On Wednesday, the APA submitted a formal response to Dr. Frances' commentary, "A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences Here's an excerpt:
"The process for developing DSM-V has been the most open and inclusive ever. The process began with a planning session that led to 13 NIH-supported international research conferences and a series of monographs. These conferences included more than 400 scientists, clinicians and others in the field. The DSM-V Task Force and Work Groups include more than 150 experts in various specialties and sub-specialties from 16 countries, including both scientists and clinicians. Over 200 advisors have thus far been asked to share expertise with DSM Work Groups. The DSM-V Task Force established a Web site, www.dsm5.org, to accept comments and provide work group updates. Unfortunately, to bolster his unjustified ad hominem attacks, Dr. Frances used the readily available DSM-V updates and misrepresented them as final decisions, rather than as statements of work in progress."
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Thursday, July 2, 2009
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Dear Psychiatric Times and Colleagues,
ReplyDeleteI responded to the chance to upload to the dsm5.org website an article I published with suggested DSM-V criteria for addiction - perhaps six months ago. There was never a response. My comments went off into cyberspace. I had my administrator try to follow up with a call to the head of the DSM-V committee, Charles O'Brien M.D. No response. So while it is true that there is a way to "give input," there is no evidence that anyone on the DSM-V committee I wrote to ever saw the input. It was like writing a letter to Santa Claus at the North Pole.
Sincerely,
Brian Johnson M.D.
Director of Addiction Psychiatry
SUNY Upstate Medical University
I agree with Drs. Schatzberg, Scully, Kupfer and Regier. In my busy clinical practice, I do not see DSM-IV doing justice to clinical reality. Less than 25% of my patients have a genuinely good syndromatic fit with specific DSM diagnoses.
ReplyDeleteWith diagnostic criteria strictly applied, I find myself with numerous NOS diagnoses with little in terms of treatment or prognosis utility. Preserving the current DSM structure would make it increasingly irrelevant to clinical practice.
DSM IV seems to misconstrue how psychiatric diagnosis is made in real-world clinical situations which seem to parallel GK Chesterton’s famous quote "you can only find truth with logic if you have already found truth without it”. While a paradigm shift may be clearly disruptive, that is what Psychiatry needs at this juncture to keep classification relevant to day today clinical practice.
While advances in neurobiology may help resolve some of our diagnostic stalemates, the complex sequential interaction between neurobiology, changing adaptive demands and existential issues may continue to make psychiatric diagnosis a moving target.
Although literature review seems to be an important avenue in DSM revision, we must not overvalue it because we could easily get sidetracked by a circular situation where literature is based on classification and vice versa.