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.

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Comments on “National Institute For Mental Health Abandons DSM Just As American Psychiatric Association Prepares Massive Update”

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Dennis S. (profile) says:

A couple of good articles from The Verge; first one goes into some detail on DSM criticisms.

The Verge – 2013-04-19 – Controversial update to ‘bible’ of psychiatry fuels debate over foundations of mental health – One book raises big questions

The Verge – 2013-05-03 – Federal institute for mental health abandons controversial ‘bible’ of psychiatry

Anonymous Coward says:

Re: Re:

It is an interesting problem. However, I think most people diagnosed will keep their mark and thus the effect will only be on newer cases. I konw several of the tests and I am not impressed by the methods used in the field in general for diagnosing purpose. In my opinion the DSM was more of a symptom of a profession who tried to run on past experience for way too long and didn’t sufficiently move in on blood tests and later diagnostic equipment to identify useful markers.

When that is said, psychiatrists already had a bad reputation compared to other doctors, so accepting biomarkers instead of “psychological tests” or “yes/no questionaire” is a tremendous improvement for my trust.

Btw: This move is probably gonna revolutionize the treatment of what was known as “major depressive disorder” since it has been a public secret that the symptoms cover a variety of biochemical imbalances with several unrelated underlying conditions. When it comes to other diagnoses it is gonna be a lot more hairy. The pop-diagnosies of Asperger’s or ADHD are gonna be almost impossible to keep up since everyone gets a benefit from ADHD medicin while nobody can see the exact symptoms for the highest functioning end of the autism spectrum.

Anonymous Coward says:

Re: Re:

You have to ask yourself several questions:

Why does mental diagnosises exist?
Is it relevant to treat?

In the end, it is just not a mental disorder. It can be a personality disorder, though, but the psychitric diagnosis is used for the patients treatment and since it is irrelevant for other mental illnesses or perception of reality, it is not gonna help a patient to have that label.

Votre (profile) says:

Where's the fun in that?

A truly scientific diagnostic tree based on hard and current ‘best of breed’ verifiable data? Where’s the fun in that?

One of our favorite games back in college was sitting around with a bunch of inebriated friends while a graduate psych major “referee” went through the DSM (III at the time) trying to see which of us could “scientifically” claim to be the ‘provably’ craziest among us.

How can they just walk away from such a terrific form of entertainment?

Anonymous Coward says:

I caution that this move might be designed by insurance companies. For decades they have pushed towards “biological-based” mental illness only. This may be a big step in that direction. The problem comes when a variety of obvious mental health illness are not biologically based (at first glance) such as those resulting from trauma, PTSD. That can’t be cured with a pill.

Often clinical experience is far ahead of the science behind what works and why. I’m familiar with trauma based disorders and I need to read more, but those disorders, such as the most common ones reported by veterans, run the risk of being thrown under the bus even though clinical treatment (not a pill) has been shown highly effective.

Anonymous Coward says:

to be fair, homosexuality WAS considered a mental illness until surprisingly recently. (1973 was when it was removed from the DSM. To put it in perspective, it was 9 years after the last execution in the UK)

as for internet addiction, I would actually venture to suggest that it does occur. They aren’t taking about people who simply use the internet a lot, but that’s entire lives are the internet. Specifically, it mentions ignoring kids or a spouse in favor of spending time on the net. For example, I’ve heard of gamers who spent so long on a game that they starved (I can’t remember if it was to death or not)

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