In a major milestone, a powerful organization of mental health researchers has said it will not be using the new, fifth edition of the Diagnostical and Statistical Manual of Mental Disorders (DSM-V), a handbook that has virtually defined the field of psychiatry in the United States for decades. Here's what this means.
The National Institute on Mental Health (NIMH) has said it no longer wants to rely on the definitions of mental illness put forth in the DSM for a variety of reasons. First, neuroscience is slowly rendering psychiatric definitions of mental illnesses obsolete. According to Time's Maia Szalavitz:
Dr. Thomas Insel, the director of the National Institute on Mental Health, said in a blog post last week that “NIMH will be re-orienting its research away from DSM categories.”
The change will not immediately affect patients. But in the long run, it could completely redefine mental health conditions and developmental disorders. All of the current categories — from autism to schizophrenia — could be replaced by genetic, biochemical or brain-network labeled classifications. Psychiatrists, who are already reeling from the conflict-filled birth of the fifth edition of the Diagnostical and Statistical Manual of Mental Disorders, are feeling whipsawed.
Insel, for his part, is lobbying for a more comprehensive approach. For scientific purposes, he argues, the DSM may have outlived its usefulness.
Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain… 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…Patients with mental disorders deserve better.
Another big issue is that the DSM definitions of disorders are often used to justify prescriptions for drugs. Over three quarters of the editors for the new DSM have done work that was paid for by pharmaceutical companies. That raises some questions about the objectivity of their work, and whether they are tailoring diagnoses to suit drug companies.
Doctors have also raised questions about the way the new DSM defines disorders relating to sexuality. Outdated diagnoses like "nymphomania" have been brought back into the DSM under new names, which could result in Girl, Interrupted scenarios where young women are institutionalized simply because they have sex before marriage.
Read more at Time.