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Newsflash From APA Meeting: DSM-5 Has Flunked Its Reliability Tests- So why is it still being published in May 2013??
- The writing of the DSM-5 criteria sets was far too raw and imprecise to be ready for the rigors of field testing. The ambiguity cried out for expert editing, without which reasonable reliability is impossible.
- The design of the field trial was byzantine in complexity and could never be done on schedule.
- Constant delays in starting and completing Stage 1 of the study forced DSM-5 to cancel the planned Stage 2, which was meant to clean up the poorly performing criteria sets identified in the first stage.
- With Stage 2 cancelled without explanation, it looks like even the worst diagnoses are being given a social pass.
- Most absurdly, the design was totally off-point, failing to ask the only question that really counted: the impact of DSM-5 on rates.
- DSM5 ; DSM4; ICD10; DSM3
GAD. .2 .65. .30 .72
PTSD. .67 .59. .76 .55
Schizophr.. .46 .76. .79 .81
Bipolar .1 .54. .69
MDD. .32 .59. .53 .80
Maj neuro .78. .6 .91
Mild. ". .50
Alc use. .4. .71. .8
Bipolar 2. .40
Antisoc pd. .22
Autis spec. .69 .85. .77. .01
ADHD. .61. .59. .85 .50
ODD. .41. .55. .66
Conduct. .48 .57 .78. .61
Some of the reliability scores are shamefully poor e.g. antisocial disorder, ODD, OCD, MADD, MDD, GAD and Bipolar 1 + 2. THIS UNDERMINES THE SCIENTIFIC VALIDITY OF USING DSM5 OUTCOMES AS A RELIABLE INDICATOR OF THESE CONDITIONS
What can be done to salvage this deplorable mess?
- DSM-5 has never had anyone on board who could write a clean, consistent, unambiguous criteria set. DSM-5 appears to have received either no editing at all, or amateur editing at best. Getting the words right is certainly not enough, but if you can't even get them right, nothing else can ever be safe.
- For DSM-5 to retrieve credibility, it must complete the second planned stage of its field testing. If doing the job right must delay publication, so be it. Public trust must trump private publishing profits, and it is self-defeating for APA to publish a book no one can trust.
I have been consistently pessimistic and critical about DSM-5 since my first piece on it three years ago. The sad thing is I can still be so surprised. Each step of the way I predict it will fail in one or another way. But then I discover that DSM-5 has managed to fail in ways that go beyond my poor imagination. This assault on reliability was predicted, but its scope exceeds even my jaundiced fears and creates a DSM-5 emergency.