Psychiatric News July 15, 2005
Volume 40 Number 14
© 2005 American Psychiatric Association
p. 29
More Frequent DSM Updates Recommended
Roger Peele, M.D.
Rockville, Md.
Maryam Razavi, M.D.
Washington, D.C.
There should be a new edition of the Diagnostic and Statistical Manual
of Mental Disorders (DSM) each year. The present DSM has
diagnostic criteria last updated in the early 1990s, with text last updated in
the late 1990s. The clinician turning today to the DSM-IV-TR does not
know whether the conceptualization of the criteria over the past dozen years
has changed and does not know the currency of the text. Examples of the need
for diagnostic criteria classification are in the areas of childhood bipolar
disorder and adult attention-deficit/hyperactivity disorder, where
DSM-IV-TR is unenlightening. In addition, disorders have emerged and
grown, such as fetal alcohol syndrome, on which the DSM-IV-TR is
silent.
Some say that the costs of such an endeavor would be astronomical and that
to develop each new criterion set would be a million-dollar project. That is
not true. APA can and should do what other medical specialties do: have the
experts state where the field is today—not require the development of
new science.
Some say that publishing a new DSM each year would be seen as a
revenue-driven initiative. That is not true. Each year the specific changes
could be placed on the APA Web site for those not wanting to buy the book.
APA does not plan to complete a substantial revision of the DSM
until about 2012. We should not assume that the growth of knowledge in
psychiatry is so minimal that we are justified in waiting until then.
Letters to the Editor - Response
Darrel Regier, M.D., M.P.H., He is director of APA's Division of Research and executive director of
the American Psychiatric Institute for Research and Education
The possibility of developing a process for more frequent updates of the
DSM has been discussed with APA's Committee on Psychiatric Diagnosis
and Assessment and the Board of Trustees on several occasions over the past
two to three years. Models for such updates are the AMA's CPT procedure codes,
APA's practice guidelines, and the National Center for Health Statistics'
ICD-9-CM annual updates of diagnostic codes. These organizations and
agencies have established a permanent infrastructure to support regular
reviews of emerging medical procedures, the clinical trials and other research
bases to support treatment modifications, and proposals from the scientific
community for changes in diagnostic names or code numbers. However,
modifications of explicit diagnostic criteria in the DSM-III, DSM-III-R,
DSM-IV, and DSM-IV-TR have not been made between revisions
because of the absence of a credible, established scientific review structure
and because of a concern that each change could have significant impacts on
national and international research studies, which include the clinical trials
that lend support for treatment guidelines.
The Division of Research is currently reviewing the research base for
modifying diagnostic concepts and criteria in DSM-V with a $1.2
million grant from the National Institutes of Health. At the same time, we are
examining alternatives both for modifying the text more frequently to reflect
new associated features and for considering changes in the criteria for
individual disorders when substantial scientific evidence supports such
changes. 
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