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.”
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