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Revision of the APA's diagnostic bible, the DSM-V has been underway for nearly a decade. Complaints about the process, originally low-key or whispered with hushed tones, are now leaking into the press and blogs. Critics charge secrecy and lack of transparency for the 13 different work groups comprising the ambitious -- too ambitious(?) -- task of reconsidering the criteria for the diagnosis of psychiatric disorders. Spokespersons for the APA disagree, pointing to planning conferences, advisors, a website posting updates, and conflict-of-interest criteria.

The protests gained interest as a result of Drs. Robert Spitzer and Allen Frances, editors of DSM-III and DSM-IV, respectively, airing their concerns. Some of the complaints outlined by Frances addressed the "goals, methods, and products" of the revision.

Revisions have consequences for patients, insurance payments and training for clinical practice. Will Borderline Personality Disorder be elevated to an Axis I diagnosis? Will bereavement after the loss of a loved one be included for treating major depression? How these questions are answered will also have a significant impact on the pharmaceutical industry which markets drugs to symptoms.

Prominent researchers are now leaving committees they have long served. When Duke University's Dr. Jane Costello resigned from the Child and Adolescent Disorders group in March, she questioned the impact of gaps in knowledge and research on some of the decisions they were asked to make. Her letter was posted on the Carlat Psychiatry Blogspot. Last week, Dr. Alan Schatzberg, president of the APA, along with other representatives of the DSM-V Task Force responded, accused critics of "disregard for the facts." As Dr. Danial Carlat writes, what began as "a group of top scientists reviewing the research literature has degenerated into a dispute" more like "a bar room brawl."

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Phyllis Vine

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