Current Activities: Report of the DSM-V Task Force (September 2008)

DSM-V Task Force and Work group Update
APA Division of Research Report to the APA BOT
Submitted by: David J. Kupfer, M.D. and Darrel A. Regier, M.D., M.P.H.
September 15, 2008

Current Status and Activities of the DSM-V Task Force, Study Groups, and Work Groups

The sixth meeting of the DSM-V Task Force is being held October 26-27, 2008.  The four DSM-V Task Force study groups on cross-cutting issues (Lifespan Developmental Issues, Diagnostic Spectra, Gender and Cross-Cultural Expression and Psychiatric/General Medical Interface) 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 10-15 conference calls since their formation, in April of 2007.  The study groups are being expanded slightly so that work group chairs are no longer also chairs of study groups, and the Lifespan Developmental group has been restructured to bring in additional expertise across the entire lifespan.  A fifth study group, charged with working to implement measures of impairment across diagnoses, has been formed, and will hold its first in-person meeting October 7-8.

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.  Plans for secondary data analysis to address these questions have been developed, and are beginning to be 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 has now had two to four 2-day face-to-face meetings.  The following meetings have been convened since the last report to the BOT:

  • September 15-16, 2008: Autism and Other Developmental, ADHD and Disruptive Behaviors, Childhood & Adolescent, and Substance-Related Disorders
  • September 16-17, 2008: Eating, Neurocognitive, Somatic Distress Disorders
  • September 17-18, 2008: Sleep-Wake Disorders
  • October 6-7, 2008: Anxiety, Obsessive Compulsive Spectrum, Posttraumatic, and Dissociative;
  • October 7-8, 2008: Impairment Study group

DSM-V Work group and Task Force Member Nominations

A subcommittee of the BOT, now chaired by David Fassler, M.D., has completed the  review and approval process of all nominated work group members.  Since the last BOT report, 7 new nominees were approved, completing the roster for all DSM-V Work groups, pending any new replacement nominations.  Since completion of the groups, three members have withdrawn from work group membership.   In summary, 131 nominated work group members have been appointed (83.5%), 18 self-withdrew (11.5%), and 8 were not appointed (5%).

BOT Appointed Committee to Review Advisor Nominations

During the last meeting of the BOT, the BOT appointed a committee to review and appoint advisors to the DSM-V Task Force, Study groups, and Work groups (Advisor Committee).  To date, the Advisor Committee has created a standard operating procedures document for nominating, reviewing, and appointing DSM-V Advisors.  A standard acceptance form, created in collaboration with APA Attorneys, and official appointment letter have also been created. 

To date, the group has approved over 45 advisors.  Disclosure information for 3 nominees has been sent to GYMR for additional review.

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.   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 Spectra study group, which is addressing such issues as organizing principles for the DSM-V, and prioritization of specific types of validators. This group is currently establishing recommendations and guidelines for distribution and discussion at the October Task Force meeting.  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 a threshold for making changes to criteria 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 a possible overarching “metastructure” for the future manual.  The “metastructure” is slated to be further discussed, with specific recommendations for each work group, during the October Task Force meeting.   

Research Activities

As noted above, the work groups are now actively developing literature reviews and secondary data analysis plans.  To date, 25 data analysis proposals have been received.  

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:  

  • To identify effective mechanisms to share information on developmental processes of the two diagnostic systems.
  • To find strategies to narrow the differences between the two diagnostic systems.
  • To coordinate efforts towards harmonization of the two diagnostic systems by making specific recommendations to the respective decision making bodies.
  • To provide a forum in which difficult issues around harmonization can be discussed and common approaches identified.

Activities

A symposium, titled: “Conceptual Considerations for Revising DSM and ICD Disorders” has been scheduled to take place Sunday, September 21st, at the World Psychiatric Association’s 14th World Congress in Prague.  The session will be chaired by Darrel Regier, with speakers highlighting globally-relevant outcomes from key areas of the DSM-V Research Planning conferences.  Another WPA symposium, chaired by Dr. Norman Sartorius, with participation by David Kupfer, is also slated, entitled: “Preparations for DSM-V/ICD-11”.

The DSM-V will be the focus of the 99th Annual American Psychopathological Association (APPA) meeting, to be held in New York City on March 5-7, 2008.  Sixteen speakers will be speaking in 5 topic sessions and two award lectures.  The topics are: 

  • Diagnostic Spectra: Assessing the Validity of Disorder Groupings
  • Integrating Dimensional Concepts into a Categorical System
  • Assessing Functional Impairment for Clinical Significance and Disability
  • Identifying Important Culture- and Gender-Related Expressions of Disorders
  • Incorporating Developmental Variations of Disorder Expression Across the Lifespan

This meeting will be chaired by Dr. Regier, who is the current president of the APPA, and the winner of the association’s Hamilton Award.

The 2009 APA Annual Meeting will have several opportunities for members and other interested persons to hear the latest news in the development of DSM-V.  The planned DSM-V track will begin with the annual DSM-V Forum, which provides an overview of activities over the past year, as well as a preview of upcoming Annual Meeting sessions.  There will be four symposia related to DSM-V.  Two symposia will cover the final two conferences in the APA/NIH/WHO conference series, “Public Health Aspects of Psychiatric Classification” and “Autism and Other Pervasive Developmental Disorders.”  Another symposium will summarize the APPA meeting, and cover the five cross-cutting DSM-V topics listed above.  Finally, a symposium on Gender Identity Disorder will bring together transgender advocates and DSM-V group members to give a status report on work group activities and discuss issues around this controversial diagnosis, including whether it should be listed in DSM-V at all.

Members of the DSM-V Task Force and Work Groups will continue to make presentations at smaller meetings, such as the AACAP Annual Meeting and the WPA World Congress.

Diversity Representation among DSM-V Task Force and Workgroup Nominees

 

Country Representation

 

 

Australia

2

1%

 

Brazil

1

1%

 

Canada

8

5%

 

China

2

1%

 

Denmark

1

1%

 

France

1

1%

 

Germany

4

2%

 

Italy

1

1%

 

Mexico

1

1%

 

Netherlands

6

4%

 

Puerto Rico

1

1%

 

South Africa

1

1%

 

Sweden

1

1%

 

Switzerland

1

1%

 

UK

8

5%

 

USA

124

76%

 

Total

163

100%

 

 

 

 

 

Degree Representation

 

 

AB, ScB

1

1%

 

PhD

50

31%

 

MD

110

67%

 

RN, PhD

2

1%

 

Total

163

100%

 

*PhD includes other doctorate degrees (i.e., DSW, DrSc, ScD, etc.)

 

 

 

 

Sex

 

 

 

Female

49

30%

 

Male

114

70%

 

Total

163

100%

 


* Note: 4 candidates withdrew after having been appointed, they were 3 male MDs and 1 female PhD, 2 from the U.S., 1 from Netherlands and 1 from Switzerland.

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