Sigh of relief. The DSM-5 website announced Wednesday morning that two of its most controversial proposals have finally been dropped. We have dodged bullets on "psychosis risk" and "mixed anxiety depression." Both are now definitively rejected as official DSM-5 diagnoses and instead are being exiled to the appendix. And one other piece of good news: The criteria set for attention-deficit hyperactivity disorder have been tightened (not enough, but every little bit helps).
The world is a safer place now that "psychosis risk" will not be in DSM-5. Its rejection saves our kids from the risk of unnecessary exposure to antipsychotic drugs (with their side effects of obesity, diabetes, cardiovascular problems, and shortened life expectancy). "Psychosis risk" was the single worst DSM-5 proposal; we should all be grateful that DSM-5 has finally come to its senses in dropping it.
For the first time in its history, DSM-5 has shown some flexibility and capacity to correct itself. Hopefully, this is just the beginning of what will turn out to be a number of other necessary DSM-5 retreats. Wednesday's revisions should be just the first step in a systematic program of reform, a prelude to all the other changes needed before DSM-5 can become a safe and scientifically sound document.
The turnabout here can be attributed to the combination of 1) extensive criticism from experts in the field; 2) public outrage; 3) uniformly negative press coverage; and 4) the abysmal results in DSM-5 field testing. The same factors working together should deep-six many of the other risky DSM-5 proposals. This is certainly no time for complacency. Much of the rest of DSM-5 is still a mess. The reliabilities achieved for many of the other disorders are apparently unbelievably low, and the writing of the criteria sets is still unacceptably imprecise. The following specific issues need to be addressed.
- Why introduce "disruptive mood dysregulation disorder" when it has been studied by only one research team for only six years and risks further encouraging the inappropriate use of antipsychotic drugs for kids with temper tantrums?
The public has six weeks to comment on the current DSM-5 suggestions. Then there will be a round of final decisions, with everything probably sewn up by mid-fall. This opening chink in the previously impervious DSM-5 armor should spur renewed efforts to get the rest of DSM-5 right.
Take this last opportunity to be heard.
For more on the latest revisions of the DSM 5 criteria sets, see
http://www.dsm5.org/Pages/Default.aspx.
Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.