ACA Expresses DSM-5 Concerns to the American Psychiatric Association

Nov 28, 2011
ACA President Don W. Locke has sent a letter to the American Psychiatric Association on behalf of professional counselors expressing current concerns about the DSM-5 revision process.


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Controversial Revisions to DSM and Lack of Open Process, Scientific Rigor Cited

Alexandria, VA (Nov. 28, 2011). . . .The American Counseling Association (ACA) expressed its alarm recently over several proposed changes to the chief tool used by mental health professionals to determine a diagnosis for their clients.

The main concerns regarding revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA) and due out in 2013, are insufficient scientific and validation data to back up the proposed revisions, lack of transparency in the development process, and a rewrite of the definition of mental disorder implying that all mental disorders have a biological component.

In a Nov. 8 letter from ACA President Dr. Don W. Locke to APA President Dr. John Oldham, Locke indicated that there are 120,000 licensed professional counselors in the U.S. -- the second largest group that routinely uses the DSM -- and that these professionals have expressed uncertainty about the quality and credibility of the DSM-5. (The edition of the DSM in use now is the 4th edition.)

In general, ACA is concerned that many of the proposed revisions will promote inaccurate diagnoses, diagnostic inflation, and the prescribing of unnecessary and potentially harmful medication.

One of the major areas of concern for professional counselors is the proposed definition of mental disorders. The language suggested implies that all mental disorders have a biological component. An example of mental disorders that do not necessarily have a biological basis is the severe anxiety an individual may face upon losing a job. This is an environmental issue, according to ACA, not necessarily a problem rooted in biology. The trauma faced by an earthquake victim or the grief following the death of a loved one are other examples of mental conditions that might lead an individual to seek therapy, yet would not qualify under the proposed definition emphasizing a biological basis.

"Although advances in neuroscience have greatly enhanced our understanding of psychopathology, the current science does not fully support a biological connection for all mental disorders," Locke stated in the letter.

According to Rebecca Daniel-Burke, staff liaison on the ACA DSM task force, "in general, counselors are against pathologizing or 'medicalizing' clients with diagnoses as we prefer to view clients from a strength-based approach and avoid the stigma that is often associated with mental health diagnoses."

The revision has generated controversy among many mental health professionals who not only disagree with some of the content, but also with the process and the lack of scientific rigor. For example, all work group members were required to sign confidentiality agreements prohibiting them from divulging information about the DSM-5 process, even after it is published, and the DSM-5 scientific review process is confidential and not available for public inspection. This is a violation of one of the most basic and vital tenets of science -- open access to data and/or processes for independent evaluation and critique.

ACA appointed a task force to work on this issue in 2010. In the letter, ACA called for an independent scientific review to ensure that counselors can have faith that the DSM-5 will be a safe and scientifically sound guide to psychiatric diagnosis.

In a reply dated Nov. 21, APA addressed ACA's concerns and expressed their strong desire to ensure that the DSM-5 is a tool that is useful to the counseling profession and all mental health providers. The letter also stated that the definition of mental disorder is still a work in progress and, in fact, a revised definition will be posted in the spring and will be open to another round of public comment.

The American Counseling Association ( is a not-for-profit professional and educational organization that is dedicated to the growth and enhancement of the counseling profession. Founded in 1952, ACA is the world's largest association exclusively representing professional counselors in various practice settings.

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