Tuesday, June 01, 2010

John M Grohol PsyD - You Do Make a Difference in the DSM-5

Cool article from John M Grohol, PsyD, at Psych Central on how comments made on the proposed changes to the DSM-5 have impacted the decision-making process. Is this how Democracy is supposed to work?

I'll try ti get more on this from the article he summarizes in the next couple of days.
You Do Make a Difference in the DSM-5

By John M Grohol PsyD

You Do Make a Difference in the DSM-5

Good news — you can make a difference!

According to a presentation at the annual meeting of the American Psychiatric Association last week, the 8,600 comments submitted in response to the draft of the new version of the Diagnostic and Statistical Manual for Mental Disorders (called the “DSM-5″ for short — the 5 stands for the 5th edition of the book) helped spur changes in the draft.

To me, this kind of change demonstrates a fundamental shift in the ability to engage in a meaningful scientific/clinical dialogue. Twenty years ago, there was no easy feedback mechanism for a project of this scale. Back then, significant time and resources would be needed in order to get legitimate and critical feedback (e.g., setting up focus groups in multiple geographic locations, soliciting researchers and clinicians to participate through phone calls and mailings, etc.).

Because of the Internet and the “Web 2.0″ movement — where there is an inherent expectation of the ability to engage in a two-way dialogue about content found online — the DSM-5 has done something never done before. It has encouraged a two-way dialogue with the workgroups responsible for making changes and edits in this important diagnostic manual.

The largest number [of comments submitted to the DSM-5 draft website] — 1,337 — were about neurodevelopmental disorders.

[David Kupfer, MD, of the University of Pittsburgh, chairman of the APA's DSM-5 taskforce] said that wasn’t surprising, as the proposed revision makes significant changes to autism-related disorders. Whereas the current version of the DSM has four separate classifications for autism and related conditions, the draft collapsed these down to a single Autism Spectrum Disorder with various “specifiers” to identify subtypes such as Asperger’s syndrome.

Also attracting many comments were the anxiety disorders (1,217) and those involving sex and gender identity (811).

The smallest number were in the category of sleep disorders, Kupfer’s own specialty, with just 57. “But those 57 comments were quite useful,” he said.

According the the DSM-5 website, the following changes have been made due to the comments:

  • For anorexia nervosa, numerical examples of “body weight less than 85% of that expected” were replaced simply with “markedly” low weight to describe patients’ physical appearance.
  • Mechanisms of compensatory behavior for diagnosing bulimia nervosa were expanded to include medication, excessive exercise, and fasting.
  • Wording of one criterion for adjustment disorders was expanded to include “other important areas of functioning.”

The Sexual and Gender Identity Disorders Work Group also made revisions to language involving several disorders within that category:

  • For all Paraphilia Disorders, two specifiers were added: “in remission” and “in controlled environment.”
  • Within Pedohebophilic Disorder — a new classification that takes in sexual preference for pubescent children as well as the prepubescent — wording of one criterion was revised to read “use of pornography depicting prepubescent or pubescent children…” and another was modified to refer to it.
  • Hypersexual Disorder was modified to specify that patients must be at least 18 years old.
  • Transvestic Disorder now includes the specifier With Autoandrophilia (Sexually Aroused by Thought or Image of Self as Male) and was also changed to allow for the possibility of diagnosing females with this disorder.

Now, of course there will be criticism about this process and whether all 8,600 comments were equally considered or weighted. I’m certain they weren’t. I’m also certain that the fact the workgroups were even able to review all 8,600 comments and take some of their criticisms into account for the draft of the DSM-5 is astonishing. I know of no equivalent publisher that has done anything similar in the field.

Is the process perfect? No, nor will it ever be. By purpose, the current DSM-5 process has had a fundamental difficulty with transparency. It’s only been in the past year where transparency has finally started to occur, based upon many critics speaking out against the DSM-5 review and editing process.

But I say — better late than never. The DSM-5 will be an important edition. Opening the draft up to review comments was something I recommended back in December 2009 and while it may be that was always the intention, it’s good to see it actually happen.

The DSM-5 is scheduled for publication in May 2013.

Read the full article: Comments Lead to Changes in DSM-5 Draft

Dr. John Grohol is the CEO and founder of Psych Central. He has been writing about online behavior, mental health and psychology issues, and the intersection of technology and psychology since 1992.

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