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But Its in the DSM (DSM-5)

FMSF News Alert - May 6, 2013

But it’s in the DSM

The long delayed new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled to be released by the American Psychiatric Association soon. This is an important book, often referred to as the ‘Bible’ for psychiatry. Insurance companies use the DSM to determine what conditions to cover, and attorneys use it in legal cases.

Edition 5 has come under a great deal of criticism. Perhaps the most publicized criticisms involved the expansion of behaviors determined to be disorders rather than ordinary experiences. The most recent criticism comes from the Director of the National Institute of Mental Health, a very powerful organization.

Federal Research Funding Organization Deemphasizes the DSM

On April 29, 2013, the Director of The National Institute of Mental Health (NIMH) announced that it will be focusing it’s research support funding in a new direction, away from the diagnostic criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) in preference of a new criteria known as the RDoC, or Research Domain Criteria.

According to NIHM director Dr. Thomas Insel:

"While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been ‘reliability’ -- each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. ... " Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. ... Patients with mental disorders deserve better [than the DSM]."

The goal of using the [Research Domain Criteria] is to encourage studies which are unrestricted by the DSM categories, in hopes that a new way of categorizing mental disorders might be found based on a ‘cluster’ of biological, genetic, cognitive and behavioral data.

Dr. Insel points out that this change does not currently effect how mental disorders are diagnosed or treated: "[Research Domain Criteria], for now, is a research framework, not a clinical tool. This is a decade-long project that is just beginning."

We have spoken to several FMSF Scientific Advisory Board members about the NIMH approach. These advisors’ conclude that it is not obvious that the new NIMH direction will be superior to the DSM.

For a very interesting discussion of the issues involved in critiques of the DSM see:

McHugh, P.M. & Slavney, P.R. (2012, May 17)
Mental Illness -- Comprehensive Evaluation or Checklist?
The New England Journal of Medicine