Frances and Spitzer: A Message to DSM-V Workgroup

Drs Spitzer and Frances sent over the following in response to Dr Renato Alarcon's article, "Inside the DSM-V Process: Issues, Debates, and Reflections" (Psychiatric Times, July 2009, p 1).

We have no argument at all with any of the DSM-V work group members, all of whom undoubtedly have the best of intentions and are working hard to do a good job in revising the diagnostic system. Indeed, we are pleased that Workgroup members have often made their own efforts to engage in discussions with their colleagues and are making presentations about their work at meetings.

Instead, our problem is with the conditions imposed on the work group members by the DSM-V leadership, particularly: (1) the confidentiality agreements; (2) the unwillingness to post on the DSM-V Web site the work done so far by the workgroups (i.e., the literature reviews, results of any of the secondary data analyses, and, most importantly, the exact wording of the proposed criteria sets or dimensions; and (3)the rush to prematurely start these field trials in order to meet an artificially imposed publication deadline.

The basic, obvious, and unanswered question is how can field trials begin now before any of the DSM-V options and supportive literature have been posted and time given for a thorough critique from the entire field? Would it not help Dr Alarcon and other work group members to get input from the largest possible number of reviewers before deciding on which suggestions deserve to move forward and which have too many previously unrecognized risky unintended consequences? Would Dr Alarcon and other work group members not prefer to be given sufficient time to make sure that DSM-V is as problem-free as possible?

There is no justification for a fixed publication date in 2012 now that ICD-11 will not appear before 2014. Let's have everything posted and thoroughly reviewed first, and then it will be appropriate to plan field trials. We wrote to the American Psychiatric Association Board of Trustees precisely to help ensure the best possible environment for the efforts of Workgroup members like Dr. Alarcon - an environment unconstrained by confidentiality agreements, artificial time pressures, and lack of external input. We wish him (and all the DSM-V Workgroup members) well in their continued work on DSM-V.

Allen Frances, MD and Rober Spitzer, MD