Weighing in on the DSM5 Debate: From our Readers

I have been closely following the discussions of the proposed DSM5 in Psychiatric Times. Your publication of this discourse is a significant contribution to our field. As a research psychiatrist who has published over 150 peer-reviewed papers, I strongly support Allen Frances’ emphasis on the importance of continuity in diagnostic criteria for DSM5.

It would be disastrous for research progress if diagnostic standards were changed so that we become unable to compare new research findings to previous results. Moreover, the announced DSM5 schedule is unrealistic. New diagnostic instruments for complex behavioral syndromes cannot be developed, and their reliability and validity established, in 1 or 2 years. Some of the members of the DSM5 Committee should know this from their own experience. After all, it required 15 years to learn that short REM latency is not diagnostic of depression. Despite early claims and several years of research, we still don’t know whether the proprietary version of RU-486 is an effective antidepressant. Yet these research questions are trivially simple compared to the challenge of defining reliable and valid behavioral syndromes.

There is a serious question as to whether DSM5 is needed. In his debate with Dr Frances on the PBS News Hour, Dr Alan Schatzberg stated that these new categories are required to accommodate new findings in brain imaging and genetics. I keep up with the literature reasonably well. But I don’t know of any findings in genetics or brain imaging that demand new syndromes or are diagnostic of those that exist. It is also not clear why we need DSM5 in addition to ICD-11. Instead of developing new diagnostic categories or tweaking old ones, would it not be more valuable for society if we undertook the hard work of discovering why the US and UK have vast differences in the diagnosis of ADHD and pediatric bipolar disorder?

If our profession cannot resolve discrepancies in relatively clear-cut diagnostic categories, it will be unable to distinguish reliably more subtle prodromal syndromes. Dr Frances touches on the problem on regional discrepancies in diagnosis in one of his communications to Psychiatric Times and I simply wish to emphasize its importance. We urgently need to determine the basis of these discrepancies for the welfare of our patients and our profession.

Irwin Feinberg, MD
Professor of Psychiatry
University of California at Davis

Just a few words of compliments and gratitude for your publication's recent pieces on the topic of Conflicts of Interest and the problems residing in the proposed DSM5.  Your recent articles by Allen Frances, and by Cosgrove and Bursztajn are models of clarity and reflect the highest and best standards in psychiatric publishing.

Your journal's dissemination of views that must be represented (even though they may not be popular with all members of the psychiatric establishment) are models of excellence.
    

Peter Barglow, MD
Clinical Professor of Psychiatry
University of California Davis Medical School