(Adds additional comments, details of draft and full
By Kate Kelland
LONDON May 10 Many psychiatrists believe a new
edition of a manual designed to help diagnose mental illness
should be shelved for at least a year for further revisions,
despite some modifications which eliminated two controversial
The new edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM 5), a draft of which is open for public
consultation this month, will be the first full revision since
1994 of the renowned handbook, which determines how to interpret
symptoms in order to diagnose mental illnesses.
But more than 13,000 health professionals from around the
world have already signed an open letter petition (at dsm5-reform.com)
calling for DSM 5 to be halted and re-thought.
"Fundamentally, it remains a bad system," said Peter
Kinderman, a professor of clinical psychology at Britain's
"The very minor revisions...do not constitute the wholesale
revision that is called for," he said in an emailed comment.
The American Psychiatric Association (APA), which produces
the manual and plans to publish DSM 5 next May, said on
Wednesday it had decided to drop two proposed diagnoses, for
"attenuated psychosis syndrome" and "mixed anxiety depressive
The former, intended to help identify people at risk of
full-blown psychosis, and the latter, which suggested a blend of
anxiety and depression, had been criticised as too ill-defined.
With these and other new diagnoses such as "oppositional
defiant disorder" and "apathy syndrome", experts said the draft
DSM 5 could define as mentally ill millions of healthy people -
ranging from shy or defiant children to grieving relatives, to
people with harmless fetishes.
"SIMPLY NOT USABLE"
Robin Murray, a professor of psychiatric research at the
Institute of Psychiatry at Kings College London, said it was a
great relief to see the changes in the draft, pa rticularly to
the attenuated psychosis diagnosis.
"It would have done a lot of harm by diverting doctors into
thinking about imagined risk of psychosis (and) it would have
led to unnecessary fears among patients that they were about to
go mad," he said in a statement.
But Allen Frances, emeritus professor at Duke University in
the United States, said it was "only a first small step toward
desperately needed DSM 5 reform".
"Numerous dangerous suggestions remain, Frances, who chaired
a committee overseeing the DSM 4, said, adding that DSM 5 "is
simply not usable" and should be delayed for an extra year "to
allow for independent review, to clean up its obscure writing,
and for retesting".
Diagnosis is always controversial in psychiatry, since it
defines how patients will be treated based on a cluster of
symptoms, many of which occur in several different types of
Peter Jones, a professor of psychiatry at Cambridge
University, said DSM 5 should be "underpinned by science" built
on an understanding of the biology and functions of the brain
and mind - something he said neuroscience was not yet able to do
"On this basis DSM 5 is, at best, premature and a waste of
time," he said.
Some argue that the whole approach needs to be changed to
pay more attention to individual circumstances rather than
slotting them into predefined categories.
Lucy Johnstone, a consultant clinical psychologist for the
Cwm Taf Health Board in Wales agreed: "(The DSM)is wrong in
principle, based as it is on redefining a whole range of
understandable reactions to life circumstances as 'illnesses',
which then become a target for toxic medications heavily
promoted by the pharmaceutical industry," she said.
"The DSM project cannot be justified, in principle or in
practice. It must be abandoned so that we can find more humane
and effective ways of responding to mental distress."
One of the proposed changes that has survived in the draft
DSM 5 - despite fierce public outcry - is in autism. The new
edition eliminates the milder diagnosis of Asperger syndrome in
favour of the umbrella diagnosis of autism spectrum disorder.
(Editing by Myra MacDonald)