DSM-5 Task Force Ponders Round 2 of Public Feedback

New Diagnostic Manual Still on Track for Publication in 2013

Deborah Brauser

August 30, 2011

August 31, 2011 — The second public feedback period for the upcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), ended July 15 and has garnered more than 2000 registered comments.

In an interview with Medscape Medical News, David Kupfer, MD, chair of the American Psychiatric Association's (APA's) DSM-5 Task Force, said the distribution of comments was "somewhat similar to the first go-round."

According to Dr. Kupfer, the specific diagnostic categories that received the most feedback were sexual and gender identity disorders, followed closely by somatic symptom and anxiety disorders.

Dr. David Kupfer

"In addition, the Neurodevelopmental Work Group continued to receive commentary on the issue of autism. But I think it was much, much less than it had received previously. After that, there was a reasonable drop-off in the other groups," he said.

Substance abuse and mood disorders received the next highest number of comments, followed by personality disorders.

Dr. Kupfer noted that all of the DSM-5 work groups are currently "sorting through the submissions." The feedback will then be used to refine proposed revisions to ensure the criteria are both understandable and accurate, and "can be practically implemented" into busy clinical settings.

"I think the most important thing is that everyone realizes we are not making changes randomly; a lot of things will not be changed. What we're trying to do is update the scientific, empirical, and public health basis of mental health diagnoses."

Valuable Input

From the time the second public comment period opened on the DSM-5 Web site in May until it closed 2 months later, 125,000 individual visits were logged from 162 countries. The final individual comment tally was 2120.

Dr. Kupfer reported that concerns voiced included how the proposed revisions may affect the ability to give a diagnosis — and whether insurance will cover treatment for it.

"These accounts are meaningful and give workgroup members information that previous revisions of DSM had less time and fewer opportunities to collect."

In addition to the public feedback comments, the workgroups will also use data from the ongoing DSM-5 field trials. As reported last October by Medscape Medical News, these trials evaluate the new draft criteria in academic and real-world clinical settings.

The APA plans to analyze and disseminate these data starting in the fall, with a view to allowing the work groups to make informed decisions about potential revisions by the end of the year.

A third and final public feedback period is planned for early 2012. This information will then be used to put together the final recommended criteria that will be presented to the APA's Board of Trustees and the General Assembly.

On Track for 2013

Dr. Kupfer said that everything is still on track for the DSM-5 to be published in time for the May 2013 APA Annual Meeting in San Francisco, California. "In other words, we'll put up the final public commentary site with a little over a year left to go."

He added that the electronic version of the manual will include links to many of the clinical and academic references used to justify the various diagnostic changes. Additional videos and re-enactments are also currently in the planning stages, with hopes they will be released at the same time as the DSM-5 or soon after.

However, the process will not end there.

"After the DSM-5 comes out, I'd imagine it won't be long before we start collecting comments for DSM-5.1," he said, noting that the manual has been designed to be "a living, ongoing" resource for clinicians.

"That's something the groups are quite proud of, that this decision was made. A lack of permanent closure will let us take advantage of opportunities to improve upon what comes out in 2013."

The latest criteria recommendations are available at the APA's Web site.


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