Therapists Seek Help with DSM-V from the President of the APA

The upcoming release of the newly revised DSM-V has spurred much debate in the past several months. A recent article, published an open letter from Dr. Don Locke, president of the American Counseling Association (ACA), to Dr. John Oldham, President of the American Psychiatric Association, which outlines the primary concerns the mental health community has with the proposed revisions to the diagnostic tool that has been relied on by medical professionals for decades. Locke summarizes the collective concerns by saying, “Our concerns focus on empirical evidence, dimensional and cross-cutting assessments, field trials, the definition of mental disorder, and transparency,” says Locke, speaking on behalf of the 120,000 licensed mental health professionals within the United States.

Locke begins his plea emphasizing the importance of empirical evidence. “While we appreciate APA’s commitment to quality research, counselors are concerned that a number of the DSM-5 proposals have little basis in empirical studies,” says Locke. “The rationales posted on the DSM-5 website provide either incomplete or insufficient empirical evidence to support many of the proposed revisions.” Additionally, members of the ACA are in agreement that assessments should be cross-cutting and dimensional, but found little evidence of external validators within the proposed revisions. Locke adds, “Furthermore, more than half the disorders-including important disorders such as attention-deficit/hyperactivity disorder and conduct disorder-have no assessments posted on the website, so we cannot effectively evaluate all of the measures being proposed.”

Locke continues by pointing out clinical concerns with new definitions in the manual. According to the DSM-V Task Force, the newly revised DSM would define a mental disorder as follows: “A behavioral or psychological syndrome or pattern that occurs in an individual that reflects an underlying psychobiological dysfunction (APA 2011).” The question being raised is whether or not all mental health issues are biologically rooted. “Although advances in neuroscience have greatly enhanced our understanding of psychopathology, the current science does not fully support a biological connection for all mental disorders,” says Locke. “We therefore request that the definition of mental disorder be amended to indicate that mental disorders may not have a biological component.” With regards to transparency, Locke believes that, despite the fact that the DSM-V Task Force has claimed to undertake the process of revision in a transparent and open way, confidentiality agreements and undisclosed information cast a shadow of doubt over the entire process. Locke says, “Most problematic, the reports of the DSM-5 SRC are not available for public inspection, which is a violation of one of the most basic and vital tenets of science-open access to data and/or processes for independent evaluation and critique. Without full transparency and openness, counselors may have difficulty having confidence in and trusting the DSM-5.” Locke concluded by adding that in order for the manual to maintain its credibility as an effective and accurate diagnostic tool, “it is essential that the DSM-5 be based on research that involves rigorous, systematic, and objective procedures; an open process; and independent, objective scientific review.”

© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Jordyn

    Jordyn

    November 25th, 2011 at 11:42 AM

    I guess sometimes you just have to go straight to the source

  • rick j

    rick j

    November 25th, 2011 at 9:13 PM

    organizations like these should not bring their disagreements into the public.they ought to sit together and come to a conclusion.if they have issues like these out in the public then how are the people supposed to believe them and follow their guidelines and definitions e respected?

  • Constance

    Constance

    November 26th, 2011 at 7:51 AM

    Not everything boils down to biology, so I agree that this little amendment needs to be made. I think that we all know situations where someone seemed perfectly fine and then some external stimuli provokes them and they develop anxiety or depression or something. That might not have been something that they would ever have had to deal with had it not been for that outside occurence, and not something that they carried around with them on the inside.

  • leon

    leon

    November 27th, 2011 at 5:41 AM

    I agree too.Biology is not always involved you know.It could be due to exposure to an event or something someone picks up during their lifetime and not necessarily comes from birth.So these things need to be considered when we’re talking about a manual for the future.

  • Jace

    Jace

    November 27th, 2011 at 6:27 AM

    An open process- that is what the whole scientific process must be. It keeps the mind open and expanding, willing to learn. I only hope that in the whole community that this does not fall on deaf ears.

  • Melissa

    Melissa

    November 27th, 2011 at 11:15 PM

    After all the years they have had to draft this,they have a disagreement so close to the release date.Great!

  • Pauline

    Pauline

    November 28th, 2011 at 5:19 AM

    If revision in assessment is a common thing in the worlds of medicine and science why is there a problem with reviosoins being made in this diagnstic tool? If it will eventually better the treatment and diagnosis of patients then that has to be a good thing.

  • Vanessa

    Vanessa

    November 28th, 2011 at 4:09 PM

    Why the uproar? So some changes need to be made? Are they really upset because they think that this works against the best interests of the patient, or is it because they are afraid of having to learn something mew? If so that is certainly not the kind of provider that I would choose to work with.

  • JOSHUA

    JOSHUA

    November 29th, 2011 at 10:51 AM

    There cud be diff between theoretical findings n the real world cases.They need to try n get the best of both world.After all it is the patients that need to be kept in focus n its their benefit that matters the most.

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