Current Activities: Report of the DSM-V Task Force (March 2009)
DSM-V Task Force and Work group Update
APA Division of Research Report to the APA Board of Trustees
Submitted by: David J. Kupfer, M.D. and Darrel A. Regier, M.D., M.P.H.
February 20, 2009
Current Status and Activities of the DSM-V Task Force, Study Groups, and Work Groups
The seventh meeting of the DSM-V Task Force will take place March 23-25, 2009. The five DSM-V Task Force Study Groups on cross-cutting issues (Lifespan Developmental Issues, Diagnostic Spectra, Gender and Cross-Cultural Expression, Psychiatric/General Medical Interface, and Impairment Measures) have met face-to-face in their respective groups and brought their recommendations back to the full task force for discussion during each of the task force meetings. Each study group has held approximately 17 conference calls since their formation, in April 2007. A sixth study group, focused on the development of diagnostic assessment instruments to be created in conjunction with development of DSM-V, is currently being formed. It is envisioned that this study group will have subgroups for brief “measurement-based care” guides for clinical practice, clinical research diagnostic assessments, and community-based epidemiological research.
Each study group is addressing specific research questions and hypotheses, based on their review of existing literature, findings from the DSM research planning conferences, and relevant work from Research Agenda white papers. Secondary data analyses to address these questions are now being conducted. These activities are being used to inform the diagnostic work groups on strategies for incorporating cross-cutting themes into their work processes. The study groups have invited members of DSM-V Work Groups with expertise in certain topics to join them on conference calls and the writing of research proposals. The study groups will continue their work throughout the life of the task force.
Each DSM-V Work Group is holding teleconferences approximately biweekly, and has now had three to five 2-day face-to-face meetings. The following meetings have been convened since the last report to the BOT:
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December 16-17, 2008: Anxiety, Obsessive Compulsive Spectrum, Posttraumatic, and Dissociative Disorders; Mood Disorders; Personality and Personality Disorders; and Psychotic Disorders
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January 12-13, 2009: Sexual and Gender Identity Disorders
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February 24-25, 2009: Mood Disorders; Sleep-Wake Disorders; Somatic Distress Disorders; and Substance-Related Disorders
The following meetings have been scheduled to take place later this year and in 2009:
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March 7-8, 2009: Gender Identity Disorders Sub WorkGroup
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March 17-18, 2009: Anxiety, Obsessive Compulsive Spectrum, Posttraumatic, and Dissociative Disorders; Childhood & Adolescent Disorders; Eating Disorders; and Neurocognitive Disorders
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April 2-3, 2009: Sexual Dysfunctions SubWorkGroup
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April 21-22, 2009: Neurodevelopmental Disorders; ADHD and Disruptive Behaviors Disorders; Personality and Personality Disorders; and Psychotic Disorders
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October 6-7, 2009: ADHD and Disruptive Behaviors Disorders; Childhood & Adolescent Disorders; Mood Disorders; and Somatic Distress Disorders
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October 19-20, 2009: Anxiety, Obsessive Compulsive Spectrum, Posttraumatic, and Dissociative Disorders; Neurodevelopmental Disorders; Neurocognitive Disorders; and Psychotic Disorders
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November 16-17, 2009: Eating Disorders; Sleep-Wake Disorders; Substance-Related Disorders; and Personality and Personality Disorders
BOT Appointed Committee to Review Advisor Nominations
To date, 198 advisors to the DSM-V Task Force, Study Groups, and Work Groups have been nominated. Regarding nominees, 104 have submitted disclosure information, and all received to date have been reviewed by the BOT-appointed committee to review and appoint advisors (“Advisor Review Committee”). The advisor review committee has approved 104 advisors. Acceptance forms have been completed by 90 of those approved.
BOT Committee to Review DSM Member Nominations
The DSM-V Task Force and Work Groups are beginning to identify gaps in needed expertise in work group membership. As a result, six additional members have been nominated. The BOT committee to review DSM member nominations is currently reviewing these.
The online DSM disclosure update web site was launched the last week of January, 2009. DSM-V Members are able to access the site via custom usernames and passwords to provide yearly updates to their disclosures. Updates will be provided to the DSM-V Membership review committee once completed.
Media Issues
APA’s confidentiality policy regarding the work of DSM-V members continues to receive attention, via editorial pieces in newsletters and on Internet “blogs”. APA and DSM leadership, in particular Drs. Nada Stotland, James Scully, David Kupfer, and Darrel Regier, have actively responded to inaccurate information regarding the policy. A list of past and future meetings where DSM activities are presented has been posted on the DSM web site. Each DSM-V report to the APA BOT Trustees and regularly updated summaries of the DSM-V Work Group activities are posted on the www.psych.org web site (also accessible via www.dsm5.org). The DSM web site also solicits suggestions and comments from all web site visitors. A main goal of the public outreach activities is to encourage scientific and clinically-related dialog between DSM-V developers and users, including members of APA.
Diversity, Conceptual, and Philosophical Issues
To ensure that those involved in the revision process represent diverse perspectives, disciplines, and areas of expertise, the task force and work groups represent a variety of clinical and scientific disciplines, patient and family groups, women, and minority/underrepresented groups (see Appendix F for a breakdown of current representation). Efforts have also been made for each work group to have at least one international member. As noted above, the task force study group on gender and cross-Cultural issues will continue its work throughout the DSM-V process. In addition, a large number of advisors involved in the revision process will increase the level of diversity involved in the revision process.
Conceptual and philosophical issues related to diagnosis and classification are being addressed at several levels. The task force has been addressing such issues from its onset, particularly through the study group on Diagnostic Spectra, which is addressing such issues as organizing principles for the DSM-V disorder groupings, and prioritization of specific types of validators for these groupings. The Developmental Study Group is evaluating alternative conceptualizations to address lifespan issues across disorders. The Gender and Cross-Cultural Study Group is considering issues of criteria changes on the basis of sex and cultural differences. All work groups are addressing the feasibility of incorporating dimensional assessments of psychopathology. As the work groups continue their literature reviews and secondary data analyses, procedures for issues such as developing guidelines for making changes to criteria and adding or deleting disorders are being developed. Several work group and task force members with a special interest in these issues continue to push this process forward by addressing possible alternative overarching “meta-structures” for the future manual. A number of the work groups have discussed these proposals. Potential strategies for incorporating these issues in the DSM-V in a clinically useful way were reviewed during the October task force meeting, and will be intensively studied in the upcoming March task force meeting.
Research Activities
As noted above, the work groups are now actively developing literature reviews and secondary data analysis plans. To date, 27 data analysis proposals and 55 literature review proposals have been received. The Research Group has its own limited-access page on SharePoint. In addition, documents have been posted on SharePoint that can be accessed by all work group members, e.g., data analysis proposal forms, literature review tracking forms, advisor nomination forms, and a statement on how the Research Group can assist the work groups in achieving their research goals.
Integration with ICD-11
The APA continues to participate with the World Health Organization in a “DSM/ICD Harmonization Coordination Group.” The aim of this group is to facilitate the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioral disorders and DSM-V. The functions of the group are:
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To identify effective mechanisms to share information on developmental processes of the two diagnostic systems.
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To find strategies to narrow the differences between the two diagnostic systems.
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To coordinate efforts towards harmonization of the two diagnostic systems by making specific recommendations to the respective decision making bodies.
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To provide a forum in which difficult issues around harmonization can be discussed and common approaches identified.
Current issues being discussed include access to data for analyses, proposal for grouping disorders, and the development of manuals for primary care.
Outreach and Dissemination Activities
The DSM-V Task Force and Work Group members are making it a high priority to maintain open lines of communication about the revision process. To this end, members have and will continue to provide general information and perspectives about DSM-V development through academic and professional presentations. A listing of past and future presentations is maintained on the APA web site (click here):
Upcoming presentations include:
David J. Kupfer, M.D., Darrel A. Regier, M.D., M.P.H.; Evelyn Bromet, Ph.D.; Glorisa Canino, Ph.D.; Patricia R. Cohen, Ph.D.; Wilson M. Compton, M.D.; Warachal Faison, M.D.; Ellen Frank, Ph.D.; Sir David Goldberg, M.D.; John E. Helzer, M.D.; Steven E. Hyman, M.D.; James S. Jackson, Ph.D.; William E. Narrow, M.D., M.P.H.; Daniel S. Pine, M.D.; Martin Prince, M.D.; Norman Sartorius, M.D., Ph.D.; Michael Von Korff, ScD; Philip Wang, M.D., DrPH; Hans-Ulrich Wittchen, Ph.D.; Kimberly Yonkers, M.D.
Evolution of the DSM-V Conceptual Framework: Development, Dimensions, Disability, Spectra, and Gender/Culture
Presented at: The 99th Annual American Psychopathology Association Meeting;
New York, NY; March 5-7, 2009
Darrel A. Regier, M.D., M.P.H.; William T. Carpenter, M.D.
Symposia on DSM-V Development and Psychotic Disorders
Presented at: The International Congress on Schizophrenia Research;
San Diego, CA; March 30, 2009
David J. Kupfer, M.D.; Darrel A. Regier, M.D., M.P.H.; Rebecca Allison, M.D.; William Carpenter, M.D.; Peggy T. Cohen-Kettenis, Ph.D.; Jack Drescher, M.D.; Warachal Faison, M.D.; Jan Fawcett, M.D.; Ellen Frank, Ph.D.; Linda Gask, Ph.D.; Howard Goldman, M.D.; Keisling; Robert F. Krueger, Ph.D.; Alberto Minoletti, M.D.; Shannon P. Minter, J.D.; William E. Narrow, M.D., M.P.H.; Katharine A. Phillips, M.D.; Diana Rose, M.D.; Shekhar Saxena, M.D.; Norman Sartorius, M.D., Ph.D.; Kelly Winters, Ph.D.; Kimberly Yonkers, M.D.
Research Planning Forum and Symposia Series on the Development of DSM-V
Presented at: The 2009 American Psychiatric Association Annual Meeting;
San Francisco, CA; May 18-19, 2009
Peggy T. Cohen-Kettenis, Ph.D.
Gender dysphoria and the DSM-V
Presented at: The World Professional Association for Transgender Health XXI Biennial Symposium;
Oslo, Norway: June 17-20, 2009
Kathleen K. Bucholz, Ph.D.; Bridget Grant, Ph.D., Ph.D.; Deborah Hasin, Ph.D.; John E. Helzer, M.D.; Howard Moss, M.D.;. Marc Schuckit, M.D.
Alcohol Use Disorders in DSM-V: A Progress Report
Presented at: The 2009 Annual Meeting of the Research Society on Alcoholism;
San Diego, CA: June 20-24, 2009
Guilherme Borges M.D., Dr.Sc.; Alan Budney, Ph.D.; Thomas Crowley, M.D.; Charles O’Brien M.D., Ph.D.
Substance Use Disorders in DSM-V: A Progress Report
Presented at: The College on Problems of Drug Dependence 71st Annual Meeting;
Reno/Sparks, NV: June 20-25, 2009