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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Filed Under: dsm, mental health, nimh, research
Companies: american psychiatric association

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  1. identicon
    Anonymous Coward, 6 May 2013 @ 3:11pm


    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.

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