General Robert Spitzer, the head of the DSM-III task force, publicly criticized the APA for mandating that DSM-5 task force members sign a
nondisclosure agreement, effectively conducting the whole process in secret: "When I first heard about this agreement, I just went bonkers. Transparency is necessary if the document is to have credibility, and, in time, you're going to have people complaining all over the place that they didn't have the opportunity to challenge anything."
Allen Frances, chair of the DSM-IV task force, expressed a similar concern.
David Kupfer, chair of the DSM-5 task force, and Darrel A. Regier, MD, MPH, vice chair of the task force, whose industry ties are disclosed with those of the task force, countered that "collaborative relationships among government, academia, and industry are vital to the current and future development of pharmacological treatments for mental disorders". They asserted that the development of DSM-5 is the "most inclusive and transparent developmental process in the 60-year history of DSM". The developments to this new version can be viewed on the APA website. During periods of public comment, members of the public could sign up at the DSM-5 website and provide feedback on the various proposed changes. In June 2009, Allen Frances issued strongly worded criticisms of the processes leading to DSM-5 and the risk of "serious, subtle, [...] ubiquitous" and "dangerous" unintended consequences such as new "false 'epidemics'". He writes that "the work on DSM-V has displayed the most unhappy combination of soaring ambition and weak methodology" and is concerned about the task force's "inexplicably closed and secretive process". His and Spitzer's concerns about the contract that the APA drew up for consultants to sign, agreeing not to discuss drafts of the fifth edition beyond the task force and committees, have also been aired and debated. In 2011, psychologist
Brent Robbins co-authored a national letter for the Society for Humanistic Psychology that brought thousands into the public debate about the DSM. Approximately 13,000 individuals and
mental health professionals signed a petition in support of the letter. Thirteen other
American Psychological Association divisions endorsed the petition. In a November 2011 article about the debate in the
San Francisco Chronicle, Robbins notes that under the new guidelines, certain responses to grief could be labeled as pathological disorders, instead of being recognized as being normal human experiences. In 2012, a footnote was added to the draft text which explains the distinction between grief and depression. The DSM-5 has been criticized for purportedly saying nothing about the biological underpinnings of mental disorders. A book-long appraisal of the DSM-5, with contributions from philosophers, historians and anthropologists, was published in 2015. A 2015 essay from an Australian university criticized the DSM-5 for having poor cultural diversity, stating that recent work done in cognitive sciences and cognitive anthropology is still only accepting western psychology as the norm. DSM-5 includes a section on how to conduct a "cultural formulation interview", which gives information about how a person's
cultural identity may be affecting expression of
signs and symptoms. The goal is to make more reliable and valid diagnoses for
disorders subject to significant cultural variation.
Gender and Sexual Identity Disorders work group The appointment, in May 2008, of two of the taskforce members,
Kenneth Zucker and
Ray Blanchard, led to an internet petition to remove them. According to MSNBC, "The petition accuses Zucker of having engaged in 'junk science' and promoting 'hurtful theories' during his career, especially advocating the idea that children who are unambiguously male or female anatomically, but seem confused about their
gender identity, can be treated by encouraging gender expression in line with their anatomy." According to
The Gay City News: The
National LGBTQ Task Force issued a statement questioning the APA's decision to appoint Kenneth Zucker and Ray Blanchard to the working group for Gender and Sexual Identity Disorders, stating that, "Kenneth Zucker and Ray Blanchard are clearly out of step with the occurring shift in how doctors and other health professionals think about
transgender people and
gender variance." Blanchard responded, "Naturally, it's very disappointing to me there seems to be so much misinformation about me on the Internet. [They didn't distort] my views, they completely reversed my views." Of the DSM-5 task force members, 69% report having ties to the pharmaceutical industry, an increase from the 57% of DSM-IV task force members. Although the APA has since instituted a disclosure policy for DSM-5 task force members, many still believe the association has not gone far enough in its efforts to be transparent and to protect against industry influence. In a 2009 Point/Counterpoint article, Lisa Cosgrove, PhD and Harold J. Bursztajn, MD noted that "the fact that 70% of the task force members have reported direct industry ties—an increase of almost 14% over the percentage of DSM-IV task force members who had industry ties—shows that disclosure policies alone, especially those that rely on an honor system, are not enough and that more specific safeguards are needed". The role of the DSM-5 in protecting the interests of wealthy and politically powerful owners of the means of production in the United States has been criticized as well. Placing the blame for predictable and common psychological distress caused by the deleterious effects of
economic inequality in the United States on individuals by attributing it to mental pathology has been criticized as hindering change of the root causes of the distress.
Borderline personality disorder controversy In 2003, the
Treatment and Research Advancements National Association for Personality Disorders (TARA-APD) campaigned to change the name and designation of
borderline personality disorder in DSM-5. The paper
How Advocacy is Bringing BPD into the Light reported that "the name BPD is confusing, imparts no relevant or descriptive information, and reinforces existing
stigma." Instead, it proposed the name "emotional regulation disorder" or "
emotional dysregulation disorder." There was also discussion about changing borderline personality disorder, an Axis II diagnosis (personality disorders and intellectual disability), to an Axis I diagnosis (clinical disorders). The TARA-APD recommendations do not appear to have affected the American Psychiatric Association, the publisher of the DSM. As noted above, the DSM-5 does not employ a multi-axial diagnostic scheme, therefore the distinction between Axis I and II disorders no longer exists in the DSM
nosology. The name, the diagnostic criteria for, and description of, borderline personality disorder remain largely unchanged from
DSM-IV-TR.
British Psychological Society response The
British Psychological Society stated in its June 2011 response to DSM-5 draft versions, that it had "more concerns than plaudits." It criticized proposed diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements... not value-free, but rather reflect[ing] current normative social expectations," noting doubts over the reliability, validity, and value of existing criteria, that personality disorders were not normed on the general population, and that "not otherwise specified" categories covered a "huge" 30% of all personality disorders. It also expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences... which demand helping responses, but which do not reflect illnesses so much as normal individual variation." The Society suggested as its primary specific recommendation, a change from using "diagnostic frameworks" to a description based on an individual's specific experienced problems, and that mental disorders are better explored as part of a spectrum shared with
normality: Many of the same criticisms also led to the development of the
Hierarchical Taxonomy of Psychopathology, an alternative, dimensional framework for classifying mental disorders.
National Institute of Mental Health National Institute of Mental Health director
Thomas R. Insel, MD, wrote in an April 29, 2013 blog post about the DSM-5: Insel also discussed an NIMH effort to develop a new classification system,
Research Domain Criteria (RDoC), currently for research purposes only. Insel's post sparked a flurry of reaction, some of which might be termed
sensationalistic, with headlines such as "Goodbye to the DSM-V", "Federal institute for mental health abandons controversial 'bible' of psychiatry", "National Institute of Mental Health abandoning the DSM", and "Psychiatry divided as mental health 'bible' denounced". Other responses provided a more nuanced analysis of the NIMH Director's post. In May 2013, Insel, on behalf of NIMH, issued a joint statement with
Jeffrey A. Lieberman, MD, president of the American Psychiatric Association, that emphasized that DSM-5 "... represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5." Insel and Lieberman say that DSM-5 and RDoC "represent complementary, not competing, frameworks" for characterizing diseases and disorders. == See also ==