We’ve all wondered at one time or another what kinds of forces drive revision/development of DSMs. We hope that those on the committees and in other drivers’ seats have the best interest of patients (at minimum) and the science of psychiatry (optimally) in mind. We know of the rumor that revisions are driven, somewhow, in dark shadowy realms and in closed-door meetings (are they different?) by Big Pharma. And we’ve heard those rumors try to be quashed. Now, in the latest public statement on Medscape about bipolar disorder criteria revisions, we hear exactly, and without sugar-coating, that drug-development is driving the revisions. And it makes me sick. It seems as though the cart is being put before the horse; revision for the sake of drug development rather than revision for the purposes of creating increasingly valid diagnoses — and that would fully be enough of a reason by itself.
“Many of these revisions are an effort to capture more clearly what our patients experience and to provide an opportunity to study in a more focused manner the full spectrum of mood disorders,” said Dr. Suppes.
“We’re basically working towards a new classification system, with new codes and new billable options, and I think it’s likely that out of this, new [Food and Drug Administration] targets for drug development will emerge.”
from: Criteria Changes for Bipolar Disorder Proposed for DSM-5
Time for a specialty change?
Treatment as Usual 