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PhotographyAllen Frances, head of the DSM-IV task force, in a scathing critique of the DSM-V and DSM-V field trials that were published on October 30th in AJP. Must-read for every clinical psychologist.
Unaccountably, it failed to address two much more crucial questions — DSM-5′s potential impact on who would be diagnosed and on how much its dramatic lowering of diagnostic thresholds would increase the rates of mental disorder in the general population. There was no possible excuse for not asking these simple-to-answer and vitally important questions. We have a right to know how much DSM-5 will contribute to the already rampant diagnostic inflation in psychiatry, especially since this risks even greater overuse of psychotropic drugs.
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APA then had to choose between delaying the publication of DSM-5 or canceling its planned second stage of field testing that was meant to provide for desperately needed quality control. APA decided to cancel the trial and instead is rushing ahead with the premature publication of DSM-5 next May — publishing profits clearly trumped concern for the quality and integrity of the product. Fiduciary responsibility was thrown out the window.
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The nine DSM-5 disorders in the kappa range of 0.40-0.59 previously would have been considered just plain poor, but DSM-5 puffs these up as “good.” Then DSM-5 has the chutzpah to call acceptable the six disorders that achieved lousy, absolutely unacceptable reliabilities with kappas of 0.20-0.39. DSM-5 finally finds unacceptable the three diagnoses that were below <0.20 (which is barely better than chance).
