The Problems Facing the New Diagnostic and Statistical Manual of Mental Disorders
Editor's Note: In April of this year, Roel Verheul and John Livesley resigned from the group of experts working to hammer out the newest version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-V. Dr. Allen Frances, former chair of the DSM-IV Task Force, reproduced an e-mail from them describing the situation on his blog DSM5 In Distress at Psychology Today. -- AVF
We did not resign earlier because we continued to cherish the hope that eventually science and common sense would prevail and that there would be an opportunity to construct a coherent, evidence-based classification that would help to advance the field and facilitate patient care. In the spring of this year, it became apparent that is was not going to happen. We considered the current proposal to be fundamentally flawed and decided that it would be wrong of us to appear to collude with it any longer.
Photo by Stephen Cummings. (Flickr)
As we see it, there are two major problems with the proposal. First, the proposed classification is unnecessarily complex, incoherent, and inconsistent. The obvious complexity and incoherence seriously interfere with clinical utility. Although the proposal is touted as an innovative and integrative hybrid system, this claim is spurious. In fact, it consists of the juxtaposition of two distinct classifications (typal and dimensional) based on incompatible models without any attempt to reconcile or integrate them into a coherent structure. This structure also creates confusion since it is not clear whether the clinician should use one or both systems in routine clinical practice.
Second, the proposal displays a truly stunning disregard for evidence. Important aspects of the proposal lack any reasonable evidential support of reliability and validity. For example, there is little evidence to justify which disorders to retain and which to eliminate. Even more concerning is the fact that a major component of proposal is inconsistent with extensive evidence. The latter point is especially troublesome because it was noted in publication from the Work Group that the evidence did not support the use of typal constructs of the kind recommended by the current proposal. This creates the untenable situation of the Work Group advancing a taxonomic model that it has acknowledged in a published article to be inconsistent with the evidence.
Read the rest of this post and what this means for the DSM-V on Dr. Frances' blog DSM5 In Distress here.