National Institute For Mental Health Abandons DSM Just As American Psychiatric Association Prepares Massive Update
from the good-for-them dept
The American Psychiatric Association’s infamous DSM or Diagnostic and Statistical Manual of Mental Disorders is often called “the Bible” of classifications for mental illnesses, but it’s perhaps almost as famous for its problems than for any usefulness. The list of criticisms and controversies over the DSM are pretty long, and there are significant concerns about the fact that it’s not scientific, and that it falls sway to both extreme biases of psychiatrists and their overall profession as well as general cultural biases. The most famous bit of controversy, of course, is that it used to include homosexuality as a mental disorder — which should be an indication of how trustworthy the book is (i.e., it’s not, at all). More recently, the discussion to possibly include internet addiction (or, more officially “Internet Use Disorder” or IUD) in DSM-5 caused a fair bit of mocking.
That’s why it’s great to see that the National Institute of Mental Health has declared that it’s effectively abandoning the DSM just as the APA releases the long awaited DSM-5. After highlighting many of the problems with the DSM, it notes:
But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.” The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.
That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.
As others have noted, this is a “potentially seismic move” since the NIMH is so central to funding so much research concerning mental health.