The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In 2022, a revised version (DSM-5-TR) was published.
In the United States, the DSM serves as the principal authority for psychiatric diagnoses. In 1993 Labor Code 3208.3 was amended to require that a compensable psychiatric injury must be diagnosed “using the terminology and criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, or the terminology and diagnostic criteria of other psychiatric diagnostic manuals generally approved and accepted nationally by practitioners in the field of psychiatric medicine.” Pursuant to L.C. 3202.3, diagnosis in California industrial injuries must now be made using DSM-V-TR which is the latest edition published by the APA.
Financial conflicts of interest are a pernicious problem across medicine, including psychiatry. A study, published in 2006, found that there were strong financial ties between the pharmaceutical industry and DSM-IV panel members in charge of developing and modifying the diagnostic criteria for mental illness. These connections were notably strong in diagnostic areas that had pharmacological treatment as the first line intervention. In 2007, the American Psychiatric Association (which produces the DSM) developed a conflict of interest policy.
In 2012, a year before DSM-5 was published, the same authors replicated their earlier study. Unfortunately, the American Psychiatric Association’s new disclosure policy had not been accompanied by a reduction in financial conflicts of interest. In fact, on three quarters of the panels a majority of members had financial ties to the pharmaceutical industry. Once again, the panels with the most conflicts of interest were concentrated among mental disorders where drugs are the first line of treatment. Perhaps this is not surprising: transparency alone won’t prevent academics or researchers from having financial relationships with industry, and more robust measures are needed to protect the integrity of the DSM’s revision process.
And this January 2024 a new study was published in the BMJ examined the extent and type of conflicts of interest of panel and task force members of the recently published text revision of DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR).
In this newest study, 168 individuals were identified who served as either panel or task force members of the DSM-5-TR. 92 met the inclusion criteria of being a physician who was based in the US and therefore could be included in Open Payments. Of these 92 individuals, 55 (60%) received payments from the industry. Collectively, these panel members received a total of $14.2 million.
The authors of the study concluded that “Conflicts of interest among panel members of DSM-5-TR were prevalent. Because of the enormous influence of diagnostic and treatment guidelines, the standards for participation on a guideline development panel should be high. A rebuttable presumption should exist for the Diagnostic and Statistical Manual of Mental Disorders to prohibit conflicts of interest among its panel and task force members. When no independent individuals with the requisite expertise are available, individuals with associations to industry could consult to the panels, but they should not have decision making authority on revisions or the inclusion of new disorders.”