Just as many authors of the new psychiatry “bible” are tied to the drugs industry as those who worked on the previous version, a study has found, despite new transparency rules.

The findings raise concerns over the independence of the revamped Diagnostic and Statistical Manual of Mental Disorders, or DSM, published by the American Psychiatric Association (APA) and scheduled for publication in May 2013.

For the current rewrite, known as DSM-5, the APA for the first time required authors to declare their financial ties to industry. It also limited the amount they could receive from drug companies to $10,000 a year and their stock holdings to $50,000.

“Transparency alone can’t mitigate bias,” says Lisa Cosgrove of Harvard University, who along with Sheldon Krimsky of Tufts University in Medford, Massachusetts, analysed the financial disclosures of 141 members of the “work groups” drafting the manual. They found that just as many contributors – 57 per cent – had links to industry as were found in a previous study of the authors of DSM-IV and an interim revision, published in 1994 and 2000 respectively.


Cosgrove also points out that the $10,000-per-year limit on payments excludes research grants. “Nothing has really changed,” she says.

What’s more, the work groups that had the most members with ties to the pharmaceutical industry were considering illnesses for which drugs are the front-line treatment – and for which proposed changes to diagnostic categories are especially controversial.

These include the mood disorders group, which proposes including bereaved people in the definition of major depression, and the psychotic disorders group, which is considering adding attenuated psychosis syndrome, a controversial diagnosis for identifying young people at risk of developing schizophrenia.

Critics claim that definitions of psychiatric illnesses have broadened over successive editions of the manual as a result of pressure from the pharmaceutical industry. A steep rise in the number of children given psychoactive drugs for bipolar disorder and attention-deficit hyperactivity disorder has been particularly controversial.

Cosgrove is especially concerned about DSM authors who serve on “speakers’ bureaus” – experts who are paid to lecture about a drug company’s products. These payments are not specifically identified in the DSM-5 disclosures, but web searches indicated that 15 per cent of the work group members were speakers’ bureau members.

Cosgrove wants the APA to remove authors who are on speakers’ bureaus before DSM-5 is finalised. She also wants the membership of work groups to be changed so that none has a majority of members with financial ties to industry.

James Scully, medical director of the APA, insists the association is “committed to evaluating and monitoring the issue of financial conflicts of interest”. He says the study “does not take into account the efforts by DSM-5 task force and work group members to divest themselves from relationships with the pharmaceutical industry”. The web searches for speakers’ bureau memberships go back to 2006, while the work groups were appointed between July 2007 and May 2008.

The DSM-5 proposals have also attracted criticism from psychologists, who tend to favour counselling over the drug treatments that dominate modern psychiatry. An online petition calling for greater involvement from psychologists has attracted more than 12,000 signatures, and is backed by professional bodies including 14 out of the 54 divisions of the American Psychological Association.

David Elkins, president of the Society for Humanistic Psychology, which wrote the open letter on which the petition is based, complains that psychiatrists have undue influence on how mental illness is defined.

“A small group with only 38,000 members has been for years responsible for telling the rest of the profession, consisting of hundreds of thousands of people, how to think about mental disorders,” says Elkins. “I think we tapped into a groundswell of mental health professionals who are not going to tolerate this.”

In January, the psychologists behind the open letter wrote to the APA asking for an independent scientific review of diagnostic changes planned for DSM-5.

The APA has rejected this call: “There is, in fact, no outside organisation that has the capacity to replicate the range of expertise that DSM-5 has assembled over the past decade to review diagnostic criteria,” replied APA president John Oldham.

Journal reference: PLoS Medicine, DOI: 10.1371/ journal.pmed.1001190