Developing DSM-V in Secret

October 17, 2008

Here’s a brief statement by Robert L. Spitzer, MD, Professor of Psychiatry at Columbia University in New York City.

It’s an editorial called Issues for DSM-V: Developing DSM-V in Secret, which was apparently rejected by the American Journal of Psychiatry.

The gist of it is that the DSM-V will be developed behind closed doors; apparently this is a significant break with the process of peer review which was in place during previous revisions of the DSM. The members of the Task Force and Sexual and Gender Identity Disorders Workgroup have all signed confidentiality agreements – a policy which is the direct opposite of that adopted by the World Health Organization for its development of ICD-11 (the next revision of the International Classification of Diseases).

According to Robert Spitzer, no meaningful reasons for this secretive approach have been offered by the DSM-V and APA leadership.

Issues for DSM-V: Developing DSM-V in Secret

Perhaps the best-kept-secret about DSM-V is that rather than being “an open and transparent process” as has been claimed (1), it will essentially be developed in secret. Task Force and Workgroup members have been required to sign “confidentiality agreements” prohibiting them from discussing with anybody anything having to do with DSM-V. The language in the agreement is quite clear: “I will not, during the term of this appointment or after, divulge, furnish or make accessible to anyone or use in any way …any Confidential Information. I understand that “Confidential Information” includes all Work Product, unpublished manuscripts and drafts and other pre-publication materials, group discussions, internal correspondence, information about the development process and any other written or unwritten information, in any form, that emanates from or relates to my work with the APA task force or work group.”

This unprecedented attempt to develop DSM-V in secret indicates a failure to understand that revising a diagnostic manual is a scientific process that benefits from the very exchange of information that is prohibited by the confidentiality agreement. Such scientific exchanges were recognized in DSM-III, DSM-III-R, and DSM-IV as being crucial in order to insure that outside perspectives were considered throughout the development process, not merely when the revision is in close-to-final form. In contrast to this new APA confidentiality policy, the World Health Organization has adopted the opposite policy with regard to developing ICD-11. Minutes of ICD-11 meetings are posted on the WHO website (2) and they have explicitly noted that “it is to the benefit of the revision process for ICD-11 advisory group members to make presentations at professional and scientific meetings in order to provide information about the revision and facilitate opportunities for participation and input.”(3).

Repeated attempts to get the DSM-V and APA leadership to explain this policy change have been met with either no response or explanations which make little sense. For example, one justification was that the confidentiality agreements are needed so that “those working on the project have the opportunity to freely discuss and candidly exchange their views with others in their Work Group or the DSM-V Task Force without concern that those initial and perhaps tentative views will be made public.” (4). It is hard to imagine a distinguished DSM-V researcher or clinician being reluctant to speak candidly because of such concerns. Nothing like this has ever been observed or reported in previous DSM revisions..

Given the fact that articles in the press critical of psychiatry are in no short supply and often distort issues for sensational effect, concern about media access is, of course, justified. However, no one is suggesting that the media be allowed to sit in during DSM-V meetings, which could certainly stifle discussion. What is suggested is simply a return to the previous policy, namely that DSM-V participants be encouraged to interact freely with their colleagues and that summaries of DSM-V meetings be made available to interested parties. This will insure that the DSM-V process will truly be open and transparent.

References

1. Moran M. Citing Importance of Advocacy, Robinowitz Urges, ‘Just Do It’. Psychiatric News 2008 June 6, 2008:1.

2. World Health Organization. (http://www.who.int/mental_health/evidence/en/. In; 2008.

3. International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. Summary Report of the 2nd Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders, 24 – 25 September 2007, Geneva, SWITZERLAND. In: World Health Organization; 2007.

4. (personal communication: May 22 2008 letter from Nada Stotland and James Scully to Robert L. Spitzer). In; 2008.

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Wikipedia on Spitzer

According to Wikipedia:

[Spitzer] was chair of the task force of the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III) which was released in 1980. He has been referred to as a major architect of the modern classification of mental disorders which involves classifying mental disorders in discrete categories, with specified diagnostic criteria.

[…]

Spitzer attracted controversy in 1973 for arguing that homosexuality is not a clinical disorder. The mainstream psychiatric community agreed, and declassified homosexuality from its list of mental disorders.

In 2001, Spitzer delivered a controversial paper at the 2001 annual APA meeting arguing that highly motivated individuals could successfully change their sexual orientation from homosexual to heterosexual. The APA immediately issued an official disavowal of the paper, noting that it had not been peer reviewed and stating that “There is no published scientific evidence supporting the efficacy of reparative therapy as a treatment to change one’s sexual orientation.”

Two years later, Spitzer published the paper in the Archives of Sexual Behavior. The publication decision sparked controversy and one sponsoring member resigned in protest. The paper has been criticized on various grounds, including using non-random sampling and poor criteria for success.

See also this transcript of an APA roundtable on gender variance and DSM-V, held in 2003.

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Here are the links to my previous posts (newest first) on the subject of DSM-V/Zucker/Blanchard:

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