Call for comments on revision of the Diagnostic and Statistical Manual of Mental Disorders

The proposed draft criteria have been released for public comment, and psychologists are encouraged to submit comments

by Practice Research and Policy Staff

February 28, 2010 — The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, is being revised. While completion of the revision process was originally scheduled for 2012, it now appears likely that the updated version of DSM will be released in 2013. 

The proposed draft criteria have been released for public comment, and psychologists are encouraged to register, review and submit comments on the DSM-5 Development website. The draft criteria will be available for review until April 20, 2010. You are encouraged to send a copy of your comments with “DSM review” in the subject line to the American Psychological Association Practice Directorate. 
Possible areas for psychologists to review include changes to current diagnostic criteria and problem areas. Changes in these areas may have an impact on the diagnostic practices of psychologists. Importantly, for the DSM to remain clinically meaningful and useful, any such changes should be grounded in the research literature and reflective of clinical practice. 

Additionally, “dimensional assessments” are proposed for inclusion with existing categorical diagnoses. Dimensional assessments are intended to provide more information than simple, categorical diagnoses but may indicate severity of symptoms, number of symptoms, duration of problem, degree of impairment or other aspects of mental health that can be captured on a continuum. Although dimensions may more accurately reflect the actual presentation of conditions compared to categorical diagnoses alone, psychologists’ evaluation of the proposed dimensional assessments is necessary to ensure that they are consistent with the psychological literature and meet established measurement standards.

The DSM revision process has stimulated controversy. For instance, the psychiatrist who led the fourth revision process, Allen Frances, MD1 , has published several editorials and raised many concerns about the work.  Some of the debate about the DSM revision process has circulated on American Psychological Association listservs. 

Additionally, a recent editorial by Steven Moffic, MD, in Psychiatric Times2 has resulted in considerable discussion and concern on some listservs.  In his editorial, Dr. Moffic suggests that only psychiatrists have the appropriate training to use the DSM for diagnostic purposes.

The American Psychiatric Association has not made any such assertion. In fact, Dr. William Narrow, associate director in the division of research at the American Psychiatric Association, has stated, “The leadership of the DSM-5 revision process is fully aware that DSM is used by multiple clinical disciplines including psychology, and the DSM-5 work group membership reflects this diversity, to our great benefit.”3  

Editorials such as Dr. Moffic’s should not distract psychologists from the important task of carefully reviewing proposed changes to the DSM-5 and submitting substantive comments.

Given the anticipated length of the draft revision of the DSM and the short timeline for submitting comments, it will be very difficult for the American Psychological Association to coordinate psychologist review of the DSM and provide an association response that integrates feedback from a large group of members. Therefore, psychologists are strongly encouraged to review the draft criteria and post comments directly to the DSM-5 Development website.

1 F.  (2009, June 26). A warning sign on the road to DSM-V: Beware of its unintended consequences. Psychiatric Times. Retrieved January 20, 2010

2 Moffic, H. S.  (2010, February 3).  CAUTION!  Who should be the DSM-V diagnostician?  Psychiatric Times. Retrieved February 16, 2010 

3 W.E. Narrow (personal communication, February 16, 2010)