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 EDITORIAL

DSM-5 is approved, but personality disorders criteria have not changed

Donald W. Black, MD

Editor-in-Chief

The American Psychiatric Association (APA) Assembly approved DSM-5 at its November meeting in Washington D.C. Although many of us have pet peeves about DSM-5, most of the changes are positive and will be embraced by psychiatrists and other mental health professions.

Some important changes have received little attention because the media focused on “hot button” issues, such as a combined category for autism spectrum disorders and ditching the “bereavement exclusion” for major depressive disorder. Other decisions may have greater impact, such as merging substance abuse and dependence categories and revamping somatizing disorders (now somatic symptom disorders). Specious arguments were made, such as that changes were made to boost prescription medication use. These arguments ignore the contributions of honorable psychiatrists and psychologists who worked on DSM-5 tirelessly and without compensation.

The APA Board of Trustees chose not to approve the overly complex scheme proposed by the Personality Disorders Work Group—which I have criticized in this column—and substituted the DSM-IV-TR personality disorder criteria. The Work Group overreached and, in my view, ignored the needs of psychiatrists and their patients. Common sense prevailed in the end.

We begin 2013 with a study by Christina M. Dording, MD, and colleagues who assessed the impact of sildenafil on quality of life in patients participating in the STAR*D antidepressant trials, and concluded that sexual function improved as did overall satisfaction and contentment. No surprise there, but this was important to document.

Maren Nyer, PhD, and colleagues—including Annals of Clinical Psychiatry (ACP) editorial board member Maurizio Fava, MD—found that college students with suicidal thoughts had greater levels of depression and hopelessness than depressed students without suicidal thoughts, but day-to-day functioning was unimpaired. This is an example of the “walking wounded”—persons who are symptomatic, but still able to function.

Dr. Soon-Beon Hong, MD, PhD, and colleagues found that family size and frequent changes of primary caregiver—often proxies for family chaos—were related to the development of tics and argued for the importance of family education. An intriguing contribution from Alina Surís, PhD, ABPP, and collaborators—including ACP editorial board member Carol S. North, MD, MPE—investigated the use of sirolimus, thought to inhibit fear memory reconsolidation, and found a signal in post-Vietnam era veterans. This not only points us in another direction for posttraumatic stress disorder psychopharmacology, but also demonstrates the values of careful exploratory analyses.

Nagy A. Youssef, MD—an ACP editorial board member—and colleagues provide a study on resilience in veterans and its impact on suicidality. Until now, researchers have been concerned with what may have contributed to a suicide rather than what may have prevented one. Not surprising, resilience was associated with lower rates of suicidality.

Please remember our American Academy of Clinical Psychiatrists/Current Psychiatry CME meeting (“Psychiatry Update 2013: Solving Clinical Challenges, Improving Patient Care”), which will take place in Chicago on April 4 to 6 at the Swissôtel Chicago. We have top-notch speakers and will focus on psychotic disorders, mood and anxiety disorders, cognitive disorders, and substance-related disorders.

Donald W. Black, MD
Editor-in-Chief