Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-10T09:07:34.131Z Has data issue: false hasContentIssue false
  • English
  • Français

The DSM revision process: needing to keep an eye on the empirical ball

A commentary on ‘Expert consensus v. evidence-based approaches in the revision of the DSM’ by Kendler & Solomon (2016)

Published online by Cambridge University Press:  13 September 2016

M. B. First
M. B. First*
Affiliation:
Department of Psychiatry, Columbia University, 1051 Riverside Drive – Unit 60, New York, NY 10032, USA
*
*Address for correspondence: M. B. First, M.D., Department of Psychiatry, Columbia University, 1051 Riverside Drive – Unit 60, New York, NY 10032, USA. (Email: mbf2@cumc.columbia.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

From DSM-III onward, successive DSM editions have strived to ground the diagnostic definitions in empirical evidence. DSM-IV established a three-stage process of empirical review, consisting of comprehensive and systematic literature reviews, secondary analyses of datasets, and field trials to provide reliability and validity data for the most substantial or controversial proposals. DSM-IV Work Group members were required to review the empirical literature to document explicitly the evidence supporting the text and criteria published in DSM-IV. As noted by Kendler and Solomon (2016), in contrast to the emphasis on systematic reviews in medicine which is a manifestation of the evidence-based medicine movement, such systematic evidence-based reviews have not been consistently integrated into the development of DSM-5, raising questions about empirical rigor underlying the DSM-5 revision. It is likely that this regression in terms of anchoring the revision process in a comprehensive review of empirical data stemmed from the emphasis during the DSM-5 revision process on trying to move DSM-5 from its categorical descriptive approach towards a more etiological dimensional approach. Although such a shift ultimately did not occur, the effort spent on trying to achieve a paradigm shift likely came at the expense of the hard work of conducting systematic empirical reviews. For the DSM to continue to remain credible in the current era of evidence-based medicine, it is essential that the developers of future editions of the DSM avoid taking their eye off the empirical ball and insure that the manual remains grounded in solid empirical evidence.

Keywords

DSM-IVDSM-5empirical reviewevidence-based medicine
Type
Commentary
Information
Psychological Medicine , Volume 47 , Issue 1 , January 2017 , pp. 19 - 22
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, Revised (DSM-III-R). American Psychiatric Association: Washington, DC.Google Scholar
APA (2004). Research Planning Launch Methods Conference (February 18–20, 2004) (http://www.dsm5.org/Research/Pages/ResearchPlanningLaunchMethodsConference(February18-20,2004).aspx). Accessed 22 July 2016.Google Scholar
Feighner, JP, Robins, E, Guze, SB, Woodruff, RA Jr., Winokur, G, Munoz, R (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 57–63.CrossRefGoogle ScholarPubMed
First, MB (2010). Paradigm shifts and the development of the diagnostic and statistical manual of mental disorders: past experiences and future aspirations. Canadian Journal of Psychiatry 55, 692–700.CrossRefGoogle ScholarPubMed
First, MB (2016). Adopting a continuous improvement model for future DSM revisions. World Psychiatry. doi: 10.1002/wps.20342.CrossRefGoogle ScholarPubMed
Frances, A, Pincus, H, Widiger, T, Davis, W, First, M (1990). DSM-IV: work in progress. American Journal of Psychiatry 147, 1439–1448.Google ScholarPubMed
Frances, A, Widiger, T, Pincus, H (1989). The development of DSM-IV. Archives of General Psychiatry 46, 373–375.CrossRefGoogle ScholarPubMed
Kendler, K, Kupfer, D, Narrow, W, Phillips, K, Fawcett, J (2009). Guidelines for Making Changes to DSM-V, Revised 10/21/09. American Psychiatric Association: Arlington, VA (http://www.dsm5.org/ProgressReports/Documents/Guidelines-for-Making-Changes-to-DSM_1.pdf). Accessed 21 July 2016.Google Scholar
Kendler, KS (2013). A history of the DSM-5 scientific review committee. Psychological Medicine 43, 1793–1800.CrossRefGoogle ScholarPubMed
Kendler, KS, First, MB (2010). Alternative futures for the DSM revision process: iteration v. paradigm shift. British Journal of Psychiatry 197, 263–265.Google Scholar
Kendler, KS, Solomon, M (2016). Expert consensus v. evidence-based approaches in the revision of the DSM. Psychological Medicine 46, 2255–2262.CrossRefGoogle ScholarPubMed
Kraemer, HK, Shrout, PE, Rubio-Stipec, M (2007). Developing the Diagnostic and Statistical Manual V: what will ‘statistical’ mean in DSM-V? Social Psychiatry and Psychiatric Epidemiology, 42, 259–267.CrossRefGoogle ScholarPubMed
Kupfer, D, First, M, Regier, D (2002). Introduction. In A Research Agenda for DSM-V (ed. Kupfer, D., First, M. , Regier, D.), pp. xv–xxiii. American Psychiatric Association: Washington, DC.Google Scholar
Kupfer, D, Kuhn, E, Regier, D (2009). Research for improving diagnostic systems: consideration of factors related to later life development. American Journal of Geriatric Psychiatry 17, 355–358.CrossRefGoogle ScholarPubMed
Kupfer, DJ, Regier, DA, Kuhl, EA (2008). On the road to DSM-V and ICD-11. European Archives of Psychiatry and Clinical Neuroscience 258, 2–6.CrossRefGoogle ScholarPubMed
Regier, D, Narrow, W, Kuhl, E, Kupfer, D (2009). The conceptual development of DSM-V. American Journal of Psychiatry 166, 645–650.CrossRefGoogle ScholarPubMed
Regier, DA, Kuhl, EA, Narrow, WE, Kupfer, DJ (2012). Research planning for the future of psychiatric diagnosis. European Psychiatry 27, 553–556.CrossRefGoogle ScholarPubMed
Regier, DA, Narrow, WE, Kuhl, EA, Kupfer, DJ (eds) (2011). The Conceptual Evolution of DSM-5. American Psychiatric Association: Arlington, VA.Google Scholar
Spitzer, R, Endicott, J, Robins, E (1975). Clinical criteria for psychiatric diagnosis and DSM-III. American Journal of Psychiatry 132, 1187–1192.Google ScholarPubMed
Spitzer, R, Endicott, J, Robins, E (1978). Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Widiger, T, Frances, A, Pincus, H, Davis, W (1990). DSM-IV literature reviews: rationale, process, and limitations. Journal of Psychopathology and Behavioral Assessment 12, 189–202.CrossRefGoogle Scholar
Widiger, T, Frances, A, Pincus, H, Davis, W, First, M (1991). Toward an empirical classification for the DSM-IV. Journal of Abnormal Psychology 100, 280–288.CrossRefGoogle ScholarPubMed
Widiger, T, Frances, A, Pincus, H, First, M, Ross, R, Davis, W (eds) (1994). DSM-IV Sourcebook Volume 1. American Psychiatric Association: Washington, DC.Google Scholar
Widiger, T, Frances, A, Pincus, H, Ross, R, First, M, Davis, W (eds) (1996). DSM-IV Sourcebook Volume 2. American Psychiatric Association: Washington, DC.Google Scholar
Widiger, T, Frances, A, Pincus, H, Ross, R, First, M, Davis, W (eds) (1997). DSM-IV Sourcebook Volume 3. American Psychiatric Association: Washington, DC.Google Scholar
Widiger, T, Frances, A, Pincus, H, Ross, R, First, M, Davis, W, Kline, M (eds) (1998). DSM-IV Sourcebook Volume 4. American Psychiatric Association: Washington, DC.Google Scholar
Widiger, T, Trull, T (1993). The scholarly development of DSM-IV. In International Review of Psychiatry (Volume 1) (ed. Costa De Silva, J., Nadelson, C.), pp. 59–78. American Psychiatric Press: Washington, DC.Google Scholar
Widiger, TA, Crego, C (2015). Process and content of DSM-5. Psychopathology Review 2, 162–176.CrossRefGoogle Scholar