American Psychiatry Is Facing “Civil War” over Its Diagnostic Manual What’s the real reason DSM-V has been delayed? Christopher Lane


See also previous postings: 

Press Release: DSM-5 Publication Date Moved to May 2013  

Opinion on DSM-V (DSM-5) revision on Psychiatric Times site and in this week’s New Scientist, 9 December

PDF of press release here:

The American Psychiatric Association (APA) has yet to update its website to reflect last Thursday’s predicted announcement that the publication date for DSM-V is being shifted from May 2012 to May 2013. According to the press release, draft changes to DSM are to be posted on the DSM-V website in January 2010. Comments will be accepted for two months for review by the relevant DSM-V Work Groups for each diagnostic category. Field trials for testing proposed changes will be conducted in three phases.

DSM-V pages here

DSM-V Timeline page here:


Interesting piece on 12 December from Christopher Lane:

Christopher Lane is the Pearce Miller Research Professor of Literature at Northwestern University and the author of Shyness: How Normal Behavior Became a Sickness.

Psychology Today

Side Effects
From quirky to serious, trends in psychology and psychiatry.

by Christopher Lane, Ph.D.

December 12, 2009, Psychiatry

American Psychiatry Is Facing “Civil War” over Its Diagnostic Manual What’s the real reason DSM-V has been delayed?

What’s the real reason DSM-V has been delayed?

Yesterday, the American Psychiatric Association announced that it is pushing back the publication of DSM-V until 2013. The APA tried to put a good face on this rather embarrassing admission—embarrassing, because several spokespeople for the organization had insisted, quite recently, that they were on-track for publication in 2012 and that nothing would deter them. They maintained that position even as an increasingly acrimonious quarrel between current and former editors of the manual spilled onto the pages of Psychiatric News…Read on

The original dissemination date for ICD-11 had also been 2012, with the timelines for ICD-11 and DSM-V running more or less in parallel (  ). ICD-11 has since slipped by two years.

The most recent timeline I can provide was included in the June 2009 PowerPoint presentation by Robert Jakob (Medical Officer, Classifications and Terminologies, WHO Geneva), download here: ICD Revision Process [PDF format 1.33 MB]

ICD Revision Process
ICD-11 June 2009

Presentation: Robert Jakob / Bedirhan Üstün

See Slide 9 for “Tentative Timeline” (for overall revision process)

Tentative Timeline

2010 : Alpha version ( ICD 10+ → ICD 11 draft)
– +1 YR : Commentaries and consultations
2011 : Beta version & Field Trials Version
– +2 YR : Field trials
2013 : Final version for public viewing
– 2014 : WHA Approval
2015+ : Implementation

See Slide 38 for “ICD-11 Alpha Drafting Timeline” (to May 2010)

See Slide 39 for “ICD-11 Alpha Draft Calendar” (to May 2010)

Alpha Draft Calendar

Preparations will finish before 31 August 2009
Overall Drafting Period: 14 September 2009 – 15 April 2010
Phase 1: 14 Sept – 11 Dec 2009 (10 WORKING WEEKS)
Provisional Interim Review: 15 Dec – 15 Jan
Phase 2: 18 Jan – 16 April 2010 (10 WORKING WEEKS)
Prefinal Review by WHOFIC: 15 April – Council
Submission for Systematic ALPHA TESTS: May 2010

According to “ICD Revision” on Facebook:

ICD-11 alpha draft will be ready by 10 May 2010
ICD-11 beta draft will be ready by 10 May 2011
ICD final draft will be submitted to WHA by 2014

It was reported, in August (DSM-V Field Trials Set to Begin, Elsevier Global Medical News), that the APA had planned to launch some field trials for DSM-V in October, with all field trials scheduled for completion by the end of 2010, for a previously anticipated publication date of May 2012. Lane claims that most of the field trials have yet to begin because the Work Groups can’t agree on their criteria.

The recently published Editorial: Is there a better term than “Medically unexplained symptoms”? Creed F, Guthrie E, Fink P, Henningsen P, Rief W, Sharpe M and White P (J Psychosoma Res:Volume 68, Issue 1, Pages 5-8, Jan 2010) discusses the deliberations of the EACLPP study group and includes references to the DSM and ICD revision processes which suggest that the progress of  the DSM-V “Somatic Distress Disorders” Work Group is in chaos.

In Advice To DSM V…Change Deadlines And Text, Keep Criteria Stable , (Psychiatric Times, 26 August), Allen Frances MD, who had chaired the revision of DSM-IV, raised the issue of non parallel timelines and the forthcoming shift from ICD-9-CM to ICD-10-CM in the US – a transition now scheduled for October 2013:

Frances wrote:

“Under normal circumstances, it would make sense to continue the tradition of publishing DSM-V and ICD-11 simultaneously, whenever ICD-11 is ready—probably in 2014. But there is also a problem with a 2014 deadline caused by a coding change that will go into effect before then. ICD-9-CM is now the official method of diagnostic coding used to specify all medical encounters in the United States. It will be replaced in October 2013 by a completely revamped ICD-10-CM. Publishing DSM-V much before October 2013 would result in great confusion and force a choice between 2 equally undesirable options: publish DSM-V in 2012 with the current ICD-9-CM codes, which would be usable only for 18 months; or else, publish DSM-V with the new ICD-10-CM codes even though DSM users would still have to use the ICD-9-CM codes for the next 18 months. Only by delaying publication of DSM-V until just before October 2013 would this problem be solved.”

On 09 July, in Dr Frances Responds to Dr Carpenter: A Sharp Difference of Opinion, Frances had called for the posting of all the suggested wordings for DSM-V criteria sets well before considering field trials:

“Will [Dr William Carpenter, MD] seems to think that his presentations at professional meetings in front of relatively small audiences provide a sufficiently open DSM-V process…We, the field, still know almost nothing about the content of what is being considered for DSM-V or how the options still in play are justified by the literature reviews and data reanalyses…We should have every wording of every proposed criteria set or dimension. Why not post these now to allow for the widest review well before field trials are started? I cannot imagine going to the trouble and expense of field testing before there is confidence that the diagnostic concepts make sense and that they are appropriately worded. Equally puzzling is the lack of posting of the literature reviews and of the methods of the proposed field trials. The DSM-V leadership has made the truly bizarre claim that they have provided the “most open process” of all the previous DSM revisions, but they have not posted any explicit or detailed indication of what they are doing and why…If the real reason for not posting is that the material is not yet in a presentable form, admit this and postpone the field trials until everything can be posted and fully vetted.”

We have no information on how closely ICD Revision and DSM have been collaborating on the revision of their respective “Somatoform Disorders” sections, what changes ICD Revision might be proposing for its corresponding Chapter V: F45 – F48 codes, or to what extent WHO intends that any changes to this section of Chapter V will mirror Task Force proposals for DSM-V. If DSM Task Force has approved radical changes to the categories currently classified under “Somatoform Disorders”, will ICD Revision still aim for “harmonisation”?

Despite the ICD Revision iCAMP meeting YouTubes, the ICD Revision blog and its Facebook site, we have no ETA for the launch of iCAT, the electronic platform through which ICD-11 will be developed. Is iCAT on schedule and will ICD-11 Alpha Draft be ready for May 2010 or is the WHO revision of ICD slipping, too?