The fifth edition of the "psychiatrist's bible" was officially released here in all its 947-page glory, with its developers offering a spirited rebuttal to their critics.
Known as DSM-5, the new version of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders was launched at a press briefing to kick off the organization's annual meeting. Most of the changes from the previous edition had already been made public, at least in general outline.
At the briefing, DSM-5 Task Force chairman David Kupfer, MD, of the University of Pittsburgh, defended several of the most heavily criticized revisions from DSM-IV, as the last edition was called.
Other top APA leaders, including current president Dilip Jeste, MD, of the University of California San Diego, and president-elect Jeffrey Lieberman, MD, of Columbia University in New York City, addressed another, more recent controversy over DSM-5, which was sparked by a blog post from National Institute of Mental Health (NIMH) Director Thomas Insel, MD.
In his blog, Insel criticized the DSM classification system's scientific validity, and his remarks were then reported in consumer media as suggesting DSM-5 is "out of touch with science," as a New York Times headline put it.
Whereas DSM-IV had four separate disorders that could be used for children showing symptoms associated with autism, these are collapsed into a single "autism spectrum disorder" with specifiers for specific symptom types and severities. Autism advocacy groups expressed concern that the revision would end up revoking some children's current diagnoses, depriving them of access to services.
Kupfer said the DSM-IV system had proved to be deeply flawed. The criteria for each of the four disorders were vague enough that diagnoses were inconsistent -- children with similar symptom constellations were being assigned to different DSM-IV classifications almost at random.
He said the task force was sensitive to worries about the consequences of revising the system, but they appear to be groundless. "We now already have findings and published studies that suggest that there will really be very little impact on prevalence or eligibility for services."The New York Times offers a correction to an earlier article:
An opinion essay last Sunday about the usefulness of the Diagnostic and Statistical Manual of Mental Disorders referred imprecisely to the use of the handbook in determining eligibility for special-education services. While many school districts rely on the D.S.M. for such assessments, it is not a federal requirement that a condition like autism, A.D.H.D. or conduct disorder be diagnosed for a child to qualify for special therapies.