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DSM-5 Inaccuracies: Setting the Record Straight

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In his Huffington Post blog dated May 30, 2012 titled "DSM-5 Costs $25 Million, Putting APA in a Financial Hole," Allen Frances, M.D., demonstrates either an embarrassing lack of knowledge and understanding of financial reporting or an intentional misrepresentation of facts in his continuing effort to attack the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association. Contrary to Dr. Frances's contention, APA is not in a "financial hole" at all. In fact, the very treasurer's report he purports to cite from in page two expressly states that there was a "preliminary year end surplus of $2.4M for the APA (the (c) (6) nonprofit entity) on a stand-alone basis and a deficit of $2.7M for the APF." The APF, or American Psychiatric Foundation, is an independent charitable subsidiary of APA whose mission is to advance the understanding, prevention, and treatment of mental disorders through public education, research, and training.

APF has no relationship with DSM-5. The APF deficit was a planned deficit encountered to support its philanthropic work, which benefits psychiatry, patients, and the public. The APA (the (c) (6) entity with the $2.4 million surplus) is responsible for the development of DSM-5. APA reports to its board of trustees on a consolidated basis, offsetting APF's deficit with APA's gains. Dr. Frances's statement that the consolidated deficit "was caused by reduced publishing profits, poor attendance at its annual meeting, rapidly declining membership, and wasteful spending on DSM-5" is either ignorant or intentionally false. And Dr. Frances apparently missed slide six of the report about reserves, which demonstrate an extremely healthy cash reserve that increases year after year. The strength of APA's reserves and the fiscally conservative approach of consolidating balances of the APA and the APF for a balanced consolidated budget demonstrate the competence of APA leadership.

Dr. Frances also complains that the revision of DSM-5 has been more expensive than that of DSM-IV. That should not come as a surprise to anyone, particularly Dr. Frances. DSM-5, unlike DSM-IV, invited comments from the world, and the work groups and task force considered every one of the more than 25,000 comments received and conducted further research where indicated. DSM-5 has employed an open process where all comments are considered, revisions are made where appropriate and the ideas are sent out again for comment with the process repeating itself. The transparency associated with the process is expensive, but it is beneficial, and will help to ensure that DSM-5 is a meaningful tool for diagnosis of mental illness when it is published, on time, in 2013.

The author is CEO and Medical Director of the American Psychiatric Association.

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