Do you work with children with autism? If so, this newly revised course is for you!
Autism Spectrum Disorder in Schools identifies DSM-5 diagnostic changes in the ASD diagnostic criteria, summarizes the empirically-based screening and assessment methodology in ASD, and describes a comprehensive developmental approach for assessing students with ASD.
The DSM-5 conceptualizations of autism require professionals to update their knowledge about the spectrum. This course will prepare you to recognize the presence of risk factors and/or early warning signs of ASD and be familiar with screening and assessment tools in order to ensure that students with ASD are being identified and provided with the appropriate programs and services. Course #30-69 | 2013 | 44 pages | 40 posttest questions
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About the Author:
Lee A. Wilkinson, EdD, PhD, NCSP, is an author, applied researcher, and practitioner. He is a nationally certified school psychologist, registered psychologist, chartered scientist, and certified cognitive-behavioral therapist. Dr. Wilkinson is currently a school psychologist in the Florida public school system where he provides diagnostic and consultation services for children with autism spectrum disorders and their families. He is also a university educator and teaches graduate courses in psychological assessment, clinical intervention, and child and adolescent psychopathology. His research and professional writing has focused on behavioral consultation and therapy, and children and adults with Asperger syndrome and high-functioning autism spectrum disorders. He has published numerous journal articles on these topics both in the United States and the United Kingdom. Dr. Wilkinson can be reached at http://bestpracticeautism.com.
Caffeine is the most widely used behaviorally active drug in the world and is present in many different types of beverages, foods, energy aids, medications, and dietary supplements. Because caffeine ingestion is often integrated into social customs and daily rituals, some caffeine consumers may be unaware of their physical dependence on caffeine. It is estimated that more than 85% of adults and children in the US regularly consume caffeine.
For anyone who has ever tried to quit drinking their favorite caffeinated beverage (my guilty pleasure is fountain soda), you know the associated pains. Headache, fatigue, difficulty concentrating, moodiness, irritability, etc.
The new DSM-5 classifies caffeine withdrawal as a potential disorder (page 506-507 if you don’t believe me). Symptoms usually begin 12-24 hours after the last caffeine dose and peak after 1-2 days of abstinence. Caffeine withdrawal symptoms typically last for 2 to 9 days, with the possibility of withdrawal headaches occurring for up to 21 days.
Gradual reduction in caffeine is suggested to reduce the incidence and severity of withdrawal symptoms.
Grief after the loss of a loved one may be considered major depression, according to the new psychiatric manual.
After years of controversy, the latest version of the “psychiatric bible” — the Diagnostic and Statistical Manual of Mental Disorders — has been released.
The DSM-5 (fifth edition)’s introduction, over the weekend at the American Psychiatric Association’s annual meeting, marks “the end of more than a decade’s journey in revising the criteria for the diagnosis and classification of mental disorders,” the association says on the DSM-5 website.
The manual includes the criteria used by mental health professionals to diagnose patients. It’s also used by insurance companies, schools and other agencies responsible for covering and creating special provisions for individuals with developmental or mental disorders.
The overhaul — the first for the DSM since 1994 — has not come without opposition from activists, some grass-roots organizations and even the National Institute of Mental Health, which last month said it was launching a project aimed at laying the foundation for a new classification system and would be “re-orienting its research away from DSM categories.”
Here are five ways the DSM changes may affect you:
Bereavement or depression?
Previously, clinicians were advised against diagnosing major depression in people within two months after the death of a loved one: the “bereavement exclusion.”
The DSM-5 removes the exclusion, a move the psychiatric association says “helps prevent major depression from being overlooked and facilitates the possibility of appropriate treatment including therapy or other interventions.”
Research has shown that for some people, the death of a loved one can precipitate major depression — much like other stressors such as losing a job, the association says on the DSM-5 website. But “bereavement is the only life event and stressor specifically excluded from a diagnoses of major depression” in previous manuals.
Binge eating is officially an eating disorder
Binge eating was approved as its own category of eating disorder in the DSM-5. It’s defined as “recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances, with episodes marked by feelings of lack of control.”
According to the association, the move is aimed at “increasing awareness of the substantial differences between binge eating disorder and the common phenomenon of overeating. While overeating is a challenge for many Americans, recurrent binge eating is much less common, far more severe, and is associated with significant physical and psychological problems.”
Binge drinkers may be diagnosed as mild alcoholics
Prior DSM editions included “alcohol abuse,” along with the more serious “dependence.” However, the DSM-5 will make “alcohol use disorder” a single condition.
“The field of substance abuse and addiction has witnessed an explosion in important research in the past two decades,” said Dr. David Kupfer, chairman of the DSM-5 Task Force, in a February statement. The changes “reflect the best science in the field and provide new clarity in how to diagnose these disorders.”
The proposal to group Asperger’s and other developmental conditions together generated a flurry of comments and concerns. In 2010, when the change was proposed, the Asperger’s Association of New England, a nonprofit organization with more than 3,000 members, wrote a letter to the American Psychiatric Association emphasizing that Asperger’s should remain separate.
But “the revised diagnosis represents a new, more accurate, and medically and scientifically useful way of diagnosing individuals with autism-related disorders,” the national group says on the DSM-5 website.
The work group that recommended the change “believes a single umbrella disorder will improve the diagnoses of ASD without limiting the sensitivity of the criteria, or substantially changing the number of children being diagnosed.”
In a statement on its website Tuesday, the New England association assures its members, “regardless of your diagnosis or label, we will continue to provide a gathering place where members of the Asperger’s community can connect to one another.”
The DSM-5 eliminates the term “gender identity disorder,” which mental health specialists, along with lesbian, gay, bisexual and transgender activists, had considered stigmatizing. It refers to “gender dysphoria,” which focuses attention only on those who feel distressed by their gender identity.
“I think it’s a significant change,” Jack Drescher, a member of the psychiatric association group that recommended the change, said late last year. “It’s clinically defensible, but it reduces the amount of stigma and harm that existed before.”
Homosexuality was removed from the DSM in 1973, a move he believes changed global views.
Some LGBT activists applauded the change, while others have questioned whether it goes far enough.
The controversial revision to psychiatrists’ “bible” of diagnostic criteria has finally arrived. The American Psychiatric Association released its fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or dubbed simply as the “DSM-5.”
The manual’s release was coincided with the APA’s annual meeting that kicked off May 18 in San Francisco.
The first major revision to the manual in almost two decades, the new DSM has been met by controversy since reports of proposed changes started to crop up last March.
Doctors often utilize the DSM to diagnose mental health disorders in patients that meet a specific set of criteria.
Among the major changes that garnered the most controversy was dropping Asperger’s syndrome, child disintegrative disorder and pervasive developmental disorder not otherwise specified (PDD), and included them under the blanket diagnosis of autism spectrum disorder.
Revisions were also made to diagnostic criteria for mental health disorders including schizophrenia, bipolar disorder, dissociative identity disorder and depressive disorders.
For example, in the last version of the manual, the 1994 DSM-IV, there was was an exclusion criterion for a major depressive episode that was applied to people with symptoms of depression lasting less than 2 months following the death of a loved one. The DSM-5 removed this after the APA realized since the last version that grief can last up to two years, and bereavement can be a severe psychological stressor that triggers depression, rather than an exception.
Besides worrying some mental health advocates over concerns changes in their diagnosis would affect their abilities to get treatment for state funding, the manual’s release also pitted the government’s National Institute of Mental Health (NIMH) and the American Psychiatric Association (APA),
NIMH director Thomas Insel wrote in a statement in early May that the NIMH felt the proposed definitions for psychiatric disorders were too broad and ignore smaller disorders that were lumped in with a larger diagnosis.
“The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever,” he wrote.
The government agency said it would use a different classification system, the Research Domain Criteria (RDoC) project, instead for its studies.
The NIH and APA released a joint statement on May 13, saying that “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.” But, the statement also said, “The National Institute of Mental Health (NIMH) has not changed its position on DSM-5.”
One vocal critic, Dr. Allen Frances, who co-authored the DSM-IV, told CBS This Morning on Thursday that we are over-treating people in this country who are “basically well” and are “shamefully neglecting” people with mental disorders who are really sick, including one million people in prison with psychiatric disorders. The new manual, he said, is too loose for its diagnoses.
He said the average diagnosis is being given by a primary care doctor in a seven minute visit.
“People who are basically normal are getting all kinds of medicine that they don’t need that makes them worse and it is a terrible drain on the economy,” Frances said.
“I’m very curious to see what happens because as you know there’s kind of this tension between the DSM and some of the new NIMH initiatives,” Dr. James Murrough, an assistant professor of psychiatry and neuroscience at Mount Sinai Hospital in New York City, told CBSNews.com Murrough was not involved in the new DSM, but will be presenting research at the APA meeting this weekend.
He said by now, some psychiatrists had hoped the new DSM would contain more information about scientific tests or scans for psychologists or psychiatrists to help aid their diagnoses. But, he added the new version doesn’t appear to look very different from the last one.
“I think everyone is kind of disappointed that we don’t have that yet,” he said.
More information about the DSM-5 can be found on the APA’s website.
When the dust of debate settles, the new revision’s benefits should be clear: good science, better diagnoses, more individualized care.
Sometime this month, the DSM-5 will replace the DSM-IV as the coin of the realm for diagnosis of mental illnesses, including substance use disorders. Despite the unprecedented criticism that has accompanied the process, the final product’s changes are based on very solid epidemiological research, and they are likely to reduce ambiguity and confusion. But there may be some surprise, too, as received wisdom about the diagnosis and treatment of addiction is turned on its head. Let’s hope that this development will result in a more rational and nuanced approach to addiction.
When the DSM-IV was developed, it appeared that abuse and dependence were two distinct disorders. Substance abuse was defined according to four criteria; dependence, according to seven criteria. In practice, “abuse” was often used to denote a milder form of Substance Use Disorder (SUD); “dependence,” a more severe SUD.
In the case of opioids, “dependence” was confusing because almost anyone on opioid-based painkillers for any length of time develops physiological dependence (they will have withdrawal if they stop suddenly), whereas in the DSM-IV, “dependence” meant “addiction” (pathological, compulsive, harmful use). So pain patients prescribed opioids were mislabeled as opioid “dependent” even though they took their medication as prescribed.
Since then, a considerable body of research has shown that there are not two distinct types of substance misuse, but only one. More important, most DSM-IV “abuse” symptoms develop only in people with severe addiction, while “dependence” symptoms are among the earliest to develop. In the DSM-5, “abuse” and “dependence” are gone. In their place is the single “Substance Use Disorder.”
With alcohol, for example, the earliest and most common problems are “internal” problems, such as going over limits, persistent desire to quit or cut down, and use despite hangover or nausea. The only “abuse” criterion that develops early is drinking and driving, but without a DUI. In the largest study of its kind, the NIAAA Epidemiological Study of Alcohol and Related Conditions (NESARC), 90 percent of people who met criteria for DSM-IV alcohol abuse—but not dependence—did so because of admitting drinking and driving. All other abuse criteria only occurred in people with the most severe and chronic addiction, and then late in the game.
In fact, legal problems occur so infrequently that this criterion was dropped from theDSM-5. This may come as a surprise to people working in the treatment industry because legal problems are the most common reason people seek treatment in rehab. But only about 12 percent of people with DSM-IV alcohol dependence ever seek specialty treatment, which suggests that the rest—who are not in treatment—have less severe disorders. People in rehab or AA are to alcohol use disorder what asthmatics on a ventilator in the ICU are to people with asthma: the most severe, treatment-refractory disorders as well as the most co-morbid psychiatric and medical problems. We’ve made a large error by assuming that everyone in the community who meets the criteria for a substance disorder has exactly the same disease as people in rehab or AA.
Are you prepared for the highly anticipated and long awaited DSM-5? This new CEU course will guide you through the revision.
Based on the book “The Intelligent Clinician’s Guide to the DSM-5®” (2013, 272 pages), this 4-hour CEU course explores all revisions to the latest version of the Diagnostic and Statistics Manual and shows clinicians how they can best apply the strong points and shortcomings of psychiatry’s most contentious resource. The book uses evidence-based critiques and new research to point out where DSM-5 is right, where it is wrong, and where the jury is still out. The author tackles the question – how can we appropriately classify and diagnose mental disorders and address the complexities of distinguishing a psychiatric ‘case’ from a ‘non-case’? He details a flawed DSM-5 ideologically-based production but encourages us to recognize that while we have to use it, we can still work our way around it. In the end he counsels clinicians to “apply extra caution and follow common sense.” Course #40-37 | 30 posttest questions | CE test available online @ https://www.pdresources.org/course/index/6/1153/DSM-5-The-Intelligent-Clinicians-Guide
About the Author:
Joel Paris, MD, is a psychiatrist who is renowned for his research on personality disorders. He obtained an MD from McGill University in 1964, where he also trained in psychiatry. Dr. Paris’ main diagnosis of interest, borderline personality disorder, affects 1% of the population and it is associated with repeated suicide attempts. Dr. Paris’ research program aims to learn more about the causes of personality disorder, how they develop during childhood and adolescence and how patients recover over time. Dr. Paris collaborates with numerous researchers within the McGill network. These collaborations have employed the methods of neuroendocrine challenge, neuropsychological assessment, behaviour genetics and molecular genetics and include studies aimed at the prediction of suicide ideas and suicide attempts in young women. The primary hypothesis is that personality traits (impulsivity and affective instability) will be the predictors of suicidality.
Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; by the National Board of Certified Counselors (NBCC) to offer home study continuing education for NCCs (Provider #5590); by the Association of Social Work Boards (ASWB Provider #1046, ACE Program); by the National Association of Alcoholism & Drug Abuse Counselors (NAADAC Provider #000279); by the California Board of Behavioral Sciences (#PCE1625); by the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); by the Illinois DPR for Social Work (#159-00531); by the Ohio Counselor, Social Worker & MFT Board (#RCST100501); by the South Carolina Board of Professional Counselors & MFTs (#193); and by the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).
Yesterday, the board of trustees of the American Psychiatric Association (APA) approved a set of updates, revisions and changes to the reference manual used to diagnose mental disorders. The revision of the manual, called the Diagnostic and Statistical Manual of Mental Disorders and abbreviated as the DSM, is the first significant update in nearly two decades.
Disorders that will be in the new DSM-5 — but only in Section 3, a category of disorders needing further research — include: Attenuated psychosis syndrome, Internet use gaming disorder, Non-suicidal self-injury, and Suicidal behavioral disorder. Section 3 disorders generally won’t be reimbursed by insurance companies for treatment, since they are still undergoing research and revision to their criteria.
So here’s a list of the major updates…
Overall Changes to the DSM
According to the American Psychiatric Association’s statement, there are two major changes to the overall DSM — the dumping of the multiaxial system, and rearranging the chapter order of disorders. Most clinicians only paid attention to Axis I and II, so it’s no surprise the Axis system was never a big hit. The current chapter order has always been a bit of a mystery to most clinicians, so it’s good to know there’s some thought going into the new order of chapters.
DSM-5’s 20 chapters will be restructured based on disorders’ apparent relatedness to one another, as reflected by similarities in disorders’ underlying vulnerabilities and symptom characteristics.
The changes will align DSM-5 with the World Health Organization’s (WHO) International Classification of Diseases, eleventh edition (ICD-11) and are expected to facilitate improved communication and common use of diagnoses across disorders within chapters.
Removal of multiaxial system:
DSM-5 will move to a nonaxial documentation of diagnosis, combining the former Axes I, II, and III, with separate notations for psychosocial and contextual factors (formerly Axis IV) and disability (formerly Axis V).
Autistic disorders will undergo a reshuffling and renaming:
“[Autism] criteria will incorporate several diagnoses from DSM-IV including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder (not otherwise specified) into the diagnosis of autism spectrum disorder for DSM-5 to help more accurately and consistently diagnose children with autism,” according to an APA statement Saturday.
The rest of this update comes from the APA’s news release on the changes:
Binge eating disorderwill be moved from DSM-IV’s Appendix B: Criteria Sets and Axes Provided for Further Study to DSM-5 Section 2. The change is intended to better represent the symptoms and behaviors of people with this condition.
This means binge eating disorder is now a real, recognized mental disorder.
Disruptive mood dysregulation disorder will be included in DSM-5 to diagnose children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year.
The diagnosis is intended to address concerns about potential over-diagnosis and overtreatment of bipolar disorder in children. Will children now stop being diagnosed with bipolar disorder, which has been a recurring concern among many clinicians and researchers? We will see.
Excoriation (skin-picking) disorder is new to DSM-5 and will be included in the Obsessive-Compulsive and Related Disorders chapter.
Hoarding disorder is new to DSM-5.
Its addition to DSM is supported by extensive scientific research on this disorder. This disorder will help characterize people with persistent difficulty discarding or parting with possessions, regardless of their actual value. The behavior usually has harmful effects — emotional, physical, social, financial and even legal — for a hoarder and family members.
Pedophilic disorder criteria will remain unchanged from DSM-IV, but the disorder name will be revised from pedophilia to pedophilic disorder.
DSM-5 will maintain the categorical model and criteria for the 10 personality disorders included in DSM-IV and will include the new trait-specific methodology in a separate area of Section 3 to encourage further study how this could be used to diagnose personality disorders in clinical practice.
Posttraumatic stress disorder (PTSD) will be included in a new chapter in DSM-5 on Trauma- and Stressor-Related Disorders.
DSM-5 pays more attention to the behavioral symptoms that accompany PTSD and proposes four distinct diagnostic clusters instead of three. PTSD will also be more developmentally sensitive for children and adolescents.
Removal of bereavement exclusion:
The exclusion criterion in DSM-IV applied to people experiencing depressive symptoms lasting less than two months following the death of a loved one has been removed and replaced by several notes within the text delineating the differences between grief and depression. This reflects the recognition that bereavement is a severe psychosocial stressor that can precipitate a major depressive episode beginning soon after the loss of a loved one.
Specific learning disorder broadens the DSM-IV criteria to represent distinct disorders which interfere with the acquisition and use of one or more of the following academic skills: oral language, reading, written language, or mathematics.
Substance use disorder will combine the DSM-IV categories of substance abuse and
substance dependence. In this one overarching disorder, the criteria have not only been combined, but strengthened. Previous substance abuse criteria required only one symptom while the DSM-5’s mild substance use disorder requires two to three symptoms.
The APA board of trustees also outright rejected some new disorder ideas. The following disorders won’t appear anywhere in the new DSM-5:
Parental alienation syndrome
Sensory processing disorder
Although clinicians are “treating” these concerns, the board of trustees felt like there wasn’t even enough research to consider putting them in Section 3 of the new DSM (disorders needing further research).
So there you have it. What do you think about these final decisions for the DSM-5?
A panel of psychiatrists revising the influential Diagnostic and Statistical Manual of Mental Disorders are holding firm to their streamlined diagnosis for autism but are backing off proposals for changes to some others.
How the definitions turn out in the fifth edition of the DSM when it is published next year has huge implications for the pharmaceutical industry, which has reaped huge returns from doctors turning to drugs more often for treatments. Drug treatments for autism are seen to have great potential in the market, for example, so how the manual ends up on that diagnosis is being closely monitored by the industry.
The doctors said evidence did not support creation of the diagnoses “attenuated psychosis syndrome” or “mixed anxiety depressive disorder.” The first is supposed to identify anyone at risk of developing psychosis, while the second was seen as a hybrid of anxiety and depression, reports The New York Times.
They also made some changes to the definition of depression so that people experiencing the kind of common sadness anyone might experience after an event such as a death in the family were not diagnosed with a mental condition.
Dr. David J. Kupfer, who is leading the group revising the manual, said there was a decision that some proposed diagnoses needed further study after reviews of field trials on whether different doctors would reach a diagnosis in the same way.
“Our intent for disorders that require more evidence is that they be studied further, and that people work with the criteria,” and refine them, said Kupfer who also is a professor of psychiatry at the University of Pittsburgh.
With crunch time looming for the ongoing revision of the psychiatry profession’s diagnostic manual, critics hoping to stop what they see as destructive changes are taking their campaign to the consumer media.
In early February, British psychologists and psychiatrists unhappy with proposed changes in the fifth edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders — the DSM-5, in its forthcoming incarnation — staged a successful press conference in London, which generated news coverage around the world.
Meanwhile, the most prominent U.S.-based critic of DSM-5, Allen Frances, MD — chairman of the task force that developed the fourth DSM edition in 1994 — has become a regular contributor to the popular Huffington Post website. Last week, he suggested there that the government should force the APA to abandon some of the proposed changes.
And the explosion in social media has allowed other, less well-connected mental health professionals and interested laypeople to create their own platforms for airing concerns about DSM-5 — starting websites and writing comments on others.
At least in part, the rising furor is driven by the DSM-5 revision schedule. The APA has committed to releasing the final version at its May 2013 meeting. Its internal process for ratifying it requires that it be in essentially final form this winter.
Thus, only a few months remain for critics to sway the DSM-5 leadership.
When Does Grief Become Depression?
Most of the criticism has focused on a few of the many dozens of changes that the DSM-5 working groups have proposed. These include eliminating the so-called bereavement exclusion in diagnosing major depression and adding new diagnoses for people with mild psychotic-like symptoms and problem child behaviors such as severe, repetitive tantrums.
The complaints have a common theme: that the DSM-5 will medicalize — and therefore stigmatize — normal human behaviors.
At the London press conference, for example, psychiatrist Nick Craddock, director of the Welsh National Centre for Mental Health in the U.K., argued that removing the bereavement exclusion would have such an effect.
Under DSM-IV criteria, someone who has lost a loved one can be diagnosed with major depression only if depression symptoms last longer than two months or if they include features not typical of normal grief, such as suicidal ideation.
The proposals for DSM-5 would drop this caveat, allowing for diagnosis of major depression two weeks after a loved one’s death.
According to the DSM-5 working group on depressive disorders, there is no evidence to justify an exclusion for grief but not for other stressors such as divorce, sudden physical disability, or losing one’s home or job.
Defenders of the proposal have also argued that individuals with normal grief may benefit from counseling, which may not be covered by insurance without a DSM-sanctioned diagnosis.
Craddock agreed, but countered that such individuals “did not need a label saying they had a mental illness.”
Similar complaints have been leveled at the proposed new diagnosis of attenuated psychosis syndrome. Its proponents intended it to cover people with persistent but mild hallucinatory symptoms and disturbed thinking — mild enough that the individuals recognize that they aren’t real, but serious enough to find the symptoms bothersome.
In a commentary published in the Feb. 18 issue of The Lancet, two researchers said it would be “premature” to include the syndrome in the DSM.
Paolo Fusar-Poli, MD, of King’s College London, and Alison R. Yung, PhD, of the University of Melbourne in Australia, said that, from the evidence so far, the population likely to receive the diagnosis “is heterogeneous in presentation, clinical needs, and outcome” — and thus too ill-defined without more research and additional diagnostic criteria.
‘Shrinking the Pool of Normality’
One British psychologist, referring to the DSM-5 as a whole, told the Guardian newspaper that its proposals “are likely to shrink the pool of normality to a puddle.”
They also allege that, by expanding the number of people potentially qualifying for a psychiatric diagnosis, DSM-5 will inevitably increase the number treated with drugs.
Another of the speakers at the London press conference, David Pilgrim, of the University of Central Lancashire in Preston, England, called it “hard to avoid the conclusion that DSM-5 will help the interests of the drug companies.”
Former New England Journal of Medicine editor Marcia Angell, MD, noted last year in the New York Review of Books that more than half of DSM-5 working group members had “significant industry interests.”
Frances, too, has written that the DSM-5 will be a “bonanza for the pharmaceutical industry.” But most of his criticisms, which he took public in 2009, have focused on the revision process.
He has been especially concerned with delays in the process — the APA had originally scheduled publication of DSM-5 for this May, but decided in 2009 to push it back one year — and what he believes has been a resulting rush to deliver a final product.
He has repeatedly called on the APA to abandon the revision in its current form. Recently he argued that the Obama administration’s decision to delay implementation of the ICD-10 classification system in the U.S. undercut the APA’s arguments for the May 2013 deadline for DSM-5.
DSM-5 Leaders Stand Their Ground
In a conversation with MedPage Today, APA President John Oldham, MD, and DSM-5 task force chairman David Kupfer, MD, defended their handling of the revision and argued that many of the criticisms were off-base.
For starters, Kupfer said, the proposed revisions were still open to change or abandonment. The DSM-5 will assume its near-final form in June or July, he said — meaning that the APA’s annual meeting in May would provide another forum to debate the changes.
“[The proposals] are still open to revision,” he said. “The door is still very much open.”
Oldham said he was satisfied with the process so far. “It’s an enormously long, and difficult, and challenging thing to do,” he said. “We’re not going to get it perfect. I don’t think anybody could. I don’t think any previous edition could.”
Oldham and Kupfer also argued in favor of removing the bereavement exclusion from the depression criteria.
Said Kupfer, “If patients are suffering not from normal sadness or grief, but are suffering from a severity of symptoms that constitute clinical depression, and need intervention, and they want help, that they should not be prevented from getting the appropriate care that they need because somebody tells them that, well, this is what everybody has when they have a loss.”
Oldham noted that extreme sadness can be triggered by any number of events — natural disasters, physical disability, job losses — yet the DSM-IV created an exclusion only for “bereavement.”
He also pointed out that there are “ranges of heritable risk for major depression” — suggesting that depression may in some sense be normal, yet deserving treatment nonetheless.
The DSM’s overarching purpose, Oldham said, is to enable “patients who need treatment [to] get it.”
Kupfer conceded that field trials of the revised criteria, by design, were not testing whether the changes would increase or decrease the number of people receiving a particular diagnosis. As a result, the critics’ worries won’t be refuted or confirmed until after the revisions go into effect.
“We won’t get 100% consensus on all the proposals,” Oldham said. “That would be totally unrealistic. But I personally think it’s been a thorough and careful process. We’re going to have disagreement. That’s going to happen.”
DSM-IV-TR vs. Proposed DSM-5: Comparison, Implications and Impact
Join NAADAC on February 29, 2012 from 3-4 p.m. EST and earn one continuing education credit. A revised edition of the Diagnostic and Statistical Manual of Mental Disorders will be released in May 2013. This webinar will examine the proposal and let professionals know what to prepare for.