Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-23T08:42:40.003Z Has data issue: false hasContentIssue false
  • English
  • Français

Expert consensus v. evidence-based approaches in the revision of the DSM

Published online by Cambridge University Press:  13 April 2016

K. S. Kendler  and
M. Solomon
K. S. Kendler*
Affiliation:
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA Department of Psychiatry, Virginia Commonwealth University, Richmond VA, USA Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
M. Solomon
Affiliation:
Department of Philosophy, Temple University, Philadelphia, PA, USA
*
*Address for correspondence: Professor K. S. Kendler, VCU, Box 980126, Richmond, VA 23298-0126, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

The development of DSM-III through DSM-5 has relied heavily on expert consensus. In this essay, we provide an historical and critical perspective on this process. Over the last 40 years, medicine has struggled to find appropriate methods for summarizing research results and making clinical recommendations. When such recommendations are issued by authorized organizations, they can have widespread influence (i.e. DSM-III and its successors). In the 1970s, expert consensus conferences, led by the NIH, reviewed research about controversial medical issues and successfully disseminated results. However, these consensus conferences struggled with aggregating the complex available evidence. In the 1990s, the rise of evidence-based medicine cast doubt on the reliability of expert consensus. Since then, medicine has increasingly relied on systematic reviews, as developed by the evidence-based medicine movement, and advocated for their early incorporation in expert consensus efforts. With the partial exception of DSM-IV, such systematic evidence-based reviews have not been consistently integrated into the development of the DSMs, leaving their development out of step with the larger medical field. Like the recommendations made for the NIH consensus conferences, we argue that the DSM process should be modified to require systematic evidence-based reviews before Work Groups make their assessments. Our suggestions – which would require leadership and additional resources to set standards for appropriate evidence hierarchies, carry out systematic reviews, and upgrade the group process – should improve the objectivity of the DSM, increase the validity of its results, and improve the reception of any changes in nosology.

Keywords

DSMevidence-based medicineexpert consensus
Type
Review Article
Information
Psychological Medicine , Volume 46 , Issue 11 , August 2016 , pp. 2255 - 2262
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agency for Healthcare Research and Quality (2015). Evidence-Based Practice Centers (EPC) Program Overview. August 2015 (internet citation). Agency for Healthcare Research and Quality: Rockville, MD.Google Scholar
Ahrens, EH (1985). The diet-heart question in 1985: has it really been settled? Lancet 1, 1085–1087.Google Scholar
APA (1968). Diagnostic and Statistical Manual of Mental Disorders, 2nd edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (1987). Diagnostic and Statistical Manual of Mental Disorders – Revised, 3rd edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association: Washington, DC.Google Scholar
Antman, EM, Lau, J, Kupelnick, B, Mosteller, F, Chalmers, TC (1992). A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. Journal of the American Medical Association 268, 240–248.Google Scholar
Decker, HS (2013). The Making of DSM-III: A Diagnostic Manual's Conquest of American Psychiatry, 1st edn. Oxford University Press: Oxford, UK.Google Scholar
Evidence-, based Medicine Working Group (1992). Evidence-based medicine. A new approach to teaching the practice of medicine. Journal of the American Medical Association 268, 2420–2425.Google Scholar
Institute of Medicine (1990). Institute of Medicine, Consensus Development at NIH: Improving the Program, Report of a Study by a Committee of the Instutite of Medicine Council on Health Care Technology 1990, National Academies Press: Washington, D.C.Google Scholar
Jacoby, I (1988). Evidence and Consensus. Journal of the American Medical Association 259, 3039.Google Scholar
Janis, IL (1983). GROUPTHINK: Psychological Studies of Policy Decisions and Fiascoes, 2nd edn, revised. Houghton Mifflin Company: Boston.Google Scholar
Kendler, KS (1990). Toward a scientific psychiatric nosology. Strengths and limitations. Archives of General Psychiatry 47, 969–973.Google Scholar
Kendler, KS (2013). A history of the DSM-5 Scientific Review Committee. Psychological Medicine 43, 1793–1800.CrossRefGoogle ScholarPubMed
Leshner, A, Davidson, E, Eastman, P, Grundy, S, Kramer, B, McGowan, J, Penn, A, Strauss, S, Woolf, S (1999). Report of the working group of the advisory committee to the director to review the Office of Medical Applications of Research, 5 August 2015.Google Scholar
Mullan, F, Jacoby, I (1985). The town meeting for technology. The maturation of consensus conferences. Journal of the American Medical Association 254, 1068–1072.CrossRefGoogle ScholarPubMed
Myers, DG (1982). Polarizing effects of social interaction. In Group Decision Making (ed. Brandstätter, H., Davis, J. H. and Stocker-Kreichgauer, G.), pp. 125–161, Academic Press: London.Google Scholar
Oxford Centre for Evidence-based Medicine (2009). Levels of evidence, 3 March 2009.Google Scholar
Robins, E, Guze, SB (1970). Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry 126, 983–987.Google Scholar
Solomon, M (2015). Making Medical Knowledge, 1st edn. Oxford University Press: New York, NY.Google Scholar
Sunstein, CR (2003). Why Societies Need Dissent. Harvard University Press: Cambridge, MA.Google Scholar
Surowiecki, J (2004). The Wisdom of Crowds. Doubleday: New York.Google Scholar
Sutherland, WJ, Burgman, M (2015). Policy advice: use experts wisely. Nature 526, 317–318.CrossRefGoogle ScholarPubMed
Tversky, A, Kahneman, D (1982). Judgment under uncertainty: heuristics and biases. In Judgment Under Uncertainty: Heuristics and Biases, 1st edn (ed. Kahneman, D., Slovic, P. and Tversky, A.), pp. 3–23. Cambridge University Press: Cambridge.Google Scholar
Widiger, TA, Frances, AJ, Pincus, HA, Davis, WW (1990). DSM-IV Literature Reviews: Rationale, Process, and Limitations. Journal of Psychopathology and Behavioral Assessment 12, 189–202.Google Scholar
Wikipedia contributors (2015). Groupthink (https://en.wikipedia.org/w/index.php?title=Groupthink&oldid=674546069). Wikipedia, The Free Encyclopedia. 6 August 2015.Google Scholar