DSM-4 author denounces new revision

DSM-4 task force chairman denounces new revision
DSM-4 task force chairman denounces new revision

HealthDay News -- The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has introduced several high-prevalence diagnoses at the boundary of normality which may lead to considerable false-positive rates and unnecessary treatment, alleges an author of the previous version of the manual.

Allen Frances, MD, who chaired the task force responsible for DSM-4, which was published in 1994, and who is now an emeritus professor at Duke University, in Durham, N.C., suggested changes in the revised DSM-5 apply disease labels to individuals who may be unhappy or offensive, but still normal.

Rates of certain psychiatric disorders, including autism and related disorders, attention deficit-hyperactivity disorder and bipolar disorder, have increased more than 20-fold over 20 years, Frances reported in the Annals of Internal Medicine.

He added that these trends reflect "overdiagnosis," and suggested that the pharmaceutical industry stands to benefit from the "loose" diagnostic criteria set forth in the new DSM-5.

"My advice to physicians is to use the DSM-5 cautiously, if at all. It is not an official manual; no one is compelled to use it unless they work in an institutional setting that requires it," Frances wrote.

He contends that the DSM-5 was prepared without "adequate consideration of risk-benefit ratios or the economic cost of expanding the reach of psychiatry," noting that the the manual's original release date was set for May 2012, but delays in developing the initial draft for subsequent review and testing forced postponement to 2013.

"I believe that the American Psychiatric Association's financial conflict of interest, generated by DSM publishing profits needed to fill its budget deficit, led to premature publication of an incompletely tested and poorly edited product," Frances wrote.

This is not the first time Frances has spoken out against the DSM-5. He has authored open letters, blog posts, articles published in mental health journals and consumer media, as well as two books on the topic, criticizing the DSM-5 editors for missing deadlines, failing to conduct necessary research and not including him and colleagues in the process.


References

  1. Frances A. Annals Intern Med 2013; DOI: 10.7326/0003-4819-159-3-201308060-00655.
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