By Galen Strawson
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Caplan, ; Follette and Houts, ; Kirk and Kutchins, ; Rogler, ; Schacht, ; Zimmerman, ). The American Psychiatric Association does have a tremendous responsibility and burden in controlling the process and outcome of the DSM. Part of this burden is to ensure that it does not exploit this power to serve its own ends. This is indeed a heavy responsibility, and one that would be difficult for any organization to fulfill, including the American Psychological Association. In my opinion, the American Psychiatric Association is to be commended for the conscientious effort it has made and for all it has done for the field of psychopathology with each edition of the DSM.
Another problem with some of the suggested additions was the potential for misuse. Would the condition be inappropriately used once it was disseminated more broadly? Do the data support the fact that it can be reliably assessed by average clinicians? Yet another concern was the added complexity of the system. Ultimately, there had to be a substan- 18 Introduction and Background tial amount of evidence—from peer-reviewed literature—to add something new to the DSM-IV. Unlike the DSM-III and DSM-III-R, which included more categories so as to help stimulate research, the DSM-IV was intended to be led by research.
Small picture” issues) related to the actual content of the DSM which were discussed earlier. Among these are decisions about what disorders are added or deleted, revisions to the criteria sets, subtyping of disorders, the organization and placement of disorders in the DSM, and, finally, text revisions. There are many issues to address, studies to conduct, and evidence to gather, but not all of these can be done. Priorities need to be set. In addition, some “nonevidence” items are actually subject to a kind of evidentiary evaluation.