Allen Frances, chair of the DSM-IV Task Force, presents an interesting take on the proposed DSM-V changes

by Michael D. Anestis, M.S.

I was just alerted to an interested article on the proposed DSM-V changes.  In it, Allen Frances, chair of the DSM-IV Task Force and a vocal critic of the DSM-V development process, explains why he is uncomfortable with many of the ideas put forth on the DSM-V website (www.dsm5.org).

Click here to read the article.

A couple quick reactions to the article (I have not read it that closely though, so take them with a grain of salt):

• Dr.Frances at times seems to mistake a flaw in the ways of psychiatrists with flaws in the DSM.  What I mean by this is that he frequently notes that certain changes will result in the misuse of medications that are not tested for that purpose.  Simply because some psychiatrists or physicians choose to prescribe a medication uncalled for in a situation does not mean that a particular diagnosis is invalid.  It seems equally likely that work is need to improve practitioners' performances as it does that the DSM needs to be revised.  I suspect the correct answer rests in the middle of that debate though.
• Dr.Frances also seems to be extremely concerned with stigma.  There's nothing wrong with that in general, as we should all hope that people can avoid the pain of being stigmatized.  That being said, diagnoses are not labels and should not be stigmatized.  Perhaps the answer in reducing stigma is increasing education and unifying that education around science so that people better understand mental illness rather than indulging bad behaviors by changing the names of diagnoses or failing to give diagnoses to individuals who need help.  You don't defeat a bully by running away from him.
• The research supporting the existence of binge eating disorder and mixed anxiety depression is remarkably strong.  Additionally, empirically supported psychosocial treatments for BED exist, so it would behoove clinicians to read the literature and make themselves aware of treatment options that exist on that front.
• On the flip side, I am also nervous about changes made to ADHD, the introduction of "psychosis risk syndrome" and "minor neurocognitive disorder," and the removal of the grief requirement in depression diagnoses.  In those cases, I think we are likely to decrease the validity of ADHD and pathologize normative behaviors/developments in the absence of interventions capable of resolving the situation.

Anyway, on the whole, I agree with several of the things Dr.Frances says and disagree with others.  As expected, there are a lot of conflicting opinions on various components of the DSM-V changes and, as we are all sorting our way through them, I think the picture will continue to change.  Should be interesting!