Coalition for DSM-5 Reform: Petition Update 1
Post #112 Shortlink: http://wp.me/pKrrB-1n4
For the most recent updates and media coverage see Coalition for DSM-5 Reform tab page.
All enquiries relating to the Coalition for DSM-5 Reform, the Open Letter and associated iPetition should be addressed to Dr David Elkins and the Coalition for DSM-5 Reform Committee.
Coalition for DSM-5 Reform: Petition Update 1
The Petition was launched on 22 October by three committee members of Division 32:
David N. Elkins, Ph.D. Email: David Elkins
President, Society for Humanistic Psychology, Division 32 of the American Psychological Association
Brent Dean Robbins, Ph.D. Email: Brent Dean Robbins
Secretary, Division 32, Society for Humanistic Psychology, American Psychological Association
Sarah R. Kamens, M.A.
Doctoral Candidate in Clinical Psychology, Fordham University, Student Representative, Division 32
The committee has co-opted
Jonathan D. Raskin, Ph.D. Email: Jonathan D. Raskin
Fellow, Society for Humanistic Psychology, Division 32, American Psychological Association;
Fellow, Society for Theoretical and Philosophical Psychology, Division 24, American Psychological Association; Member, American Counseling Association
Donna Rockwell, Ph.D.
Frank Farley, Ph.D.
Media enquiries
Media enquiries and enquiries from professional organizations who would like to discuss endorsement of the Coalition’s Open Letter should be addressed to David Elkins and Brent Dean Robbins.
The Open Letter and Petition sponsored by the Society for Humanistic Psychology (Division 32 of the American Psychological Association), in alliance with several other APA Divisions, has attracted nearly 10,000 signatures since launching quietly, on 22 October.
26 mental health professional bodies are now endorsing the Open Letter which is highly critical of many of the draft criteria and categories being proposed for the revision of DSM-IV by the American Psychiatric Association’s 13 DSM-5 Work Groups. See the Coalition for DSM-5 Reform website for a list of organizations endorsing the Petition.
The American Psychiatric Association has scheduled a third and final stakeholder review for early 2012 with the next version of the Diagnostic and Statistical Manual of Mental Disorders slated for publication in May 2013.
Alarmed by the potential dangers they see in many of the current proposals, released in May 2011, the Petition sponsors are inviting mental health professionals and mental health organizations to sign up in support of their Open Letter to the American Psychiatric Association’s DSM-5 Development Task Force.
The Coalition for DSM-5 Reform is calling for the American Psychiatric Association to submit DSM-5 to independent scientific review or drop its most controversial proposals.
You can view the Open Letter and sign the iPetition here.
Of particular concern to the Sponsors are:
(1) The lowering of diagnostic thresholds, which may artificially inflate the prevalence of numerous disorders. By increasing the number of people who qualify for a diagnosis, DSM-5 may lead to the excessive medicalization and stigmatization of normative or transient distress.
(2) The potential consequences of lowered thresholds and new disorder categories on vulnerable populations such as children and the elderly. These populations are already at risk for excessive and inappropriate treatment with medications that have dangerous side effects. We are particularly concerned about the overuse of medications for “Attenuated Psychosis Syndrome,” “Disruptive Mood Dysregulation Disorder,” “Mild Neurocognitive Disorder,” Attention Deficit/Hyperactivity Disorder, and Generalized Anxiety Disorder.
(3) The lack of scientific evidence substantiating many of these new proposals.
The Coalition for DSM-5 Reform has opened a number of platforms
Open Letter and iPetition
Coalition for DSM-5 Reform on Twitter @dsm5reform
Coalition for DSM-5 Reform on Facebook
Coalition for DSM-5 Reform website
This initiative is also being covered on
The Society for Humanistic Psychology Blog
The Society for Humanistic Psychology on Twitter @HumanisticPsych
The Society for Humanistic Psychology Blog on Facebook
Media coverage is being collated under the Coalition for DSM-5 Reform tab (far right of navigation tabs)
Developments
On November 4, the Special Projects Manager, Office of Communications & Public Affairs, American Psychiatric Association, sent a letter via email from the DSM-5 Task Force to the Editor of Psychiatric Times.
Curiously, the letter (incorrectly dated “October 4″) was unsigned by either Task Force Chair, David Kupfer, MD, or Vice-chair, Darrel Regier, MD. And although it was addressed to both Melba J.T. Vasquez, Ph.D., President American Psychological Association, and David N. Elkins, Ph.D., President, Society for Humanistic Psychology and chair of the Open Letter and Petition committee, neither had been sent a copy by the Task Force or by the American Psychiatric Association’s Office of Communications & Public Affairs.
In the absence of clarification, we can only surmise that the Task Force had submitted their letter to the Editor of Psychiatric Times with a view to publication.
The American Psychiatric Association subsequently published a copy of the Task Force’s response to the Open Letter and Petition, here on the DSM-5 Development website (with the date amended).
Or open a PDF version of the Task Force’s letter here:
DSM-5 Task Force response to Society for Humanistic Psychology 11.04.11
Text version follows:
American Psychiatric Association
1000 Wilson Boulevard
Suite 1825
Arlington, VA 22209
Telephone 703.907.7300
Fax 703.907.1085
E-mail apa@psych.org
nternet www.psych.org
November 4, 2011
Melba J.T. Vasquez, Ph.D., President
American Psychological Association
750 First Street, N.E.
Washington, DC 20002-4242
David N. Elkins, Ph.D., President
Society for Humanistic Psychology
750 First Street, N.E.
Washington, DC 20002-4242
Dear President Vasquez and President Elkins,
We are appreciative of the thoughtful concerns expressed in the Open Letter about the introduction of new diagnoses, proposals for modifying criteria definitions and thresholds for existing diagnoses. The current draft of the DSM-5 diagnostic criteria, still more than a year away from publication, is continually being refined and reworked by the DSM-5 Task Force and Work Group members. Final decisions about proposed revisions will be made on the basis of field trial data as well as on a full consideration of other issues such as those raised by the signatories to this petition, the 10,000 individuals who responded to the February 2010 and April 2011 postings of draft criteria on DSM5.org, other internal reviews by a Scientific Review Committee, the DSM-5 Task Force, and the APA Board of Trustees.
This level of both internal and external review and field trial exposure has never before been undertaken by any previous DSM or ICD revision proposals.
We wish to clarify several specific issues you raise. Several disorders that were mentioned, such as Parental Alienation Syndrome, were proposed by outside groups but have not been proposed for inclusion by the Task Force. Some of the newer diagnoses, including Disruptive Mood Dysregulation Disorder (DMDD), Attention Deficit Hyperactivity Disorder (ADHD), Attenuated Psychosis Syndrome Disorder (APSD), Complex Somatic Symptom Disorder (CSDD) [sic], Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and Personality Disorders are all being tested in the 11 large academic field trial centers that have enrolled over 2,000 patients in a rigorous test-retest design to assess the reliability and clinical utility of proposed criteria. Based on the results of these field trials the DSM-5 Task Force and Work Groups will review the criteria for any necessary changes.
The definition of a mental disorder that is contained in DSM-IV is also undergoing thorough review by the Task Force, which has not adopted the proposed revision that was published by Stein et al. in Psychological Medicine. There is certainly no intent on the part of the DSM-5 Task Force to diminish the importance of environmental and cultural exposure factors as etiological contributors to mental disorders – as indicated by an active study group charged with developing a cultural formulation section as well as culture specific expression issues for individual diagnoses.
We should also note that the DSM-5 Task Force and Work Groups include a multi-disciplinary mix of clinical and research experts in which psychologists are prominent members. There is also another field trial taking place in Routine Clinical Practice settings that will include psychiatrists and approximately 500 of each mental health specialty group of psychologists, social workers, psychiatric nurses clinical counsellors, and marriage and family counselors. The full range of disorders will be assessed in this field trial and the findings will contribute to the final decisions about the diagnoses.
We wish to express our appreciation to all of the clinicians and research investigators who have invested such intense interest and energy in assuring that the next revision of DSM will be based on the best available clinical experience and research evidence in an effort to improve patient care and our understanding of mental illnesses. We hear your concerns and are aware of those from others in the mental health field, and take them under serious consideration in our deliberations.
Please continue to visit and review the DSM-5 website for changes to the criteria, the rationale for proposed changes from DSM-IV, and an extensive set of research analyses on www.dsm5.org. We will be opening the website for public comment on the draft criteria and chapter organization one final time in 2012. We invite you all to submit your comments during that time so they can be reviewed thoroughly and systematically by the DSM-5 Task Force and Work Group members.
We would be most appreciative if you would share this information with your members.
Sincerely,
DSM-5 Task Force Members
[Ends]
On November 7, the Coalition for DSM-5 Reform responded to the Task Force:
Open the letter here in PDF format:
Response to DSM-5 Task Force 11.07.11
Text version follows:
Response to Letter from DSM-5 Task Force and the American Psychiatric Association:
Society of Humanistic Psychology
November 7, 2011
ATTENTION:
David J. Kupfer, M.D., Chair of DSM-5 Task Force
Darrel A. Ragier [sic], M.D., M.P.H., Vice Chair of DSM-5 Task Force
John M. Oldham, M.D., President of the American Psychiatric Association
Dilip V. Jeste, M.D., President-Elect of the American Psychiatric Association
Roger Peele, M.D., Secretary of the American Psychiatric Association
To the DSM-5 Task Force and the American Psychiatric Association:
Thank you for your response to the Open Letter that was composed by the Society for Humanistic Psychology (Division 32 of the American Psychological Association) and endorsed by over 4,600 individuals and 17 organizations, including nine other divisions of the American Psychological Association. In this context, it should be noted that the American Psychological Association itself has not taken a position on this matter other than to encourage its members to participate in the DSM-5 development process. It is our understanding that President Melba Vasquez will be responding to your letter separately on behalf of the American Psychological Association. We are writing on behalf of the Society for Humanistic Psychology Open Letter Committee to express our gratitude that the Task Force has opened a public dialogue about these issues and to let you know that we are happy to share your letter with our membership. We are pleased that the Task Force will consider the issues we described in our Open Letter as well as those raised by others in the mental health field.
However, we remain deeply concerned about the issues we raised and find that your response did not adequately address them. Our main concerns include:
(1) The lowering of diagnostic thresholds, which may artificially inflate the prevalence of numerous disorders. By increasing the number of people who qualify for a diagnosis, DSM-5 may lead to the excessive medicalization and stigmatization of normative or transient distress.
(2) The potential consequences of lowered thresholds and new disorder categories on vulnerable populations such as children and the elderly. These populations are already at risk for excessive and inappropriate treatment with medications that have dangerous side effects. We are particularly concerned about the overuse of medications for “Attenuated Psychosis Syndrome,” “Disruptive Mood Dysregulation Disorder,” “Mild Neurocognitive Disorder,” Attention Deficit/Hyperactivity Disorder, and Generalized Anxiety Disorder.
(3) The lack of scientific evidence substantiating many of these new proposals.
Our rationale for these concerns can be found in our open letter, which is available at http://www.ipetitions.com/petition/dsm5/ for all interested mental health professionals to sign.
Although we appreciate your explanations of the Task Force’s activities, we did not find them sufficient to address our concerns for the following reasons:
• A single set of field trials, no matter how large and diverse the sample size, is not an adequate replacement for a body of scientific literature that is built over time through the contributions of multiple and independent researchers. Many of the newly proposed disorder categories lack this important and critically necessary body of scientific support.
• Though reliability and utility are important, we are also concerned about validity and potential social consequences. As you know, increasing the number of people who qualify for a psychiatric diagnosis may lead to epidemiological inflation and, as a consequence, the inappropriate medication and stigmatization of individuals with normative conditions. It also leads to ethical and moral concerns about our professions.
• Though we are pleased to learn you are not considering the inclusion of several conditions proposed by outside sources (such as Parental Alienation Disorder), it would help to avoid confusion if you removed these conditions from the list of DSM-5 considerations at your website (where they still appear as of 11/7/11):
http://www.dsm5.org/proposedrevision/Pages/Conditions-Proposed-by-Outside-Sources.aspx
• We do not assume that the Task Force is intentionally deemphasizing social and psychological explanations. However, the proposed language deemphasizes social and psychological explanations and may lead to the pathologization of sociopolitical deviance. We emphasize again that the Stein et al. definition of mental disorder would result in the scientifically unsubstantiated reduction of all DSM-defined disorders to biological bases.
• We are aware that the DSM-5 Task Force and Work Groups include not only psychiatrists but also some psychologists and other mental health professionals. However, these teams represent a highly selective and circumscribed group of academic mental health professionals whose experiences differ from those of mental health professionals working in the field on an everyday basis. The purpose of the open letter is to represent the wide spectrum of voices in our community.
We believe it is important that the Task Force give serious consideration to the public feedback by thousands of mental health professionals and others who have signed the open letter to date. The open letter’s list of individual and organizational signatories continues to grow. As of today, we have over 4,600 individual signatures as well as endorsements from the following organizations: Behavioral Neuroscience and Comparative Psychology (Division 6 of the American Psychological Association), the Division of Developmental Psychology (Division 7 of the American Psychological Association), the Society for Community Research and Action: Division of Community Psychology (Division 27 of the American Psychological Association), Psychotherapy (Division 29 of the American Psychological Association), the Society for the Psychology of Women (Division 35 of the American Psychological Association), the Division of Psychoanalysis (Division 39 of the American Psychological Association), Psychologists in Independent Practice (Division 42 of the American Psychological Association), the Society for Group Psychology and Psychotherapy (Division 49 of the American Psychological Association), the Society for the Psychological Study of Men & Masculinity (Division 51 of the American Psychological Association), the Association for Women in Psychology, the Society for Personality Assessment, the Society for Descriptive Psychology, the UK Council for Psychotherapy (UKCP), the Constructivist Psychology Network (CPN), the Taos Institute, Psychoanalysis for Social Responsibility (Section IX of Division 39 of the American Psychological Association), and the Association for Counselor Education and Supervision (Division of the American Counseling Association). In addition, some are now considering a consumer petition that could tap into the concerns of hundreds of thousands of consumers. We believe you are also aware that the British Psychological Society (nearly 50, 000 members), the American Counseling Association (45,000 members), and two previous chairs of DSM Task Forces have also raised concerns about the current proposals for DSM-5.
Again, we appreciate the Task Force’s assurance that the concerns expressed in our open letter will be taken into consideration. However, we believe these concerns to be of sufficient gravity to warrant more than confidential deliberations among those who invented and supported the problematic proposals. Further, the scientific review of DSM-5 conducted by the American Psychiatric Association was internal, and both the methods and findings of that review remain completely undisclosed to the public.
In view of the above concerns, as well as the unprecedented level of criticism of DSM-5 as currently proposed, we respectfully request an external review of the DSM-5 proposals by scientists and scholars who are not appointed by or affiliated with the American Psychiatric Association. We believe that only such an external review (alongside the implementation of any revisions recommended by the reviewers) will assure the mental health professions that DSM-5 is credible and safe to use.
For the future welfare of our clients/patients, as well as for the credibility of our professions, we hope you will submit the DSM-5 to independent, comprehensive, and scientific review.
Yours sincerely,
David N. Elkins, Ph.D.
President, Society for Humanistic Psychology, Division 32 of the American Psychological Association
Brent Dean Robbins, Ph.D.
Secretary, Division 32, Society for Humanistic Psychology, American Psychological Association
Sarah R. Kamens, M.A.
Doctoral Candidate in Clinical Psychology, Fordham University, Student Representative, Division 32
On November 8, the Coalition for DSM-5 Reform issued a press release:
Scientists and Clinicians Warn about Dangerous Implications of DSM-5
For Immediate Release: November 8, 2011 – It started as a small committee of three persons from the Society for Humanistic Psychology (SHP) who were alarmed about the potential dangers they saw in the proposed DSM-5. Of particular concern were increased risks to vulnerable populations of children and the elderly, possible increases in the number of people who will be diagnosed with a mental disorder, and the lack of scientific basis behind some of the proposals. But what could three people do?
So far, they have generated almost 5000 signatures from mental health professionals from around the world, supporting an Open Letter to the DSM-5 Task Force and the American Psychiatric Association, posted in an online petition
(http://www.ipetitions.com/petition/dsm5/).
Additionally, to date 10 Divisions of the American Psychological Association and 7 other psychology organizations have also endorsed the letter and signed the petition.
The DSM-5 Task Force responded to the Open Letter, but the SHP committee was not satisfied with explanations offered by the Task Force. Thus, the committee has written a response (see below and attached). The letter (goo.gl/gusMy) explains why the response of the task force was not adequate, reiterates the potential dangers of the DSM-5, and requests that the DSM-5 proposals be submitted for independent review by scholars and scientists not selected by, nor affiliated with, the DSM-5 Task Force and the American Psychiatric Association which publishes the manual.
The SHP committee hopes that an independent review will result in revisions to the proposed DSM-5 that will more accurately reflect the scientific literature and help ensure that vulnerable populations are not inappropriately diagnosed with mental disorders and treated with psychiatric drugs that have dangerous side effects.
David N. Elkins, President of the Society of Humanistic Psychology and Chair of the Open Letter Committee stated, “If the proposed DSM-5 is not changed, I am concerned that hundreds of thousands of normal individuals – including children and the elderly – will be diagnosed with a mental disorder and inappropriately treated with powerful psychiatric drugs. I hope the leaders of the DSM-5 Task Force listen to our concerns and insist that changes be made. Mental health professionals, who are the major purchasers and users of the DSM, have a right to know that the manual is credible and safe to use.”
LETTER AND LINK TO BLOG: goo.gl/gusMy
CONTACT INFO:
Email: Brent Dean Robbins
Phone: 716-982-8594
Rather than respond in a letter, Darrel Regier, DSM-5 Task Force Chair, was interviewed by journalist, Deborah Brauser, for Medscape Medical News:
(Free registration is required in order to view this Medscape article.)
Medscape Medical News > Psychiatry
APA Answers DSM-5 Critics
Deborah Brauser | November 9, 2011
On November 11, Allen Frances, MD, who had chaired the DSM-IV Task Force, published this commentary on Dr Regier’s responses, as part of series of commentaries on DSM-5:
Psychology Today
DSM5 in Distress
The DSM’s impact on mental health practice and research.
DSM 5- ‘Living Document’ or ‘Dead on Arrival: ‘untested ‘scientific hypotheses’ must be dropped
Allen J. Frances, MD | November 11, 2011
News flash From Medscape Medical News—“APA Answers DSM-5 Critics”—a defense of DSM-5 offered by Darrel A. Regier, MD, vice-chair of the DSM-5 Task Force. Wonderful news that the American Psychiatric Association (APA) is attempting to address the fact that DSM-5 alarms many of its potential users—it is long past time for an open dialog.
Unfortunately, however, Dr Regier dodges the concerns that must be addressed if DSM-5 is to become a safe and credible document. Five simple questions were previously posed to APA with a request for straight answers…
Read on here
In his interview for Medscape, Darrell Regier, APA’s director of research and Task Force vice-chair, made some chilling statements. According to Dr Regier:
“Our plan is that these [judgements] will be immediately tested once the DSM is official, and then one will be able to see if revisions can be made…”
“Our workgroups are struggling with this balance…for what might be the most appropriate fix. Some of these fixes are not as well studied as others and we recognize that. But we can’t move forward without some of these put into practice. So we think this is a much more testable set of scientific hypotheses…”
“And that’s what the DSM is — a set of scientific hypotheses that are intended to be tested and disproved if the evidence isn’t found to support them….”
“We’re thinking of having a DSM-5.1, DSM-5.2, etc, in much the same way is done with software updates…”
So come May 2013, the APA plans to publish an unvalidated beta version, as though it were the next release of Firefox, test out its pet theories on vulnerable patients and use children as guinea pigs, then release post publication “patches” to fix a flawed and potentially damaging product.
On November 9, Dr Melba T Vasquez, PhD, President, American Psychological Association responded in a letter to the Task Force:
Response from Melba T Vasquez to DSM-5 Task Force 11.09.11
Updates and media coverage are also being collated under the Coalition for DSM-5 Reform tab page.
