Sunday, October 30, 2011

Autism Disorders On the Sidelines of the DSM5 Revolt

Several divisions of the American Psychological Association appear to be revolting against the American Psychiatric Association's DSM5.  A petition has been published on line.  In DSM5 in Distress Allen Frances, M.D., former chair of the DSM-IV Task Force and currently professor emeritus at Duke, summarizes the conflict between the warring APAs over the DSM5:

"Several divisions of the American Psychological Association have just written an open letter highly critical of DSM 5. They are inviting mental health professionals and mental health organizations to sign a petition addressed to the DSM5 Task Force of the American Psychiatric Association. You can read the letter and sign up at It is an extremely detailed, thoughtful and well written statement that deserves your attention and support.

The letter summarizes the grave dangers of DSM 5 that for some time have seemed patently apparent to everyone except those who are actually working on it. The short list of the most compelling problems includes: reckless expansion of the diagnostic system (through the inclusion of untested new diagnoses and reduced thresholds for old ones); the lack of scientific rigor and independent review; and dimensional proposals that are too impossibly complex ever to be used by clinicians.

The American Psychiatric Association has no special mandate or ownership rights giving it any sovereignty over psychiatric diagnosis. APA took on the task of preparing DSM's sixty years ago because it then seemed so thankless that no other group was prepared or willing to do it. The DSM franchise has stayed with APA only because its products were credible enough to gain widespread acceptance. People used the manual only because it was useful.

DSM 5 has strained that credibility to the breaking point and (unless radically changed) will be much more harmful than useful. We have reached a turning point that will soon become a point of no return. A near final version of DSM 5 must be ready by next spring and all final wording will be set in stone within a year. Time is running out if DSM 5 is to be saved from itself."

Dr. Francis has been the most vocal and persistent critic of the DSM5.  His criticisms have a particular significance because of his former role as chair of the DSM-IV revision team. His observations about the DSM5 revolt picking up steam are noted by forensic psychologist Karen Franklin, Ph.D. in her blog commentary Psychologists' DSM5 Petition Catching like Wildfire, also published on Psychology Today:

An online petition by psychologists concerned about the lack of science underlying proposed changes in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) is taking off like wildfire, with more than 1,100 signatures as of this morning.

The blaze of interest is especially remarkable because the petition was launched without any publicity at all, and has gained traction solely through word of mouth.
The coalition of psychologists is publicly urging the American Psychiatric Association to reconsider the mental illness expansions and biomedical emphasis proposed for the fifth edition of the DSM, due out in 2013. The DSM-5 will reify disorders with little empirical support, lower the threshold for mental disorder, and foreground a purely biological approach to mental illness.

The coalition's online petitition comes on the heels of a similar public statement by the British Psychological Society, which I blogged about back in June.

The petition coalition expresses grave concern about the overemphasis on biomedical explanations for mental health problems, and the resulting overprescribing of dangerous psychiatric drugs"

The online petition expresses many concerns but makes no mention of the fundamental change to the autism disorders, grouping them together as one Autism Spectrum Disorder. Nor does it mention the exclusion of intellectually disabled persons from post DSM5 Autism Spectrum Disorder diagnoses.  The debates about autism causation are currently confused by many factors including the DSM-IV changes published in 1994.  Now, with fundamental changes in the definition of autism disorders, with the many becoming one, and with exclusion of intellectually disabled persons, epidemiological studies will once again be rendered limited if not worthless in helping us understand causes of autism.  The DSM5 rebels though make no mention of autism in their Petition.  

The DSM5 will have a huge impact on the Autism world,  if it is ultimately published AND accepted by psychologists. Autism is not a concern of the rebel forces though and Autism is left on the sidelines of the revolt.  The fate of many persons with autism disorders, and our understanding of autism disorders, will be significantly affected though by the outcome of the revolution.  


Radagast said...

Hmmm. Well, it's long been my contention that the only people who can claim expertise in such matters are the people experiencing the conditions, syndromes, etc, identified in the DSM - but oddly enough, nobody seems to be asking them. Besides which, the people who wrote that dubious piece of literature (The DSM), are so terribly conflicted that they can't be trusted - the conduct of "experts" such as Biederman, Keller, Nemeroff and the rest just leave me with a nasty, nasty taste in my mouth.


Dr Clark said...
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