Division 32 President Supports DSM-5 Reform Petition

On October 22, 2011, an "Open Letter to the DSM-5 Task Force and the American Psychiatric Association" was quietly posted at a petition website, inviting professionals to read the letter and, if they agreed with it, to sign the petition. The results were overwhelming and unexpected. In only one week, more than 2,000 psychologists, counselors, and other professionals signed the letter, along with several psychology organizations. More than 150 signatures continue to come in on a daily basis. You are encouraged to considering signing the open letter at the petition website.
 
Background: In September 2011, the Division 32 Executive Committee unanimously supported a proposal by president David Elkins that Division 32 raise concerns about the draft revisions for DSM-5. Elkins appointed Brent Robbins and Sarah Kamens to join him as members of a three-person ad hoc committee to prepare an "Open Letter to the DSM-5 Task Force and the American Psychiatric Association." The "open letter" was written and submitted to the Division 32 board for approval. The letter provides a scholarly critique of some of the more problematic portions of DSM-5, which is due for publication in 2013. At the heart of the critique by the Division 32 committee are two major concerns: First: the DSM-5, as proposed, lowers diagnostic thresholds for several major disorder categories, which is likely to result in the pathologizing of normal variations in human behavior. Second: the DSM-5, as currently proposed, could be harmful to vulnerable populations, exacerbating the current national problem of overzealous and inappropriate treatment of young children, adolescents, and the elderly with powerful psychiatric drugs. The letter also describes the lack of scientific grounding for specific proposals and its new emphasis on biological theory, which departs from the manual's longstanding "atheoretical" stance. Four other APA Divisions — Divisions 7, 27, 35, and 49 — have joined Division 32 in signing the open letter, as have the UK Council for Psychotherapy, the Association for Women in Psychology, the Society for Descriptive Psychology, and the Constructivist Psychology Network. In critiquing DSM-5, Division 32 joins other psychology organizations that have also called for changes to the future manual. These include the British Psychological Society (nearly 50,000 members), the American Counseling Association (45,000 members), and the Society of Indian Psychologists. Two previous Chairs of DSM Task Forces (for DSM-III and DSM-IV) have also raised concerns about DSM-5. Allen Frances, who chaired the DSM-IV Committee, has encouraged all professionals to sign Division 32's "open letter" at the petition website.

Please go to the petition website, read the "open letter," and sign the petition if you agree with it. The more signatures generated, the more impact the "open letter" may have.

DSM-5 Reform Events at APA Convention

There are a number of presentations at the APA Convention that focus on DSM-5 reform issues. There are two "cornerstones" of our program, featuring notable individuals who, during the past year, have led the groundswell of concern among psychologists surrounding the proposed DSM-5: The symposium on the DSM-5 on Friday, August 3, 2012 at 10 a.m. and the DSM-5 interdivisional meeting on Saturday, August 4, 2012 at 10 a.m.

In addition, there are three other DSM-5-related presentations:

• The symposium - Humanistic Responses to the Commodification of Aging and Illness in Light of DSM-5, Thursday, August 2, 2012 at 1 p.m. 

• The hospitality suite session - Diagnosing Oppression: A Humanist-Multicultural Critique of the DSM System on Friday, August 3, 2012 at 8:30 a.m. 

• The poster session - DSM-5 Task Force: Secondary Data Analysis of an Online Petition on Friday, August 3, 2012 at 4 p.m.

Response to the American Psychiatric Association's Call for Public Comment on the Proposed DSM-5

To the DSM-5 Task Force and the American Psychiatric Association:

As you know, the Open Letter Committee of the Society for Humanistic Psychology and the Coalition for DSM-5 Reform have been following the development of DSM-5 closely. We appreciate the opportunity for public commentary on the most recent version of the DSM-5 draft proposals. We intend to post this brief letter for public viewing on the Coalition for DSM-5 Reform website.

Since its posting in October 2011, the Open Letter to the DSM-5, which was written in response to the second version of the draft proposals, has garnered support from almost 50 mental health organizations and over 13,500 individual mental health professionals and others.

Our three primary concerns in the letter were as follows:

1. The DSM-5 proposals appear to lower diagnostic thresholds, expanding the purview of mental disorder to include normative reactions to life events; some new proposals (e.g., "disruptive mood dysregulation disorder" and "attenuated psychosis syndrome") seem to lack the empirical grounding necessary for inclusion in a scientific taxonomy. 

2. Newly proposed disorders are particularly likely to be diagnosed in vulnerable populations, such as children and the elderly, for whom the overprescription of powerful psychiatric drugs is already a growing nationwide problem. 

3. The increased emphasis on medicobiological theories for mental disorder despite the fact that recent research strongly points to multifactorial etiologies.

We appreciate some of the changes made in this third version of the draft proposals, in particular the relegation of attenuated psychosis syndrome and mixed anxiety-depression to the appendix for further research. We believe these disorders had insufficient empirical backing for inclusion in the manual itself. In addition, given the continuing elusiveness of biomarkers, we are relieved to find that you have proposed a modified definition of mental disorder that does not include the phrase "underlying psychobiological dysfunction." Despite these positive changes, we remain concerned about a number of the DSM-5 proposals, as well as the apparent setbacks in the development process.

Our continuing concerns are as follows:

• The proposal to include new disorders with relatively little empirical support and/or research literature that is relatively recent (e.g., disruptive mood dysregulation disorder). 

• The lowering of diagnostic thresholds, which may result in diagnostic expansion and various iatrogenic hazards, such as inappropriate treatment and stigmatization of normative life processes. Examples include the newly proposed minor neurocognitive disorder, as well as proposed changes to generalized anxiety disorder, attention deficit/hyperactivity disorder, pedophilia, and the new behavioral addictions. 

• The perplexing personality disorders overhaul, which is an unnecessarily complex and idiosyncratic system that is likely to have little clinical utility in everyday practice. 

• The development of novel scales (e.g., severity scales) with little psychometric testing rather than utilizing established standards.

In addition, we are increasingly concerned about several aspects of the development process. These are as follows:  

• Continuing delays, particularly in the drafting and field testing of the proposals. 

• The substandard results of the first set of field trials, which revealed kappas below accepted reliability standards. 

• The cancelation of the second set of field trials. 

• The lack of formal forensic review. 

• Ad hominem responses to critics. 

•  The hiring of a PR firm to influence the interpretation and dissemination of information about DSM-5, which is not standard scientific practice.

We understand that there have been recent attempts to locate a "middle ground" between the DSM-5 proposals and DSM-5 criticism. We believe that, given the extremity and idiosyncrasy of some of the proposed changes to the manual, this claim of a "middle ground" is more rhetorical and polemic than empirical or measured. A true middle ground, we believe, would draw on medical ethics and scientific standards to revise the proposals in a careful way that prioritizes patient safety, especially protection against unnecessary treatment, above institutional needs. Therefore, we would like to reiterate our call for an independent scientific review of the manual by professionals whose relationship to the DSM-5 Task Force and/or American Psychiatric Association does not constitute a conflict of interest. As the deadline for the future manual approaches, we urge the DSM-5 Task Force and all concerned mental health professionals to examine the proposed manual with scientific and expert scrutiny. It is not only our professional standards, but also — and most importantly — patient care that is at stake. We thank you for your time and serious consideration of our concerns, and we hope that you will continue to engage in dialogue with those calling for reform of DSM-5.

Sincerely,

The DSM-5 Open Letter Committee of the Society for Humanistic Society, Division 32 of the American Psychological Association