Search This Blog

Tuesday, February 7, 2012

DSM-V Concerns

An editorial from Bloomberg News calls for testing the DSM-5 criteria.
It’s conceivable that such a study could be done in time for a full airing of the issues so that the APA could still make its Dec. 31 deadline for the DSM-5. If not, the organization should resist pushing through, without sufficient evidence, a change that would mean the end of insurance, education and social support for children who need it. Although this might save some tax dollars in the short term, it would cost society more in the long run, because without support these children would be less likely to succeed as independently functioning adults.
The reason the APA dropped the Roman numerals this time around was to allow for interim revisions of its manual. The matter of autism disorder could be a perfect subject for DSM 5.1. [emphasis added]
At The Huffington Post, Lloyd Sederer says that field trials are indeed under way.
The draft DSM-5 is being tested in real-world clinical settings. Two studies will examine how the diagnostic criteria work with those who will actually use and be impacted by DSM-5, namely patients and clinicians.
The first, and larger, of the two field trials involves 11 Academic Medical Centers (AMCs) in the United States and Canada. These sites were selected from 65 applicants based on their capabilities to recruit and study a diverse group of participants (e.g., children, adults, and seniors as well as ethnicities). This trial will allow the APA to compare the prevalence (rates of a condition in a population) of the disorders among AMC patients who would be given a DSM-IV diagnosis with those who would be given a similar diagnosis using the new criteria in the DSM-5.
The second type of field test involves Routine Clinical Practice Settings (RCPs). This DSM field trail will specifically examine small group or solo practices. The field work will involve a random selection of general adult psychiatrists and specialists in geriatric, child/adolescent and addiction psychiatry, and those that consult to medical colleagues as well as psychologists, advanced practice psychiatric nurses, licensed counselors, licensed marriage and family therapists, and licensed clinical social workers. This study will especially focus on how feasible and useful are the new criteria as well as the manual's measures of severity of illness.
At The Daily Beast, Casey Schwartz writes of one reason for longstanding skepticism about the diagnosis of Asperger's:
There were the usual reasons for conservatism—the potential for disruption that changing any diagnosis raises. But there were other, more hidden reasons for the resistance as well. Fred Volkmar, the director of the Yale Child Study Center, who was the head of the DSM IV working group, says he sensed there were additional obstacles, but he couldn’t immediately identify them.

It turned out, Volkmar says, that there was the question: “What was Asperger doing during the war? Asperger published in German in Austria during World War II. Do you follow what they’re saying?”

Volkmar had stumbled on a tacit belief—held, he says, by some members of the American Psychiatric Association—that Asperger had been a Nazi. (This bit of history is not well known. No other psychiatrist who spoke to The Daily Beast could confirm that he or she was familiar with it.) Volkmar says he investigated the possibility of Asperger’s association with Nazism and was ultimately convinced there was no truth to it.