Article

Moving toward DSM-5: The field trials

Commentary accepted for publication July 2010.
American Journal of Psychiatry (Impact Factor: 13.56). 10/2010; 167(10):1158-60. DOI: 10.1176/appi.ajp.2010.10070962
Source: PubMed

ABSTRACT The purpose of successive DSM revisions is to incorporate the growing knowledge base about mental disorders into diagnosis and to bring diagnostic criteria ever closer to accurate and precise identification of corresponding disorders (5). However, this goal must be accomplished while maintaining the clinical utility of the diagnostic criteria for purposes of ready, reliable, and valid use by both clinicians and researchers for prevention, early identification, and treatment. Field trials are the first real-world, empirical test of the success of these efforts in clinical settings.

1 Follower
 · 
108 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 revision is underway. The review examines draft proposals for changes in mood disorders (posted February 2010 on DSM-5 web site), explains their rationale, and considers relative costs vs. benefits. Proposals covered include recommendation for a comorbid anxiety dimension; addition of a new disorder, mixed anxiety depression; replacement of mixed manic episodes with a 'mixed features' specifier applicable to manic, hypomanic, and major depressive episodes; addition of severity dimensions for manic and major depressive episodes; and removal of the bereavement exclusion in major depressive episode. Although some proposals (particularly the anxiety dimension and the use of Patient Health Questionnaire-9 (PHQ-9) as depression severity dimension) may improve clinical and research utility, others have a high potential for false positives (e.g., addition of mixed anxiety depression, removal of bereavement exclusion), unclear clinical utility (e.g., mixed features specifier for depressive episodes), or problematic implementation (e.g., use of Clinical Global Impression (CGI), which requires prior experience of treating bipolar patients, for rating manic episode severity). A cost-benefit analysis of mood proposals yields mixed results, with some having significant benefits and others carrying the risk of significant problems. Only proposals in which benefits outweigh costs should be included in the final DSM-5.
    Current opinion in psychiatry 10/2010; 24(1):1-9. DOI:10.1097/YCO.0b013e328340b594 · 3.55 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This commentary focuses on the proposed changes to the trauma stressor criterion for PTSD for DSM-5, specifically its likely impact on malingering. PTSD is particularly susceptible to malingering because the diagnosis relies so heavily on a patient’s subjective symptoms. Because the traumatic event that is the trigger of the PTSD syndrome is generally based on objective fact and thus often easily corroborated, this element of the diagnosis is usually more challenging to malinger than subjective reports of symptoms. Therefore, one of the main gateways for limiting the misuse of the PTSD diagnosis in forensic settings is the criterion defining the range of qualifying traumas. Proposed changes to criterion A of PTSD in the draft include modifying the types of qualifying trauma by replacing “threat to physical integrity” with “sexual violation,” and clarifying the modes of exposure by replacing the phrase “confronted with” with two criterion: “learning that the event occurred to a close relative or close friend” and “experiencing repeated or extreme exposure to aversive details of the event.” Each of these changes has the potential to significantly broaden the range of qualifying stressors and consequently expand the potential pool of individuals who might be in a position to malinger the disorder. Given the likelihood that the DSM-5 field trials will be unable to provide information relevant to assessing the impact of making these changes in forensic settings, it would be prudent to resist the inclination to tinker with the wording unless other mechanisms are available to ensure that the wording changes do more good than harm. KeywordsPTSD-Malingering-DSM-5
    Psychological Injury and Law 12/2010; 3(4):255-259. DOI:10.1007/s12207-010-9096-6
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We review briefly the contributions of Skodol, Pincus, and Widiger (this issue) describing and critiquing the proposed changes in the assessment of personality and personality disorders for the DSM-5. Despite the hard work of the DSM-5 Work Group to date, there are shortcomings and areas of controversy in the current proposal that demand further attention and change. We discuss the controversy in the broader context of the DSM over the past 30 years. In addressing specific problems, we focus on the limitations of the proposed system for assessing traits (even as we endorse the movement toward dimensional assessment of personality) and the difficulties posed by the current "hybrid" model that attempts to include both traits and types. In moving forward, we suggest greater emphasis on decision-making regarding the presence and severity of any personality disorder (understood on the basis of generalized failures in adaptation) and greater flexibility in identifying the variants of personality disorders in order to accommodate both traits and types more inclusively during this transition toward dimensional approaches to assessment.
    Personality Disorders: Theory, Research, and Treatment 01/2011; 2(1):68-82. DOI:10.1037/a0022226 · 3.54 Impact Factor
Show more