7/30/2019 DSM5 Ignore Dont Use It Allen Frances
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Does DSM-5 Have a Captive Audience?
DSM-5 sells at a price gouging $200 per copy. The American
Psychiatric Association has assumed that it has a fully
captiveaudience of people who will feel compelled to buy DSM-5 for
coding and reimbursement purposes -- even if they don't like
itscontents or cost.
To reinforce this rather cynical selling point, APA recently
posted a misleading statement implying that DSM-5 has some sort
ofofficial status. The message is that clinicians and institutions
must buy DSM-5 if they hope to be reimbursed by insurance.
This is simply not the case. The only official codes are the
ones provided by the International Classification of Disease (ICD)
-- inthe U.S., that now means ICD-9-CM. The editors of DSMs simply
pick the ICD codes they feel most resemble the DSM categories.Their
choices are based solely on their own opinions, not through any
officially sanctioned mechanism and they carry no specialweight.
There is nothing sacred about the DSM-5 choices -- I know because I
am the one who made the final choices for DSM-IV.
So there is no reason for potential buyers of DSM-5 to feel the
slightest bit captive or intimidated by APA. The DSM-5 codes will
beessentially the same as the old ICD-9-CM codes that are already
contained in DSM-IV.
People who are concerned about the risky suggestions in DSM-5,
or are angry about its startling price tag, can simply stick
tocoding using their old DSM-IV. Or they can buy one of many
alternative guides to psychiatric diagnosis that will be available
(COIdisclosure -- I have written one of these myself.) Or they can
download the ICD-9-CM codes completely for free here.
My advice to clinicians, insurance companies, educators, and
policy makers is simply to ignore DSM-5. Its suggestions
arereckless, unsupported by science, and likely to result in a
great deal of loose, inaccurate diagnosis and unnecessary, harmful,
and
costly treatment.
Diagnostic inflation is already running rampant at what seems
like an accelerating pace. Last week the CDC reported that rates
ofautism had jumped rapidly once again to one in 50 -- 40 times
greater than 20 years ago and up from one in 80 last year and one
in110 two years ago.
The CDC also found that a ridiculous 20 percent of high school
boys now have a diagnosis of ADD and that a troubling 10 percentare
on medication. This makes no sense.
DSM-5 threatens to turn the current diagnostic inflation into
future hyper-inflation.
My advice -- the best protection against wild over-diagnosis is
to ignore DSM-5. It is not official. It is not well done. It is not
safe.Don't buy it. Don't use it. Don't teach it.
Allen Frances is a professor emeritus at Duke University and was
the chairman of the DSM-IV task force.
Apr il 1 4, 20 1 3
Posted: 04/14/2013 2:58 pm
http://www.huffingtonpost.com/science/http://www.huffingtonpost.com/science/http://www.huffingtonpost.com/allen-frances/www.nytimes.com/2013/04/01/health/more-diagnoses-of-hyperactivity-causing-concern.htmlhttp://thechart.blogs.cnn.com/2013/03/20/cdc-number-of-children-with-autism-higher-than-previously-thought/http://www.cdc.gov/nchs/icd/icd9cm.htmhttp://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Insurance-Implications-of-DSM-5.pdf
