November 28, 2008

Spitzer update on DSM-V transparency

The latest on the controversy

Robert Spitzer, MD, chair of the DSM-III and DSM-III-R workgroups, has issued an update on efforts to reduce the secrecy surrounding the American Psychiatric Association's DSM-V revision process:
"As those of you who have followed this issue know, APA leadership has been resistant to improving the transparency of the revision process. At the outset, all DSM-V Task Force and Workgroup members were required to sign a confidentiality agreement that prohibited them from discussing anything about the DSM-V revision process.... Requests to APA leadership to see minutes of Task Force and Workgroup meetings were refused on the grounds that releasing minutes would compromise the revision process by inhibiting free discussions among Workgroup members. It also was argued that making minutes of meetings and conference calls would jeopardize APA's intellectual property rights. How this would happen has never been explained....

"Pressure on APA leadership to increase transparency culminated in the drafting of an Action Paper by some members of the APA Assembly. The paper called for the posting of the minutes to the DSM-V workgroup and task force meetings on the DSM-V web site....

Although clearly a move in the right direction, I believe that these reports fall far short of providing the requisite transparency. The Workgroup reports are quite variable in terms of the amount of detail they provide regarding possible directions for change in the DSM-V....

"Full transparency of the process will only be satisfied by posting the minutes of all DSM-V conference calls and meetings so that the process of the deliberations is evident to all . Anything less is an invitation to critics of psychiatric diagnosis to raise questions about the scientific credibility of DSM-V. That is exactly what Christopher Lane, a harsh critic of the DSMs, did in an Op-Ed piece for the LA Times.

"One of the oft-repeated DSM-V talking points is that the process is 'open and transparent.' To be truly transparent, the nuts and bolts of the DSM-V process needs to be open for outside scrutiny. When it comes to the crucial issue of transparency, even the appearance of impropriety must be avoided. Rather than appearing open and transparent, current APA policy continues to give the appearance that APA has something to hide about how it is developing DSM-V. It remains likely that unwanted media attention will fall on the DSM process until full transparency is achieved."
The only Task Force report posted so far is here. Progress reports from the individual workgroups are posted here.

My readers will be especially interested in the report from the Sexual and Gender Identity Disorders workgroup, which will make recommendations for the highly controversial Paraphilias section of the DSM. The brief report is very vague and really doesn't say much. Rumor has it that the workgroup may be considering adding a new diagnosis for nonsadistic rapists, a highly controversial proposal that was rejected the last time around but would help government experts at civil commitment proceedings. With the continuing secrecy surrounding the process there is no way to know for sure what the workgroup is up to; we'll just have to stay tuned.

Robert Spitzer can be reached via email at

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