The DSM-5 controversies: How should psychologists respond?

Abstract

The American Psychiatric Association (APA) published DSM-5 in May 2013. The revision process was fraught with controversy. In the first section of this article, we briefly summarise the controversies related to the actions of the APA and the Task Force responsible for the revision process. These include allegations of secrecy, accusations of conflicts of interest, apprehension over a promised paradigm shift, concerns about the definition of mental disorder, charges of medicalizing normality, and claims of poor methodology. In the second section, we briefly summarise the controversies related to some of the revisions to the DSM-5 disorders and diagnostic criteria. In the third section, we argue that DSM-5 development was unnecessarily contentious for reasons that could have been foreseen and prevented. Because incremental updates to the DSM-5 are anticipated in the near future (American Psychiatric Association, 2010, APA modifies DSM naming convention to reflect publication changes, Washington, DC: Author), we propose that psychologists external to the revision process should use their unique expertise to assist in resolving the controversies that have beset the DSM-5 and thereby facilitate a less contentious development of the next iteration of the DSM.Keywords: DSM-5, controversies, psychologistsThe American Psychiatric Association (APA) published the DSM-5 in May 2013 (APA, 2013). The revision process was fraught with controversy. Our purpose is to summarise those controversies and then to examine how psychologists might respond to them. We reviewed the literature using PsycINFO, PsychiatryOnline, Medline, and Google Scholar databases using DSM V, DSM-V, DSM 5, and DSM-5 as search terms, through December 2012. Two major areas of controversy were identified. The first was the way the APA and DSM-5 Task Force conducted the revision process. The second related to some of the proposed revisions to the disorders and diagnostic criteria that were posted on the APA's website, DSM-5 Development (APA, 2010b; the proposed disorders, criteria sets, and rationales were removed from the website in 2012.) The search yielded a plethora of articles. Consequently, we reviewed only as many articles as necessary to provide an awareness of the main controversies and to provide a context for understanding why we believe that psychologists should respond to them.BackgroundThe DSM-5 Task Force was responsible for the revision process. In 2006, David Kupfer, MD, was appointed Chair and Darrel Regier, MD, MPH, was appointed Vice-Chair. Members of 13 Work Groups were announced in 2008. The Task Force developed four guiding principles (Kupfer, Regier, & KA¼hl, 2008). The first was that proposals be based on empirical evidence. The second was that continuity with previous versions of DSM be maintained when possible. The third, and most controversial, was the removal of all limitations on the amount of change that could occur. The fourth was that DSM-5 be a living document that could be updated periodically. The APA (2010a) replaced the conventional Roman numeral with an Arabic numeral to permit incremental updates using decimals (e.g., DSM-5, 5.1, 5.2).Controversies Related to the Task ForceThe issue of secrecy is one of the most significant controversies surrounding the development of the DSM-5. Robert Spitzer, MD (2008), Chair of the DSM-III and DSM-III-R Task Forces, reported that Regier had denied his request for the minutes of Task Force meetings in order to maintain DSM-5 confidentiality. Spitzer (2008) was incredulous. He reported that all Task Force and Work Group members were required to sign an acceptance form that prevented them from discussing their work publicly. Spitzer said the confidentiality agreement was unprecedented in the development of prior DSMs. He argued that the development of DSM-5 in secrecy indicated a failure by the Task Force to understand the necessity for an open and transparent revision process (Spitzer, 2008). …