Tag Archives: American Psychiatric Association

The problem with the DSM

Do you have a shopping addiction disorder? Perhaps an addiction to food? Maybe one of your kids has Internet addiction disorder, or video-game attachment syndrome. Well, not quite yet, because these kinds of new mental diagnoses are only proposed, not final, for the new revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of the American Psychiatric Association (APA).

And there is a terrible problem with this. The DSM was first created in the 1920s. Based on psychoanalytic theory, it enumerated fewer than 100 mental problems that a psychiatrist could diagnose, all of them attributable to environmental conditions, generally the role of parenting. We know now that this theoretical stance was limited and, in many cases, wrong. In 1980, the second revision of the DSM took place. Freud was discarded, and the revised bible now included several hundred disorders, all delineated by a list of observable symptoms and a framework for limiting and differentiating diagnoses.

Three versions later, the current DSM lists more than 1,000 disorders. No theories are espoused for their origins, though implicit in it is that there is a mix of genetic and environmental causes that shape neurological development. During this period of about three decades, the incidence of attention disorders in the general population has increased from 2 percent to 10 percent. In the 1980s, people diagnosed with bipolar disorder represented less than 1 percent of the population; now the number has increased to 5 percent. New diagnoses, like oppositional defiant disorder and conduct disorder, now cover as many as 5 percent of children.

Autism, which afflicted a tiny percentage of the population in the 1990s, now accounts for 1 out of every 100 children. What is wrong with this picture? Do we have an epidemic on our hands? Something in the water we drink, or the air we breathe?

The business of ADHD

As the DSM-V looms closer to becoming a reality, I can’t help but think of words from the man who chaired the committee for the DSM-IV. Allen Frances, M.D., wrote in the in the LA Times:

As chairman of the task force that created the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which came out in 1994, I learned from painful experience how small changes in the definition of mental disorders can create huge, unintended consequences.

Our panel tried hard to be conservative and careful but inadvertently contributed to three false ‘epidemics’ – attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many ‘patients’ who might have been far better off never entering the mental health system.

American Psychiatric Association Stunned Again with Ghostwriting Controversy

Like an aging, punch drunk fighter struggling through the twelfth round, the American Psychiatric Association (APA) can’t seem to slip the punches coming its direction. Last week, a host of blogs went after them for refusing to print a letter written by three academics that was critical of a medical textbook the APA published with help from the ghostwriting company Scientific Therapeutics Information (STI).

The letter criticized the APA for failing to publish records that explain the provenance of the textbook, including drafts, contracts with STI and/or GlaxoSmithKline, and any communications regarding editing. The text’s purported authors are Dr. Charles Nemeroff of the University of Miami and Dr. Alan Schatzberg of Stanford University.

As The New York Times reported, the textbook was funded by GlaxoSmithKline. Author and blogger Dr. Danny Carlat reviewed the book and wrote that it read like “an advertisement for Paxil.”

Yesterday, a writer over at MIWatch landed a blistering combination on the APA. When she poked them for a response, the APA covered up and peeked back through their gloves. “The APA’s official response has been unconvincing,” she jabbed.

She then landed a solid uppercut.

American Psychiatric Association’s Ghost Written (Allegedly Pharma Funded) Book Magically ‘Disappears’

File this under The Case of The Missing Book. When last seen, Scientific Therapeutics Information was at the center of an ongoing controversy over an allegedly ghostwritten book – yes, an entire book – that was published in 1999 by the American Psychiatric Association. Funding came from a grant provided by SmithKline Beecham, which is now part of GlaxoSmithKline (back story).

The listed co-authors were Charles Nemeroff, who chairs the psychiatry department at the University of Miami medical school, and Alan Schatzberg, who until recently chaired the psychiatry department at the Stanford University School of Medicine. Both men were at the center of a long-running probe by the US Senate Finance Committee into undisclosed conflicts of interest among academic researchers. They were also regular speakers for Glaxo, which makes the Paxil antidepressant