english.prescrire.org > Spotlight > Archives : 2015 > Psychiatry: DSM-5 fraught with conflicts of interest

Spotlight: Archives

Every month, the subjects in Prescrire’s Spotlight.

2015 : 1 | 30 | 60

Psychiatry: DSM-5 fraught with conflicts of interest

The drawing-up of the American Diagnostic and Statistical Manual of Mental Disorders (DSM) is marred by conflicts of interest.

The American Diagnostic and Statistical Manual of Mental Disorders (DSM), produced by the American Psychiatric Association, is the standard work used worldwide for diagnosing psychiatric disorders. With each new update, both the DSM and the way it has been drawn up have attracted mounting criticism, especially due to the growing number of clinical pictures presented as pathological and requiring drug therapy.

Researchers have investigated how the Association has dealt with potential conflicts of interest with contributors to the 5th version of the DSM, published in 2013, and how many of them have interests in pharmaceutical companies

For six new controversial diagnostics, they checked to see whether any of the contributors had interests in the pharmaceutical companies financing clinical trials for these indications. For these six diagnostics, they identified 13 clinical trials involving 11 drugs. For 3 of the 13 clinical trials (23%), a contributor to the DSM had been a speaker for one of the companies. In 3 cases, the head researcher in the clinical trial also took part in drawing up the DSM-5. Ultimately, only one trial did not include any active members of the DSM-5 team. Of the 55 members of the groups working on one of these six diagnostics, 15 (27%) had at least one connection with one of the companies concerned, as well as 19 of the 33 members (61%) of the groups responsible for the final approval of the DSM-5.

Clearly, the working parties in charge of including new diagnostics in the DSM were influenced by the pharmaceutical companies. And these diagnostics correspond to the indications claimed for some drugs produced by these firms.

The porosity of this scientific association, incapable of putting in place effective regulations to distance itself from the pharmaceutical companies, discredits the DSM.

©Prescrire 1 January 2015

"DSM-5: riddled with conflicts of interest" Prescrire Int 2015; 24 (156): 4. (Pdf, free).
Download the full review.
Pdf, free

Classification of mental disorders:
beware of a dangerous trend
(January 2011)
Free

"Mental health", emotions,
psychological pain: just what
are we trying to treat?
(December 2010)
Free