More Frequent DSM Updates Recommended

The possibility of developing a process for more frequent updates of the DSM has been discussed with APA's Committee on Psychiatric Diagnosis and Assessment and the Board of Trustees on several occasions over the past two to three years. Models for such updates are the AMA's CPT procedure codes, APA's practice guidelines, and the National Center for Health Statistics' ICD-9-CM annual updates of diagnostic codes. These organizations and agencies have established a permanent infrastructure to support regular reviews of emerging medical procedures, the clinical trials and other research bases to support treatment modifications, and proposals from the scientific community for changes in diagnostic names or code numbers. However, modifications of explicit diagnostic criteria in the DSM-III, DSM-III-R, DSM-IV, and DSM-IV-TR have not been made between revisions because of the absence of a credible, established scientific review structure and because of a concern that each change could have significant impacts on national and international research studies, which include the clinical trials that lend support for treatment guidelines.

The Division of Research is currently reviewing the research base for modifying diagnostic concepts and criteria in DSM-V with a $1.2 million grant from the National Institutes of Health. At the same time, we are examining alternatives both for modifying the text more frequently to reflect new associated features and for considering changes in the criteria for individual disorders when substantial scientific evidence supports such changes. ▪