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How Many Psychiatrists Does it Take to Change a DSM - - or Rowing Backwards Into the Future . . . The DSM Process

(PSYCHIATRIC TIMES) - We were encouraged to participate in the DSM revision process, and I excitedly contributed my suggestions to correct the flaws which I believed had been introduced by the symptom-based criteria-sets and decision-tree-thinking of DSM III and IV. (See Psych News, Viewpoints: “DSM-V Needs Mid-Course Correction” Dec.5,2008). I learned that many others also had suggested changes, but we all seemed to get similar, almost form-letter generic responses, thanking us and assuring us that the Work Groups would review our submissions in the light of existing studies and scientific research, including reviews of the world literature that had already been assembled.
I was surprised that there was scientifically compiled research already in existence. I learned that even at the time that DSM-IV was published, that there was a list of “perceived limitations” and known defects in the DSM already approved for distribution. There were proposed solutions for these problems, and a series of meetings and conferences devoted to resolving these issues were held between 1999 and 2003, resulting in monographs and ‘white papers’ which serve as the research studies to be used in the DSM process.
I also learned that there are a bunch of pre-conditions for DSM revision, which include among others, that the new version must not be a radical departure, and must be consistent and compatible with the existing DSM, thus guaranteeing continuity and preventing disruptions in the diagnosis and treatment of existing patients, assuring continuity in education and training for residents in psychiatry and existing practitioners, and in managed care and insurance coverage, and Treatment Guidelines and in psychiatric record-keeping, as well as research, unless we start labeling our diagnoses with vintage-like DSM numbers, like we label wines.

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