American Psychiatric Association (APA) releases third draft of DSM-5 for final stakeholder review and comment
Post #163 Shortlink: http://wp.me/pKrrB-20I
The American Psychiatric Association, publishers of the Diagnostic and Statistical Manual of Mental Disorder (DSM), has today released its third draft of proposed revisions to DSM-IV diagnostic categories and criteria.
The next edition of the DSM, which will be known as DSM-5, is due for publication in May 2013.
This third and final stakeholder review and comment period runs for six weeks until June 15, 2012
Revised proposals can be found on the DSM-5 Development website here:
http://www.dsm5.org/ProposedRevision/Pages/Default.aspx
Submitting comment
As with the two previous feedback exercises, comments from professionals, professional bodies, consumer groups and individuals are being accepted via a registration process on the DSM-5 Development website, for which a valid email address is required for validation purposes. Comments are uploaded via a WYSIWYG/html editor.
(If you had registered to submit comment for either of the earlier feedback exercises your log in details may still work.)
These review and feedback exercises are open to all stakeholders in DSM-5 – medical professionals, clinicians, researchers, psychiatrists, psychologists, allied mental health and health professionals, counselors, social workers, OTs, lawyers, teachers, patients and their families, caregivers, advocates and patient organizations.
These public reviews are not run as formal consultation exercises and the DSM-5 Task Force does not publish comments received nor lists of the names of professional bodies, organizations, institutions and individuals who have submitted feedback.
This page on the DSM-5 Development site says:
“…At this time, we are accepting comment submissions on this Web site until June 15, 2012. Comments about specific diagnoses can be made on the pages below, while you may leave feedback about non-diagnostic specific issues in DSM-5 in the Overall Comments section. The work group members will review all feedback and make decisions about further revisions based in part on the comments provided as well as on results from field trial testing, which is currently underway. Once the next edition of changes have been implemented, we will post the revised criteria on this site to allow commentary once again…”
However, the Home Page announcement states,
“…This commenting period marks the third and final time DSM-5 draft criteria will be available for your feedback. Following this period the site will remain viewable with the draft proposals until DSM-5’s publication…”
The second public review exercise ran from May 4 to June 15, 2011 but was extended a further month until July 15. If the closure date for receipt of submissions for this third review is extended I will update this site.
THIRD and FINAL stakeholder review published
http://www.dsm5.org/Pages/Default.aspx
Final Updates to DSM5.org
For the next 6 weeks we are pleased to once again offer the opportunity to submit comments on the draft fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This commenting period marks the third and final time DSM-5 draft criteria will be available for your feedback. Following this period the site will remain viewable with the draft proposals until DSM-5’s publication.
Following the previous commenting period (May-July 2011), members of the DSM-5 Task Force and Work Groups reviewed feedback submitted to this site and, where appropriate, revised their proposed diagnostic criteria and made other changes. With the completion of the DSM-5 Field Trials, Work Group members have spent the past several months examining data and findings from these important studies. Therefore, the proposed diagnostic criteria found on this site are the result of the DSM-5 Work Groups’ ongoing deliberations, based on findings from scientific field studies, patient and clinician perspectives, and views from the general public. We want to stress that revisions will continue to be made, as necessary, over the next several months.
What’s New?
What specifically has changed on this site over the past year? Visitors may notice differences in the ways in which some proposed disorders are classified. Below are some of the changes.
Based on concerns about the reliability of the proposed Attenuated Psychosis Syndrome and Mixed Anxiety Depressive Disorder in the field trials, these two conditions are being recommended for further study in Section III, an area of DSM-5 for conditions that require further research before consideration as formal disorders.
We also added a footnote to the Major Depressive Disorder criteria to clarify the difference between normal bereavement associated with a significant loss and a diagnosis of a mental disorder. Many commentators noted the previous criteria erroneously implied that bereavement could be assumed to only last 2 months and we wanted to correct that misunderstanding and provide more information on how bereavement and other loss reactions differ from Major Depressive Disorder. The extensive public comment also highlighted the need to clarify that use of a checklist of the diagnostic criteria by people without clinical training is insufficient to make a clinical diagnosis.
Among the other significant changes in this posting is a more extensive Personality Disorders rationale for change with the reliability of dimensional measures and the categorical diagnosis of Borderline Personality Disorder now supported by Field Trial data. However, additional data analysis in this area is ongoing.
Diagnostic criteria for Pedophilic Disorder have been modified. The adjusted boundaries of this disorder are based more on biological developmental indicators of early puberty in victims to avoid implications that the disorder involves post-pubertal adolescent victims and to make the criteria consistent with the International Classification of Diseases.
Communication Disorders now include two diagnoses – Language Disorders and Speech Disorders – each with appropriate subtypes to cover all seven of the disorders previously proposed for categorization here.
Similarly, based on clinical feedback and the field trial documentation that Simple Somatic Symptom Disorder was a milder form of Complex Somatic Symptom Disorder, the two have now been combined as a single disorder: Somatic Symptom Disorder.
The diagnosis of Suicidal Behavioral Disorder is a newly proposed disorder that is intended to complement the previous proposal for Non-Suicidal Self Injury Disorder. The latter disorder was tested in the Field Trials with highly variable levels of reliability—final decisions about its placement in Section III for further study have not been made. Another disorder suggested for placement in Section III includes Persistent Complex Bereavement Disorder which has had conflicting disorder criteria proposed from previous studies of this condition. The Work Group has suggested a new criteria set that builds on previous research prior to full endorsement of this condition.
Readers will also notice changes in specific criteria for some of the disorders, including those in the Neurocognitive Disorders and the Anxiety Disorders chapters. Finally, we have also now included a proposed Cultural Formulation Interview for DSM-5, which also includes some specific questions for visitors to consider in thinking about how the manual can help clinicians more effectively assess cultural aspects of psychiatric diagnosis.
A detailed listing of changes to draft proposals that have been made since July 2011 can be found on the Recent Updates page. We also encourage readers to visit each diagnostic section, which includes a brief introductory statement about changes within that section, as well as a listing of the proposed disorders for that particular section.
Next Steps
It is important to note that the proposed changes listed here do not represent the final changes for DSM-5. The proposals listed here reflect the most up-to-date drafts, final versions of which will be put forth for review and approval by the Board of Trustees of the American Psychiatric Association (APA) later this year. However, these proposed changes will undergo further revisions between now and the end of 2012, in part generated from your input, and also because results from the DSM-5 Field Trials continue to be analyzed, discussed, and integrated into proposals, along with an extensive review process that is taking place for these proposals. This review process includes: a Scientific Review Committee which will review the scientific validating evidence for revisions; an extensive peer review process where hundreds of expert reviewers will consider the clinical and public health risks and benefits of making changes from DSM-IV; and a review by an Assembly DSM-5 committee. Revisions will continually be made based on feedback from these various groups. This represents an unprecedented level of internal and external review for the DSM including the public review via the three postings on the DSM5.org.
Finally, there will be an overall review by the DSM-5 Task Force that integrates these assessments and sends final recommendations along with all supporting data to the APA’s Board of Trustees for a final review. The Board of Trustees will consider the recommendations of the Task Force along with those from the Scientific Review Committee as well as other review committees mentioned above and the public comments. The final manual approved by the Board will be submitted to the American Psychiatric Publishing for publication by December 31, 2012. The 166th APA Annual Meeting in San Francisco, May 18-22, 2013, will mark the official release of DSM-5.
(Ed: See DSM-5 Development site for links)
Neurodevelopmental Disorders
Schizophrenia Spectrum and Other Psychotic Disorders
Bipolar and Related Disorders
Depressive Disorders
Anxiety Disorders
Obsessive-Compulsive and Related Disorders
Trauma and Stressor Related Disorders
Dissociative Disorders
Somatic Symptom Disorders
Feeding and Eating Disorders
Elimination Disorders
Sleep-Wake Disorders
Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse Control, and Conduct Disorders
Substance Use and Addictive Disorders
Neurocognitive Disorders
Personality Disorders
Paraphilias
Other Disorders
http://www.dsm5.org/ProposedRevision/Pages/Default.aspx
Proposed Draft Revisions to DSM Disorders and Criteria
The draft disorders and disorder criteria proposed by the DSM-5 Work Groups for new and existing mental disorders can be found on these pages. You will notice that the diagnostic chapters listed below are no longer organized according to DSM-IV. Instead, we have restructured the diagnostic chapters in DSM-5 to better reflect advances in our scientific understanding of psychiatric disorders, as well as to make diagnosis easier and more feasible for clinicians. You can read more about the proposed chapter structure by clicking here.
Use the links below to read about proposed changes to the disorders that interest you. Although the disorders listed below are listed according to their proposed placement in DSM-5, you may click here if you are interested in seeing which work groups are addressing which disorders. Please note that the proposed criteria listed here are not final. These are initial drafts of the recommendations that have been made to date by the DSM-5 Work Groups.
You will also notice for each disorder a section pertaining to the assessment of disorder severity. The severity criteria being proposed differs somewhat across disorders, largely because the work groups are in different stages in their deliberation processes. Therefore, you will notice some variability in the range of options presented across disorders, as well as differences in the severity scales being proposed. However, by DSM-5’s completion, we look forward to presenting a standardized method for assessing severity for all diagnoses, with an emphasis on simplicity and clinical utility. Finally, in addition to pages on each of the DSM-IV diagnostic categories, please be sure to review the sections on proposed revisions to the definition of a mental disorder, a listing of Conditions Proposed by Outside Sources that are still under consideration, and Other Clinical Conditions that may be the Focus of Clinical Attention. Please be sure to review these sections in addition to the diagnostic categories.
At this time, we are accepting comment submissions on this Web site until June 15, 2012. Comments about specific diagnoses can be made on the pages below, while you may leave feedback about non-diagnostic specific issues in DSM-5 in the Overall Comments section. The work group members will review all feedback and make decisions about further revisions based in part on the comments provided as well as on results from field trial testing, which is currently underway. Once the next edition of changes have been implemented, we will post the revised criteria on this site to allow commentary once again.*
*Please note that all input we receive will be reviewed, though we can not guarantee that your suggestions will be incorporated into any revisions.
*Ed: Update @ May 3, 2012
I am advised that APA has clarified that the paragraph above contained erroneous text; the webpage has since been amended to read:
“…At this time, we are accepting comment submissions on this Web site until June 15, 2012. Comments about specific diagnoses can be made on the pages below, while you may leave feedback about non-diagnostic specific issues in DSM-5 in the Overall Comments section. The work group members will review all feedback and make decisions about further revisions based in part on the comments provided as well as on results from field trial testing, which is currently underway.”
*Please note that all input we receive will be reviewed, though we can not guarantee that your suggestions will be incorporated into any revisions.
(Ed: One focus of this site has been the monitoring of proposals for the Somatic Symptom Disorders. The categories and criteria proposals for Somatic Symptom Disorders, as published today, do not appear to have changed since April 27, other than an edit to the introduction reflecting the proposal to merge CSSD with SSSD and name “Somatic Symptom Disorder”. See Post #162: DSM-5 proposals for Somatoform Disorders revised on April 27, 2012 )
http://www.dsm5.org/ProposedRevision/Pages/SomaticSymptomDisorders.aspx
Somatic Symptom Disorders
Please find below a list of disorders that are currently proposed for the diagnostic category, Somatic Symptom Disorders. This category contains diagnoses that were listed in DSM-IV under the chapter of Somatoform Disorders. The Somatic Symptom Disorders Work Group has been responsible for addressing these disorders. Among the work group’s recommendations is the proposal to rename this category Somatic Symptom Disorders. Because the current terminology for somatoform disorders is confusing and because somatoform disorders, psychological factors affecting medical condition, and factitious disorders all involve presentation of physical symptoms and/or concern about medical illness, the work group suggests renaming this group of disorders Somatic Symptom Disorders. In addition, because of the implicit mind-body dualism and the unreliability of assessments of “medically unexplained symptoms,” these symptoms are no longer emphasized as core features of many of these disorders. Since Somatization Disorder, Hypochondriasis, Undifferentiated Somatoform Disorder, and Pain Disorder share certain common features, namely somatic symptoms and cognitive distortions, the work group is proposing that these disorders be grouped under a common rubric called Somatic Symptom Disorder. The work group had previously suggested separate diagnoses of Complex Somatic Symptom Disorder and Simple Somatic Symptom Disorder, but they are now proposing that these be combined into a singular diagnosis of Somatic Symptom Disorder. The work group has also proposed that Factitious Disorder be moved from its previous location under Other Disorders to this chapter. Lastly, the work group is proposing that Conversion Disorder now be named Conversion Disorder (Functional Neurological Symptom Disorder) . We appreciate your review and comment on these disorders.
J 00 Somatic Symptom Disorder |
J 01 Illness Anxiety Disorder |
J 02 Conversion Disorder (Functional Neurological Symptom Disorder) |
J 03 Psychological Factors Affecting Medical Condition |
J 04 Factitious Disorder |
J 05 Somatic Symptom Disorder Not Elsewhere Classified |
