Clinician's Digest III


Navigating the Maze of DSM-5

November/December 2012


The American Psychiatric Association is scheduled to publish the much-delayed fifth edition of the Diagnostic and Statistical Manual (DSM) by May 2013. With its worldwide influence, changes in a reference work as influential as the DSM, often called the bible of the mental health field, was bound to provoke controversy and concern, and the revision process has been short on neither. Among the fears are that new proposals haven't had adequate time for rigorous scientific testing, that expanded diagnostic criteria will lead to over-diagnosis and pathologizing of normal behavior, and that rampant financial conflicts of interest (some 70 percent of DSM-5 task force members have disclosed financial relationships with pharmaceutical companies) will tarnish what should be an impeccably scientific and independent endeavor.

While there have been a series of public outcries about different DSM diagnoses, proposed changes to the personality disorders section for DSM-5 have been a particular target for criticism. "As it stands now, the DSM-5 personality section is not readable, much less usable," writes psychiatrist Allen Frances for his blog, DSM5 in Distress. Frances, once chair of the DSM-IV Task Force, is now one of DSM-5's most vocal opponents. The personality disorder section, he says, "will be ignored by clinicians and will do grave harm to research."

The central conflict in the…

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