A former head of the UBC psychiatry department and a University of Amsterdam professor have resigned from the committee classifying personality disorders for health practitioners and researchers around the world.
Dr. John Livesley, now a UBC professor emeritus, and Dr. Roel Verheul wrote a joint email explaining why they quit in April from the Personality Disorder Work Group for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the DSM-5.
"As it stands now, the DSM 5 personality section is not readable, much less usable," Livesley and Verheul wrote. "It will be ignored by clinicians and will do grave harm to research. This is the sad product of small group of cloistered DSM 5 'experts' stubbornly ignoring the sharp criticism from within their own group and the near universal rejection of their proposals by everyone else in the field."
Their email, which was recently posted on the Psychology Today website, declares that the work group "has advanced a proposal that is seriously flawed".
"It has also demonstrated an inability to respond to constructive feedback both from within the Work Group and from the many experts in the field who have communicated their concerns directly and indirectly," Livesley and Verheul stated. "We also regret the need to resign because we were the only International members of the Work Group which is now without representation from outside the US."
Livesley is an internationally recognized expert in borderline personality disorder, which leads about two percent of adults to feel tormented by unstable relationships, moods, and behaviour.
Verheul's research focuses on the efficacy and cost-effectiveness of psychotherapeutic treatment of personality disorders.
The DSM-V is expected to be released in May 2013.
"We did not resign earlier because we continued to cherish the hope that eventually science and common sense would prevail and that there would be an opportunity to construct a coherent, evidence-based classification that would help to advance the field and facilitate patient care," the two experts noted in their email. "In the spring of this year, it became apparent that is was not going to happen. We considered the current proposal to be fundamentally flawed and decided that it would be wrong of us to appear to collude with it any longer."
Specifically, they claimed that the proposed classification "is unnecessarily complex, incoherent, and inconsistent", which has the potential to interfere with its utility.
First, they objected to the juxtaposition of two distinct classifications, arguing that this will create confusion for clinicians.
"Second, the proposal displays a truly stunning disregard for evidence," Livesley and Verheul maintained. "Important aspects of the proposal lack any reasonable evidential support of reliability and validity. For example, there is little evidence to justify which disorders to retain and which to eliminate. Even more concerning is the fact that a major component of proposal is inconsistent with extensive evidence."
The DSM has already come under fire
This latest attack on the DSM-V comes nearly a year after UBC law professor Joel Bakan delivered a withering exposé in his book Childhood Under Siege: How Big Business Targets Children.
He cited a study showing that every member of DSM-IV panels on mood disorders, schizophrenia, and other psychotic disorders had ties to at least one pharmaceutical company.
Furthermore, Bakan pointed out that the creator of the modern DSM system, Robert Spitzer, and the researcher who oversaw the DSM-IV, Allen Frances, believe that the DSM-V "could push psychiatry even deeper into the arms of the pharmaceutical industry by including, as it likely will, subthreshold (such as mild depression) and premorbid (such as prepsychotic) categories".
The two experts are even quoted telling the American Psychiatric Association that it "might well be accused of a conflict of interest in fashioning DSM-V to create new patients for psychiatrists and new customers for the pharmaceutical companies".
This, according to Frances, will lead to "a wholesale medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatments—a bonanza for the pharmaceutical industry but at a huge cost to the new false-positive patients caught in the excessively wide DSM-V net".
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