About this blog.

My son was diagnosed with PDD-NOS at 24 months. I created this blog to bring meaning to the often-confusing label. Sometimes I have answers. Other times, just more questions.

Friday, December 18, 2009

DSM- V Epilogue

This week, we learned arrogance has a price.

To recap, the proposed DSM-V (which defines the defines the diagnostic criteria for autism) has been criticized for several reasons, including its insular process. Of the process, Dr. Allen Frances writes:

The secretiveness of the DSM‐V process is extremely puzzling. In my entire experience working on DSM‐III, DSM‐IIIR, and DSM‐IV, nothing ever came up that even remotely had to be hidden from anyone. There is everything to gain and absolutely nothing to lose from having a totally open process. Obviously, it is much better to discover problems before publication ‐and this can only be done with rigorous scrutiny and the welcoming of all possible criticisms.
Apparently, DSM-V Task Force knows it all because, by all outward indications, they prefer a closed process. When the self-appointed stewards of psychiatric diagnosis speak, the rest of the psychiatric community must bow to their wisdom.

But! This week, in a small victory to the DSM-V critics, the American Psychiatric Association (APA), announced it would postpone publication of the controversial DSM-V until 2013. The APA previously insisted the DSM-V would be published in 2012, critics be damned. The change of heart may have been prompted by an editorial published by the New Scientist, which suggested that the DSM V be replaced by an open source model:

With the advent of the internet, there is no longer any compelling need to rewrite the diagnostic criteria for the whole of psychiatry in one go. Yes, diagnoses should be revised as new scientific findings come in. But for this, specialists can be assembled when necessary to address specific areas that have become outmoded. Their suggestions can be posted on the web for comment. More research can be commissioned, if necessary. And when consensus is reached, new diagnostic criteria can be posted online.

Scientific method over ego. Consider this blogger sold on the New Scientist proposal.

And speaking of arrogance, this week Tiger Woods learned he isn't beyond reproach either. Which is ironic because the DSM V Task Force would have pathologized Tiger's...er...proclivities if they had their wish. And they may still do so, but at least it won't happen until 2013. I hear they're going to use the extra time to do more research, so perhaps Tiger can be a subject. Arrogance vindicating arrogance.


father of four said...

Hear, hear.

Nyx said...

What a fascinating show. (I'm really talking about the DSM V adoption, because I'm not sure what's going on with Tiger Woods, but it must be pretty interesting too.) There's so much human-ness in this story. The arrogance, the arm-chair quarterbacking, the politicking, the worrying over pharmaceutical companies and insurance coverage and labeling and .... What weird things we humans do. How predictable we are.

Emily said...

This is great news! I hope we'll move to a more open-source DSM in the future.

Do you think seeing the politicking and backroom compromises behind the DSM will make clinicians use it differently? More like a guideline and less like a bible?

Kris said...

I just hope for better diagnostic criteria for autism in the new addition. All this confusion about 2 from this category and 1 form this category, etc is too confusing - and then if you don't fit the "mold" you are given a dx of PDD-NOS (or ADHD in our case).
I would like to see a list of a few things that HAVE to be present for a dx of ASD (both Greesnpan and the Eides have done this so why can't the DSM?) and then use the severe, moderate, mild that is currently being considered. I also hope to see SPD in the new addition. I think there is way too much confusion, way too much blurring of lines and way too many "dump" dx currently. I say get the Eides and Greenspan to work on the DSM! What a mess.

Laura said...

Emily, as I understand it, the real question is insurance. Will drug X be covered in connection with the treatment of disorder Y. Currently, the DSM-IV is the "bible" for insurance coverage. Adding the litany of addictions would open up those "disorders" to drug coverage.

Nyx said...

and yet, the dsm is only for MENTAL DISORDERS! so ... what do they use for other neurological disorders that aren't considered "mental"? I assume, e.g., that cerebral palsy is not in the DSM.