DSM-5 Debuts to a Scornful Review in Annals, Skepticism from NIMH

By Joe Elia

The new, fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has been panned in an Annals of Internal Medicine commentary. The author, chair of the DSM-4 task force, advises that clinicians use it "cautiously, if at all."

Separately, the director of the National Institute of Mental Health says that "patients with mental disorders deserve better." Late last month he wrote that the institute will be "re-orienting its research away from DSM categories" to focus on biomarkers of mental disease rather than clusters of symptoms.

The Annals commentator seems especially disappointed with the proliferation of diagnoses "at the fuzzy boundary with normality." He says the result "will probably lead to substantial false-positive rates and unnecessary treatment." Perhaps most damning is his charge that the American Psychiatric Association has a financial conflict of interest driven by DSM revenues (the new edition costs about $200), which led to "premature publication of an incompletely tested and poorly edited product."