The American Psychiatric Association announced yesterday that the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) will be delayed until 2013. Although the APA’s press release (copied in full below) emphasizes coordination with the next edition of the European International Classification of Diseases, the development of the new edition of the DSM has been dogged with controversy about the insularity of the committee responsible for deciding which psychiatric conditions to include (see here, here, and here). Inclusion in the DSM facilitates coverage by private insurance companies in the US, which in turn means a bonanza for the pharmaceutical companies holding the patents to treatments for those conditions. Lack of inclusion means lack of coverage for that condition, and corresponding lack of revenue for the relevant pharmaceutical companies. Billions of dollars are at stake.
The sudden announcement comes in the wake of a damning report on APA’s handling of the DSM-V process by American Scientist, and an editorial calling for a halt.
For Information Contact:
Beth Casteel 703-907-8640
Jaime Valora 703-907-8562
For Immediate Release:
December 10, 2009
Release No. 09-65
DSM-5 Publication Date Moved to May 2013
ARLINGTON, Va. (Dec. 10, 2009) – The American Psychiatric Association revised the timeline for publishing the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, moving the anticipated release date to May 2013.
“Extending the timeline will allow more time for public review, field trials and revisions,” said APA President Alan Schatzberg, M.D. “The APA is committed to developing a manual that is based on the best science available and useful to clinicians and researchers.” The extension will also permit the DSM-5 to better link with the U.S. implementation of the ICD-10-CM codes for all Medicare/Medicaid claims reporting, scheduled for October 1, 2013. Although ICD-10 was published by the WHO in 1990, the “Clinical Modification” version (ICD-10-CM) authorized by the U.S. Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control (CDC) is not being implemented in the U.S. until 23 years later. The ICD-10-CM includes disorder names, logical groupings of disorders and code numbers but not explicit diagnostic criteria. The APA has already worked with CMS and CDC to develop a common structure for the currently in-use DSM-IV and the mental disorders section of the ICD-10-CM.
The International Classification of Diseases (ICD) is published by the WHO for all member countries to classify diseases and medical conditions for international health care, public health, and statistical use. The WHO plans to release its next version of the ICD, the ICD-11, in 2014. APA will continue to work with the WHO to harmonize the DSM-5 with the mental and behavioral disorders section of the ICD-11. Given the timing of the release of both DSM-5 and ICD-11 in relation to the ICD-10-CM, the APA will also work with the CDC and CMS to propose a structure for the U.S. ICD-10-CM that is reflective of the DSM-5 and ICD-11 harmonization efforts. This will be done prior to the time when the ICD-10-CM revisions are “frozen” for CMS and insurance companies to prepare for the October 1, 2013, adoption.
David Kupfer, M.D., chair of the DSM-5 Task Force, which is in charge of the DSM revision process, noted that draft changes to the DSM will be posted on the DSM-5 Web site in January 2010. Comments will be accepted for two months and reviewed by the relevant DSM-5 Work Groups in each diagnostic category. Field trials for testing proposed changes will be conducted in three phases.
The process for developing the DSM-5 began a decade ago, with an initial research planning conference under the joint sponsorship of the APA and the National Institute of Mental Health. Additional global research planning conferences, under the auspices of the American Psychiatric Institute for Research and Education (APIRE), the World Health Organization, and three institutes of the National Institutes of Health produced a series of monographs, which helped lay the groundwork for the revisions. The APA’s DSM-5 Task Force and Work Group members were identified in 2007; they are tasked with reviewing scientific advances and research to develop draft diagnostic criteria in diagnostic categories of psychiatric disorders. Information about the revision process is available online at www.DSM5.org.
The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psych.org and www.healthyminds.org.