in a couple of months' time we'll be anticipating the third and final public review and feedback on the APA's draft proposals for changes to categories and criteria for the revision of DSM-IV.
During the first feedback exercise, over 8,600 comments rolled in; during the second comment period (which was extended by an additional four weeks), over 2000 comments were received.
According to the current DSM-5 Timeline:
"September-November 2011: Work groups will be provided with results from both field trials and will update their draft criteria as needed. Field trial results and revised proposals will be reviewed at the November Task Force meeting.
"January-February 2012: Revised draft diagnostic criteria will be posted on www.dsm5.org and open to a third public feedback period for two months. Feedback will be shared directly with work group members, and further edits to proposals will be made as needed." [1]
"January-February 2012: Revised draft diagnostic criteria will be posted on www.dsm5.org and open to a third public feedback period for two months. Feedback will be shared directly with work group members, and further edits to proposals will be made as needed." [1]
According to the DSM-5 Development home page:
"...Following analysis of field trial results, we will revise the proposed criteria as needed and, after appropriate review and approval, we will post these changes on this Web site. At that time, we will again open the site to a third round of comments from visitors, which will be systematically reviewed by each of the work groups for consideration of additional changes. Thus, the current commenting period is not the final opportunity for you to submit feedback, and subsequent revisions to DSM-5 proposals will be jointly informed by field trial findings as well as public commentary..." [2]
So assuming the APA's schedule remains on target, US and international patient organizations and advocates need to start preparing well in advance of the New Year for how best to engage our own medical and allied professionals in this process and encourage their input.
Because of increased family and business commitments following my husband's recent major surgery, I shall not be in a position to undertake very much in the way of awareness raising or contacting patient organizations and professionals, early next year, when revised draft proposals are expected to be published.
As soon as revised proposals are posted on the DSM-5 Development site, I shall put out alerts on my websites, via Co-Cure and on other platforms and I shall be contacting UK patient organizations, as I have done for the previous two public review exercises.
But I hope that other advocates and groups, in the US and internationally, will work to take this forward and ensure that as many international patient organizations, ME clinicians and researchers, like those who collaborated on the new ME-ICC, and allied professionals are made aware of the proposals of the "Somatic Symptom Disorders" Work Group and the implications for ME, CFS, FM, IBS, CI, CS and GWS patient groups, and are encouraged to submit comments as professional stakeholders.
Today I was alerted to an Open Letter and petition sponsored by the Society for Humanistic Psychology, Division 32 of the American Psychological Association, in alliance with the Society for Community Research and Action: Division of Community Psychology (Division 27 of APA) and the Society for Group Psychology and Psychotherapy (Division 49 of APA) [3].
These American Psychological Association bodies are inviting mental health professionals and mental health organizations to sign up in support of an open letter to the American Psychiatric Association's DSM-5 Task Force. Their response to DSM-5 structure and proposals may be of interest to psychiatrists and psychologists affiliated to, or on the boards of our own ME and CFS patient organizations.
The Open Letter to the DSM-5 Task Force can be read here and a copy is also appended: http://www.ipetitions.com/petition/dsm5/
Under the subheading "New Emphasis on Medico-Physiological Theory", the petition sponsors comment on some aspects of the DSM-5 proposals for the "Somatic Symptom Disorders" categories. The Open Letter also supports concerns set out within the formal response to DSM-5 draft proposals submitted by the British Psychological Society, earlier this year, and more recent concerns published by the American Counseling Association.
A couple of points: both the American Psychological Association, whose bodies are sponsors of this Open Letter, and the American Psychiatric Association use the acronym "APA". It is the American Psychiatric Association's DSM-5 Task Force that is developing the DSM-5.
Secondly, although the first release of draft DSM-5 proposals did have "Factitious Disorder" placed with "Somatic Symptom Disorders (SSDs)", the most recent (May 2011) DSM-5 draft proposes placing "Factitious Disorder" within "Other Disorders", not within the SSDs, as the Open Letter states [4], [5].
[1] DSM-5 Development Timeline: http://www.dsm5.org/about/Pages/Timeline.aspx
[2] DSM Development website: http://www.dsm5.org/Pages/Default.aspx
[3] Society for Humanistic Psychology: http://www.apadivisions.org/division-32/index.aspx
[4] DSM-5 Draft Proposals, Somatic Symptom Disorders: http://www.dsm5.org/proposedrevision/Pages/SomaticSymptomDisorders.aspx
[5] DSM-5 Draft Proposals, Other Disorders: http://www.dsm5.org/proposedrevision/Pages/OtherDisorders.aspx
-------------------------
http://www.ipetitions.com/petition/dsm5/
Open Letter to the DSM-5: Society for Humanistic Psychology, Division 32 of the American Psychological Association
Signaturies: http://www.ipetitions.com/petition/dsm5/signatures
Sponsor
Society for Humanistic Psychology, Division 32 of the American Psychological Association, in alliance with Society for Community Research and Action: Division of Community Psychology (Division 27 of APA) and Society for Group Psychology and Psychotherapy (Division 49 of APA). We invite mental health professionals and mental health organizations to sign on in support of this petition to the DSM5 Task Force of the American Psychiatric Association
To the DSM-5 Task Force and the American Psychiatric Association:
As you are aware, the DSM is a central component of the research, education, and practice of most licensed psychologists in the United States. Psychologists are not only consumers and utilizers of the manual, but we are also producers of seminal research on DSM-defined disorder categories and their empirical correlates. Practicing psychologists in both private and public service utilize the DSM to conceptualize, communicate, and support their clinical work.
For these reasons, we believe that the development and revision of DSM diagnoses should include the contribution of psychologists, not only as select individuals on a committee, but as a professional community. We have therefore decided to offer the below response to DSM-5 development. This document was composed in recognition of, and with sensitivity to, the longstanding and congenial relationship between American psychologists and our psychiatrist colleagues.
Overview
Though we admire various efforts of the DSM-5 Task Force, especially efforts to update the manual according to new empirical research, we have substantial reservations about a number of the proposed changes that are presented on www.dsm5.org. As we will detail below, we are concerned about the lowering of diagnostic thresholds for multiple disorder categories, about the introduction of disorders that may lead to inappropriate medical treatment of vulnerable populations, and about specific proposals that appear to lack empirical grounding. In addition, we question proposed changes to the definition(s) of mental disorder that deemphasize sociocultural variation while placing more emphasis on biological theory. In light of the growing empirical evidence that neurobiology does not fully account for the emergence of mental distress, as well as new longitudinal studies revealing long-term hazards of standard neurobiological (psychotropic) treatment, we believe that these changes pose substantial risks to patients/clients, practitioners, and the mental health professions in general.
Given the changes currently taking place in the profession and science of psychiatry, as well as the developing empirical landscape from which psychiatric knowledge is drawn, we believe that it is important to make our opinions known at this particular historical moment. As stated at the conclusion of this letter, we believe that it is time for psychiatry and psychology collaboratively to explore the possibility of developing an alternative approach to the conceptualization of emotional distress. We believe that the risks posed by DSM-5, as outlined below, only highlight the need for a descriptive and empirical approach that is unencumbered by previous deductive and theoretical models.
In more detail, our response to DSM-5 is as follows:
Advances Made by the DSM-5 Task Force
We applaud certain efforts of the DSM-5 Task Force, most notably efforts to resolve the widening gap between the current manual and the growing body of scientific knowledge on psychological distress. In particular, we appreciate the efforts of the Task Force to address limitations to the validity of the current categorical system, including the high rates of comorbidity and Not Otherwise Specified (NOS) diagnoses, as well as the taxonomic failure to establish zones of rarity between purported disorder entities (Kendell & Jablensky, 2003). We agree with the APA/DSM-5 Task Force statement that, from a systemic perspective,
The DSM-III categorical diagnoses with operational criteria were a major advance for our field, but they are now holding us back because the system has not kept up with current thinking. Clinicians complain that the current DSM-IV system poorly reflects the clinical realities of their patients. Researchers are skeptical that the existing DSM categories represent a valid basis for scientific investigations, and accumulating evidence supports this skepticism. (Schatzberg, Scully, Kupfer, & Regier, 2009)
As researchers and clinicians, we appreciate the attempt to address these problems. However, we have serious reservations about the proposed means for doing so. Again, we are concerned about the potential consequences of the new manual for patients and consumers; for psychiatrists, psychologists, and other practitioners; and for forensics, health insurance practice, and public policy. Our specific reservations are as follows:
Lowering of Diagnostic Thresholds
The proposal to lower diagnostic thresholds is scientifically premature and holds numerous risks. Diagnostic sensitivity is particularly important given the established limitations and side-effects of popular antipsychotic medications. Increasing the number of people who qualify for a diagnosis may lead to excessive medicalization and stigmatization of transitive, even normative distress. As suggested by the Chair of DSM-IV Task Force Allen Frances (2010), among others, the lowering of diagnostic thresholds poses the epidemiological risk of triggering false-positive epidemics.
We are particularly concerned about:
Attenuated Psychosis Syndrome, which describes experiences common in the general population, and which was developed from a risk concept with strikingly low predictive validity for conversion to full psychosis.
The proposed removal of Major Depressive Disorders bereavement exclusion, which currently prevents the pathologization of grief, a normal life process.
The reduction in the number of criteria necessary for the diagnosis of Attention Deficit Disorder, a diagnosis that is already subject to epidemiological inflation.
The reduction in symptomatic duration and the number of necessary criteria for the diagnosis of Generalized Anxiety Disorder.
Though we also have faith in the perspicacity of clinicians, we believe that expertise in clinical decision-making is not ubiquitous amongst practitioners and, more importantly, cannot prevent epidemiological trends that arise from societal and institutional processes. We believe that the protection of society, including the prevention of false epidemics, should be prioritized above nomenclatural exploration.
Vulnerable Populations
We are also gravely concerned about the introduction of disorder categories that risk misuse in particularly vulnerable populations. For example, Mild Neurocognitive Disorder might be diagnosed in elderly with expected cognitive decline, especially in memory functions. Additionally, children and adolescents will be particularly susceptible to receiving a diagnosis of Disruptive Mood Dysregulation Disorder or Attenuated Psychosis Syndrome. Neither of these newly proposed disorders have a solid basis in the clinical research literature, and both may result in treatment with neuroleptics, which, as growing evidence suggests, have particularly dangerous side-effects (see below)as well as a history of inappropriate prescriptions to vulnerable populations, such as children and the elderly
Sociocultural Variation
The DSM-5 has proposed to change the Definition of a Mental Disorder such that DSM-IVs Feature E: Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, will instead read [A mental disorder is a behavioral or psychological syndrome or pattern] [t]hat is not primarily a result of social deviance or conflicts with society. The latter version fails to explicitly state that deviant behavior and primary conflicts between the individual and society are not mental disorders. Instead, the new proposal focuses on whether mental disorder is a result of deviance/social conflicts. Taken literally, DSM-5s version suggests that mental disorder may be the result of these factors so long as they are not primarily the cause. In other words, this change will require the clinician to draw on subjective etiological theory to make a judgment about the cause of presenting problems. It will further require the clinician to make a hierarchical decision about the primacy of these causal factors, which will then (partially) determine whether mental disorder is said to be present. Given lack of consensus as to the primary causes of mental distress, this proposed change may result in the labeling of sociopolitical deviance as mental disorder.
Revisions to Existing Disorder Groupings
Several new proposals with little empirical basis also warrant hesitation:
As mentioned above, Attenuated Psychosis Syndrome and Disruptive Mood Dysregulation Disorder (DMDD) have questionable diagnostic validity, and the research on these purported disorders is relatively recent and sparse.
The proposed overhaul of the Personality Disorders is perplexing. It appears to be a complex and idiosyncratic combined categorical-dimensional system that is only loosely based on extant scientific research. It is particularly concerning that a member of the Personality Disorders Workgroup has publicly described the proposals as a disappointing and confusing mixture of innovation and preservation of the status quo that is inconsistent, lacks coherence, is impractical, and, in places, is incompatible with empirical facts (Livesley, 2010), and that, similarly, Chair of DSM-III Task Force Robert Spitzer has stated that, of all of the problematic proposals, Probably the most problematic is the revision of personality disorders, where theyve made major changes; and the changes are not all supported by any empirical basis.
The Conditions Proposed by Outside Sources that are under consideration for DSM-5 contain several unsubstantiated and questionable disorder categories. For example, Apathy Syndrome, Internet Addiction Disorder, and Parental Alienation Syndrome have virtually no basis in the empirical literature.
New Emphasis on Medico-Physiological Theory
Advances in neuroscience, genetics, and psychophysiology have greatly enhanced our understanding of psychological distress. The neurobiological revolution has been incredibly useful in conceptualizing the conditions with which we work. Yet, even after the decade of the brain, not one biological marker (biomarker) can reliably substantiate a DSM diagnostic category. In addition, empirical studies of etiology are often inconclusive, at best pointing to a diathesis-stress model with multiple (and multifactorial) determinants and correlates. Despite this fact, proposed changes to certain DSM-5 disorder categories and to the general definition of mental disorder subtly accentuate biological theory. In the absence of compelling evidence, we are concerned that these reconceptualizations of mental disorder as primarily medical phenomena may have scientific, socioeconomic, and forensic consequences. New emphasis on biological theory can be found in the following DSM-5 proposals:
The first of DSM-5s proposed revisions to the Definition of a Mental Disorder transforms DSM-IVs versatile Criterion D: A manifestation of a behavioral, psychological, or biological dysfunction in the individual into a newly collapsed Criterion B: [A behavioral or psychological syndrome] That reflects an underlying psychobiological dysfunction. The new definition states that all mental disorders represent underlying biological dysfunction. We believe that there is insufficient empirical evidence for this claim.
The change in Criterion H under Other Considerations for the Definition of a Mental Disorder adds a comparison between medical disorders and mental disorders with no discussion of the differences between the two. Specifically, the qualifying phrase No definition adequately specifies precise boundaries for the concept of mental disorder was changed to No definition perfectly specifies precise boundaries for the concept of either medical disorder or mental/psychiatric disorder. This effectively transforms a statement meant to clarify the conceptual limitations of mental disorder into a statement equating medical and mental phenomena.
We are puzzled by the proposals to De-emphasize medically unexplained symptoms in Somatic Symptom Disorders (SSDs) and to reclassify Factitious Disorder as an SSD. The SSD Workgroup explains: because of the implicit mind-body dualism and the unreliability of assessments of medically unexplained symptoms, these symptoms are no longer emphasized as core features of many of these disorders. We do not agree that hypothesizing a medical explanation for these symptoms will resolve the philosophical problem of Cartesian dualism inherent in the concept of mental illness. Further, merging the medico-physical with the psychological eradicates the conceptual and historical basis for somatoform phenomena, which are by definition somatic symptoms that are not traceable to known medical conditions. Though such a redefinition may appear to lend these symptoms a solid medico-physiological foundation, we believe that the lack of empirical evidence for this foundation may lead to practitioner confusion, as might the stated comparison between these disorders and research on cancer, cardiovascular, and respiratory diseases.
The proposed reclassification of Attention Deficit/Hyperactivity Disorder (ADHD) from Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence to the new grouping Neurodevelopmental Disorders seems to suggests that that ADHD has a definitive neurological basis. This change, in combination with the proposal to lower the diagnostic threshold for this category as described above, poses high risk of exacerbating the extant over-medicalization and over-diagnosis of this disorder category.
A recent publication by the Task Force, The Conceptual Evolution of DSM-5 (Regier, Narrow, Kuhl, & Kupfer, 2011), states that the primary goal of DSM-5 is to produce diagnostic criteria and disorder categories that keep pace with advances in neuroscience. We believe that the primary goal of DSM-5 should be to keep pace with advances in all types of empirical knowledge (e.g., psychological, social, cultural, etc.).
Taken together, these proposed changes seem to depart from DSMs 30-year atheoretical stance in favor of a pathophysiological model. This move appears to overlook growing disenchantment with strict neurobiological theories of mental disorder (e.g., chemical imbalance theories such as the dopamine theory of schizophrenia and the serotonin theory of depression), as well as the general failure of the neo-Kraepelinian model for validating psychiatric illness. Or in the words of the Task Force:
epidemiological, neurobiological, cross-cultural, and basic behavioral research conducted since DSM-IV has suggested that demonstrating construct validity for many of these strict diagnostic categories (as envisioned most notably by Robins and Guze) will remain an elusive goal (Kendler, Kupfer, Narrow, Phillips, & Fawcett, 2009, p. 1).
We thus believe that a move towards biological theory directly contradicts evidence that psychopathology, unlike medical pathology, cannot be reduced to pathognomonic physiological signs or even multiple biomarkers. Further, growing evidence suggests that though psychotropic medications do not necessarily correct putative chemical imbalances, they do pose substantial iatrogenic hazards. For example, the increasingly popular neuroleptic (antipsychotic) medications, though helpful for many people in the short term, pose the long-term risks of obesity, diabetes, movement disorders, cognitive decline, worsening of psychotic symptoms, reduction in brain volume, and shortened lifespan (Ho, Andreasen, Ziebell, Pierson, & Magnotta, 2011; Whitaker, 2002, 2010). Indeed, though neurobiology may not fully explain the etiology of DSM-defined disorders, mounting longitudinal evidence suggests that the brain is dramatically altered over the course of psychiatric treatment.
Conclusions
In sum, we have serious reservations about the proposed content of the future DSM-5, as we believe that the new proposals pose the risk of exacerbating longstanding problems with the current system. Many of our reservations, including some of the problems described above, have already been articulated in the formal response to DSM-5 issued by the British Psychological Society (BPS, 2011) and in the email communication of the American Counseling Association (ACA) to Allen Frances (Frances, 2011b).
In light of the above-listed reservations concerning DSM-5s proposed changes, we hereby voice agreement with BPS that:
clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.
The putative diagnoses presented in DSM-V are clearly based largely on social norms, with 'symptoms' that all rely on subjective judgments, with little confirmatory physical 'signs' or evidence of biological causation. The criteria are not value-free, but rather reflect current normative social expectations.
[taxonomic] systems such as this are based on identifying problems as located within individuals. This misses the relational context of problems and the undeniable social causation of many such problems.
There is a need for a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience and the fact that strongly evidenced causal factors include psychosocial factors such as poverty, unemployment and trauma.
An ideal empirical system for classification would not be based on past theory but rather would begin from the bottom up starting with specific experiences, problems or symptoms or complaints.
The present DSM-5 development period may provide a unique opportunity to address these dilemmas, especially given the Task Forces willingness to reconceptualize the general architecture of psychiatric taxonomy. However, we believe that the proposals presented on www.dsm5.org are more likely to exacerbate rather than mitigate these longstanding problems. We share BPSs hopes for a more inductive, descriptive approach in the future, and we join BPS in offering participation and guidance in the revision process.
References
American Psychiatric Association (2011). DSM-5 Development. Retrieved from http://www.dsm5.org/Pages/Default.aspx
British Psychological Society. (2011) Response to the American Psychiatric Association: DSM-5 development.
Retrieved from http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5 2011 - BPS response.pdf
Compton, M. T. (2008). Advances in the early detection and prevention of schizophrenia.
Medscape Psychiatry & Mental Health. Retrieved from http://www.medscape.org/viewarticle/575910
Frances, A. (2010). The first draft of DSM-V. BMJ. Retrieved from http://www.bmj.com/content/340/bmj.c1168.full
Frances, A. (2011a). DSM-5 approves new fad diagnosis for child psychiatry: Antipsychotic use
likely to rise. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/display/article/10168/1912195
Frances, A. (2011b). Who needs DSM-5? A strong warning comes from professional counselors
[Web log message]. Psychology Today. Retrieved from http://www.psychologytoday.com/blog/dsm5-in-distress/201106/who-needs-dsm-5
Hanssen, M., Bak, M., Bijl, R., Vollebergh, W., & van Os, J. (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology, 44, 181-191.
Ho, B-C., Andreasen, N. C., Ziebell, S., Pierson, R., & Magnotta, V. (2011). Long-term antipsychotic treatment and brain volumes. Archives of General Psychiatry, 68, 128-137.
Johns, L. C., & van Os, J. (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21, 1125-1141.
Kendell, R., & Jablensky, A. (2003). Distinguishing between the validity and utility of psychiatric diagnoses. The American Journal of Psychiatry, 160, 4-11.
Kendler, K., Kupfer, D., Narrow, W., Phillips, K., & Fawcett, J. (2009, October 21). Guidelines
for making changes to DSM-V. Retrieved August 30, 2011, from
http://www.dsm5.org/ProgressReports/Documents/Guidelines-for-Making-Changes-to-DSM_1.pdf
Livesley, W. J. (2010). Confusion and incoherence in the classification of Personality Disorder: Commentary on the preliminary proposals for DSM-5. Psychological Injury and Law, 3, 304-313.
Moran, M. (2009). DSM-V developers weigh adding psychosis risk. Psychiatric News Online.
Retrieved from http://pn.psychiatryonline.org/content/44/16/5.1.full
Regier, D. A., Narrow, W. E., Kuhl, E. A., & Kupfer, D. J. (2011). The conceptual evolution of DSM-5. Arlington, VA: American Psychiatric Publishing.
Schatzberg, A. F., Scully, J. H., Kupfer, D. J., & Regier, D. A. (2009). Setting the record straight: A response to Frances commentary on DSM-V. Psychiatric Times, 26. Retrieved from http://www.psychiatrictimes.com/dsm/content/article/10168/1425806
Whitaker, R. (2002). Mad in America. Cambridge, MA: Basic Books. Also see http://www.madinamerica.com/madinamerica.com/Schizophrenia.html
Whitaker, R. (2010). Anatomy of an epidemic. New York, NY: Random House.
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Suzy Chapman
_____________________
me.agenda@virgin.net
http://dxrevisionwatch.wordpress.com
http://meagenda.wordpress.com
http://www.facebook.com/MEagenda
http://twitter.com/MEagenda
Psychology Today:
http://www.psychologytoday.com/blog...10/psychologists-start-petition-against-dsm-5
Psychiatric Times:
http://www.psychiatrictimes.com/blog/dsm-5/content/article/10168/1976081
Psychologists Petition Against DSM-5: Users Revolt Should Capture APA Attention
By Allen Frances, MD | 24 October 2011
Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine.
http://www.psychologytoday.com/blog...10/psychologists-start-petition-against-dsm-5
Psychiatric Times:
http://www.psychiatrictimes.com/blog/dsm-5/content/article/10168/1976081
Psychologists Petition Against DSM-5: Users Revolt Should Capture APA Attention
By Allen Frances, MD | 24 October 2011
Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine.
A second blog from Karen Franklin
Forensic Psychologist
http://forensicpsychologist.blogspot.com/2011/10/dsm-5-petition-takes-off-like-wildfire.html
Karen Franklin Ph.D. | Sunday, October 27, 2011
DSM-5 petition takes off like wildfire
Karen Franklin, Ph.D. is a forensic psychologist and adjunct professor at Alliant University in Northern California.
A second article from Allen Frances
The Petition Against DSM 5 Gets Off To Fast Start
Could It Be A Game Changer
http://www.psychologytoday.com/blog...10/the-petition-against-dsm-5-gets-fast-start
By Allen Frances, MD | 27 October 2011
Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine
also at Psychiatric Times, October 26, 2011
(Registration for Psychiatric Times site required)
Counseling Today
http://ct.counseling.org/2011/10/psychologists-circulate-petition-against-dsm-5-revisions/
Psychologists circulate petition against DSM-5 revisions
October 24, 2011 | CT Daily
Heather Rudow
Britsh Psychological Society (BPS)
http://www.bps.org.uk/news/psychologists-petition-against-dsm-5
Psychologists petition against DSM-5
25/10/2011
Psychology Today
DSM-5 in Distress
http://www.psychologytoday.com/blog...10/psychologists-start-petition-against-dsm-5
Dr Allen Frances
Psychologists Petition Against DSM-5: Users Revolt Should Capture APA Attention
By Allen Frances, MD | 24 October 2011
Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine
also (with registered access) same text at Psychiatric Times
Forensic Psychologist
http://forensicpsychologist.blogspot.com/2011/10/psychology-coalition-urges-rethinking.html
Karen Franklin Ph.D. | Sunday, October 23, 2011
Psychology coalition urges rethinking of DSM-5 expansions
Karen Franklin, Ph.D. is a forensic psychologist and adjunct professor at Alliant University in Northern California.
Dr Franklin also blogs at Psychology Today Witness, A blog about forensic psychology
Forensic Psychologist
http://forensicpsychologist.blogspot.com/2011/10/dsm-5-petition-takes-off-like-wildfire.html
Karen Franklin Ph.D. | Sunday, October 27, 2011
DSM-5 petition takes off like wildfire
Karen Franklin, Ph.D. is a forensic psychologist and adjunct professor at Alliant University in Northern California.
A second article from Allen Frances
The Petition Against DSM 5 Gets Off To Fast Start
Could It Be A Game Changer
http://www.psychologytoday.com/blog...10/the-petition-against-dsm-5-gets-fast-start
By Allen Frances, MD | 27 October 2011
Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine
also at Psychiatric Times, October 26, 2011
(Registration for Psychiatric Times site required)
Counseling Today
http://ct.counseling.org/2011/10/psychologists-circulate-petition-against-dsm-5-revisions/
Psychologists circulate petition against DSM-5 revisions
October 24, 2011 | CT Daily
Heather Rudow
Britsh Psychological Society (BPS)
http://www.bps.org.uk/news/psychologists-petition-against-dsm-5
Psychologists petition against DSM-5
25/10/2011
Psychology Today
DSM-5 in Distress
http://www.psychologytoday.com/blog...10/psychologists-start-petition-against-dsm-5
Dr Allen Frances
Psychologists Petition Against DSM-5: Users Revolt Should Capture APA Attention
By Allen Frances, MD | 24 October 2011
Dr Frances was Chair of the DSM-IV Task Force and is Professor Emeritus of the Department of Psychiatry at Duke University School of Medicine
also (with registered access) same text at Psychiatric Times
Forensic Psychologist
http://forensicpsychologist.blogspot.com/2011/10/psychology-coalition-urges-rethinking.html
Karen Franklin Ph.D. | Sunday, October 23, 2011
Psychology coalition urges rethinking of DSM-5 expansions
Karen Franklin, Ph.D. is a forensic psychologist and adjunct professor at Alliant University in Northern California.
Dr Franklin also blogs at Psychology Today Witness, A blog about forensic psychology