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Alert to the Research Community—Be Prepared to Weigh in on DSM-V

(PSYCHIATRIC TIMES) - This commentary will suggest how the research community can be instrumental in improving DSM-V and helping it avoid unintended consequences. According to several converging, anonymous (but I think quite reliable) sources to which I have had access, the draft options for DSM-V will finally be posted between mid-January and mid-February 2010. There will then be just one additional month until mid-March for collecting comments. The good news is that the products of a previously closed process will finally be available for wide review and correction. The bad news is that there will be only a very brief period allotted for this absolutely crucial input from the field.

The research community has a central role and a great responsibility in taking advantage of this precious opportunity to carefully review and identify the problems in the DSM-V drafts and to suggest solutions.

Problems with the DSM-V process
The dangers of the “everything is on the table,”1 ambitious, innovative bias of DSM-V have been amplified by its secrecy and weak methods. There has been a remarkable lack of the free flow of ideas that is necessary to prevent any DSM process from becoming idiosyncratic and arbitrary. Many of the work groups have functioned mostly on their own without sufficient monitoring from the DSM-V Task Force, a large group of diverse advisors, or the field as a whole.

The original DSM-V timeline had the fatal flaws of scheduling field trials before the proposed changes could be vetted by the field and an impossible publication deadline of May 2012. Fortunately, my sources suggest that this plan has been shelved, and that a new timeline has field trials following the posting of options and a new DSM-V publication date of May 2013.

Unfortunately, there are still numerous process problems. There is a continued bewildering secrecy concerning timelines and methods. My sources indicate that a grant request for external funding for the DSM-V field trials has been rejected, and there is no indication that there is sufficient money, time, or expertise to conduct meaningful field trials that would measure the impact of changes on the rates of disorder. The few papers published to date by the DSM-V leadership1-3 (and the wordings of the few work group criteria sets that have surfaced at meetings or informally) display a lack of the one skill that is absolutely essential in crafting an acceptable diagnostic manual—the ability to write clearly and consistently.

It will be no surprise if the draft criteria sets that appear early next year are written poorly and include many worrisome suggestions. This should not be at all blamed on the DSM-V work group members. It is my experience (repeated 3 times with DSM-III, DSM-IV-TR, and DSM-IV) that early work group drafts are always, and probably inherently, riddled with serious problems.

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