Comments On The DSM-5 Process

There have been multiple criticisms of both the proposed content of DSM-5 and the process by which it is being developed. I have expressed my concerns about its proposals for diagnoses dealing with pain, especially the creation of the new diagnosis of Complex Somatic Symptom Disorder, to readers of Psychiatric Times in my Pain Management columns. I also noted that although I chaired the DSM-IV and DSM-IV-TR work groups on pain disorder, no one involved in creating DSM-5 ever contacted me for input and that this was in contrast to my experience when DSM-IV was being developed where we actively sought out the input of those who had worked on DSM-III and DSM-III-R.

I now will add another criticism of the DSM-5 process. Through the DSM-5 website which encouraged input, several months ago I sent comments to the Somatic Symptoms Disorders work group detailing my concerns about how it was handling pain. I also sent comments to the Substance-Related Disorders work group regarding the absence of a diagnosis covering iatrogenic substance abuse, a well recognized problem among patients being treated for chronic pain, and the Sexual and Gender Identity Disorders work group regarding the continuing inclusion of genital pain disorders with a physical cause as mental disorders. In all my comments, I noted my involvement in the DSM-IV and DSM-IV-TR.

I have received no response to my comments; not even a thank-you for taking the time to write them. Once again this was in marked contrast to my experience with DSM-IV and DSM-IV-TR where those of us involved in developing them were asked to provide a timely response to all comments that were received. I not only acknowledged receiving such comments but wrote detailed responses as to whether the recommendations could be considered and why or why not.

As anyone who has followed the widely reported debate about how autism and related diagnoses will be dealt with, there does not appear to be any official policy that criticism of the proposed diagnoses can’t be commented upon by those involved with DSM-5. I am therefore at a loss for an explanation of the discourteous lack of response I have encountered. I do not know if anyone on any of the three work groups I contacted even bothered to read my comments much less an explanation of why my concerns were not worthy of consideration for a revision of the proposed diagnoses.