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From the Editor

DSM-5

A Work in Progress

Oldham, John Editor MD

Journal of Psychiatric Practice: November 2010 - Volume 16 - Issue 6 - p 371
doi: 10.1097/01.pra.0000390755.30130.c7
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November, 2010. There has been wide interest in the work of the American Psychiatric Association Task Force that is developing the draft changes being considered for DSM-5, now scheduled for publication in 2013. After extensive deliberation by experts in 13 workgroups and 6 “cross-cutting study groups,” the proposed changes were posted for public comment from February 10 to April 20, 2010. More than 8,600 comments were received, which led to revision and further development of the proposed changes. Out of approximately 50 full applications that were received, 11 sites were selected to carry out Field Trials, which are currently being launched.

The complex challenge of making changes in our diagnostic system is daunting and involves careful review of published research, along with input from wise and experienced clinicians and from many stakeholder groups, including patients and their families. Careful thought must be given to potential unintended consequences of any change, such as forensic concerns, insurance coverage, epidemiologic prevalence estimates, and many others. One additional challenge facing the Task Force is the need to “harmonize” the classification categories in DSM-5 with the International Classification of Diseases system, so that common numerical codes can be in place. Interesting information that you may not know is that the United States currently uses ICD-9 codes, even though ICD-10 was published in 1990 and adopted by most World Health Organization “member states” in 1994. Congress has directed the implementation of ICD-10 in the United States on October 1, 2013 (only 23 years after its initial publication, and despite the fact that ICD-11 is scheduled to be published in 2014). A “meta-structure” study group for DSM-5 is working on a “crosswalk” to allow DSM-5 to utilize common codes with ICD, but many challenges remain. In this issue of the Journal, Pierre reviews the development of our diagnostic manual, and he describes in interesting detail some of the cross-currents and controversies involved in the current efforts to develop DSM-5.

Also in this issue, Cohen and colleagues present data in two related papers, comparing patients who have been diagnosed with pedophilia with patients struggling with problems of addiction—focusing on sexual histories and on executive functioning. These conditions, by the way, illustrate one of the forensic issues facing DSM-5—how do we differentiate valid psychiatric disorders from illegal behavior or “social deviance”? In a very different realm, Privitera and colleagues report on the use of light therapy as an intervention for seasonal affective disorder. Here again, we must consider that there is a spectrum from “normal winter blues” to a valid, potentially treatable mood disorder. The classification of human behavior, along the gradient from what we call normal to what we call abnormal, is challenging indeed!

John Oldham MD

Editor

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