Proposed DSM-5 Receives 'Unprecedented' Public Response

First Phase of Field Trials Testing Proposed Diagnostic Criteria Set to Begin This Summer

Caroline Cassels

June 15, 2010

June 15, 2010 (New Orleans, Louisiana) — After a 2-month period of public review and commentary, which garnered "unprecedented" response, the first phase of field trials testing some of the proposed diagnostic criteria changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are set to begin this summer.

Speaking at a press briefing here at the American Psychiatric Association (APA) 2010 Annual Meeting, DSM-5 Task Force chairman David J. Kupfer, MD, told reporters that the new manual appears to be on track for the target publish date of May 2013.

Dr. David J. Kupfer

On February 20, the APA released the long-awaited draft of the DSM-5 and posted it for public feedback on the DSM-5 Website ( "We provided an opportunity for individuals from all over the world to provide us with written commentary," said Dr. Kupfer.

By April 20, when the APA closed the 10-week public review period, Dr. Kupfer said the DSM-5 Task Force, which includes 13 work groups representing different categories of psychiatric diagnoses, had received close to 10,000 written responses.

Not surprisingly, he said, the work group that garnered the largest response was in the Neurodevelopmental Work Group, specifically in the area of autism spectrum disorders.

The draft DSM-5 includes a new category of autism spectrum disorders that will incorporate the current diagnosis of autistic disorder, Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorder (not otherwise specified).

Rather than being distinct disorders the symptoms would be viewed on a continuum from mild to severe, said Dr. Kupfer.

There was also a significant amount of public feedback to the Disorders in Childhood and Adolescence Work Group, said Dr. Kupfer, particularly with respect to pediatric bipolar disorder, a controversial diagnosis that has "invoked a tremendous amount of commentary" from various professional groups, including the American Academy of Child and Adolescent Psychiatry. This work group has recommended a new diagnostic category of temper dysregulation with dysphoria that would help differentiate children with this condition from those with bipolar disorder or oppositional defiant disorder.

Any revisions based on public feedback will be posted on the DSM-5 Website before starting field trials in July. These trials, said Dr. Kupfer, will test some of the proposed diagnostic criteria in several "real-world" clinical settings.

"The field trials themselves are designed to test feasibility, clinical utility, and the reliability of the [proposed] criteria," said Dr. Kupfer. The results of the phase 1 trials, he added, will then be used to inform a second wave of field trials slated to take place in 2011.

Dr. Kupfer said the task force was "gratified" by the intense interest of the academic community in participating in these trials. "We had almost 70 letters of intent from many of our large clinical settings that are mostly academic centers across North America and overseas."

However, he noted, that based on a budget of approximately $2.5 million the task force is in a position to fund 8 to 10 field trials in large academic centers.

He added that there will be further opportunities for centers that are not chosen in round 1 to participate in phase 2 field trials. "We hope to engage as many interested parties as possible. One would wish that we had 2 or 3 times the amount of funds to do this, but we have what we have and I think that phase 1 of the field trials will yield a tremendous amount of useful information," said Dr. Kupfer.

American Psychiatric Association (APA) 2010 Annual Meeting. Presented May 24, 2010.


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