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Feds To Move Away From DSM


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(Updated: May 7, 2013 at 10:07 AM CT)

Just weeks before a new version of the Diagnostic and Statistical Manual of Mental Disorders is scheduled for release, the head of the National Institute of Mental Health says it’s time to change how mental conditions are categorized.

The agency will be redirecting its research focus away from the symptom-based diagnostic criteria of the DSM toward more scientifically verifiable standards, the mental health agency’s director, Thomas Insel, wrote in a recent blog post.

By shifting away from thinking about mental disorders as they are currently classified in the DSM, Insel says researchers will be able to establish a new diagnostic system based on emerging science.

“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,” Insel wrote. “Patients with mental disorders deserve better.”

Accordingly, Insel says the NIMH is launching a new project known as Research Domain Criteria designed to collect the data needed for a new classification system by using genetics, imaging, cognitive science and other techniques and supporting studies that overlap currently existing categories.

Insel calls this new approach a “research framework” and acknowledges that it will be a long time before it can be applied as a clinical tool but he says it’s a valuable first step toward a more exact diagnostic method.

The comments come as the first new version of the DSM in more than a decade is slated for release in less than two weeks. The fifth edition of the manual — often considered the bible of psychiatry — will be unveiled at the American Psychiatric Association’s annual meeting beginning May 18 in San Francisco.

While officials at the psychiatric organization agreed that they would like to see biomarkers to pinpoint mental disorders with greater accuracy, David Kupfer, chair of the group’s DSM-5 Task Force, said in a statement that such discoveries remain “disappointingly distant.”

“Efforts like the National Institute of Mental Health’s Research Domain Criteria (RDoC) are vital to the continued progress of our collective understanding of mental disorders. But they cannot serve us in the here and now, and they cannot supplant DSM-5,” Kupfer said. “In the meantime, should we merely hand patients another promissory note that something may happen sometime?”

The DSM update has been met with significant controversy, particularly surrounding changes to the definition of autism. The new version is expected to eliminate Asperger’s syndrome and fold it as well as childhood disintegrative disorder and pervasive developmental disorder, not otherwise specified under a broader diagnosis of “autism spectrum disorder.”

Separately, the new manual is also expected to replace “mental retardation” with the more commonly accepted term “intellectual disability.” What’s more, the definition of the disorder is being tweaked to put less emphasis on IQ score and allow more consideration for clinical assessment.

The DSM is relied on by mental health professionals, researchers, insurers and others to determine what symptoms merit a clinical diagnosis. The current edition was originally released in 1994 and was updated in 2000.

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Comments (10 Responses)

  1. Psych Survivor says:

    This is a development that was inevitable because the DSM-5 people became so greedy that they pushed the envelope too hard. The DSM process was never anything different from this day and age’s Inquisition: a bunch of self appointed “mind guardians” deciding who is normal and who isn’t. Just as the Inquisition members derived their authority from their theology training, these new mind guardians derived their authority from their medical credentials. The problem? That the process was no different and the results no better. Where, during the Inquisition times, there was “religious” bias, in the DSM process there was the personal biases of the committee members, which explains why homosexuality was at some time considered “mental illness” and then no more. There was never any science to back it up.

    As long as those labeled “heretics” under the new inquisitorial system were a small segment of the population, the impact in society was small and few cared. Now, with DSM-5, psychiatrists got greedy and thought that they could get away with labeling up to 50% of the American people “mentally ill”. They looked only at their Big Pharma inflated pay checks and forgot that society would notice. And they noticed. So the NIMH did what it did because Tom Insel might have correctly concluded that labelling 50% of Americans as mentally ill is something that even him could not possibly accept.

    What the NIMH did was to say, if there is something called “mental illness”, it has to be falsifiable using the tools of medicine: bio-markers in a quantitative matter. I am of the thought that there is not such a thing as “mental illness”, just a desire for “mind guardianship”, so this new approach gives those who think along my lines what we always wanted: a scientific approach to test the falsifiability of “mental illness”. I believe that my side will win. That the NIMH decided to level the playing field along our lines vs the lines of the “mind guardians” is a first step toward the abolition of psychiatry as the fraudulent endeavor it is.

    Now, if there is a winner in this, is the late Thomas Szasz. If there is an after life, he must have a big smile in his face now. The NIMH has officially adopted talking points from his groundbreaking essay “The Myth of Mental Illness”. God bless!

  2. Adrian says:

    Thank you for posting about this. As both an experienced medical coder/CCS exam candidate and the parent of a child with autism, I’ve been following this development closely. Speaking for myself only, the DSM is deeply flawed and I firmly believe that it has problems with both scientific credibility and conflicts of interest. The DSM is neither respected nor relied upon precisely because of those glaring flaws. The strong ties to the pharmaceutical industry are damning. It does not correspond well enough with the ICD-9 / ICD-10 classification system put together by the WHO and allows a small group of American psychiatrists entirely too much power. It is my hope that the classification changes to the DSM regarding autism which were so controversial may not end up mattering as much. These changes could mean better quality research about autism and an increased focus on TREATMENT of autism from a multidisciplinary approach.

  3. Barbara Grimes says:

    Diagnoses are the key to unlock the door to funding to treat a person and get paid for it. Fewer diagnosed persons mean fewer customers coming in the door. Changes in the DSM mean the experts are changing the locks. I’d like to see investigative reporting on the money change.

  4. VMGillen says:

    @Barbara Grimes: You got that right. One of my law profs used to say “follow the money” when looking for answers… I am a candidate for a Masters in Disability Studies, and very, very few classes are offered on the economics of disability. Check out the APA’s shift to “behavior” paradigms from the analytical/cognitive: the profession was NOT going to lose the billing opportunities presented by rising ASD numbers. THEN they discovered that this group includes some people who are NOT easy to work with… hence the latest revisions, which, in essence, allow the gate-keepers to cherry-pick their billing opportunities.

  5. Adrian says:

    This comment is respectfully directed to Barbara’s points. Speaking strictly of the differences between ICD-9-CM and the DSM-IV-TR, in several Federal Registers CMS has recognized the discrepancies between the systems and pointed out that the final rule of Standards for Electronic Transaction recognizes ICD-9-CM as the official reporting system for diagnoses.

    In my understanding, the DSM is simply an extension of the old Glossary of Mental Health Disorders section in ICD-9. It is no Bible, but more like a dictionary of sorts of symptoms. With respect to autism, it is used more for documentation purposes, mainly in America, and not for diagnosis. Documentation is important, as it justifies the codes and codes = payment. However, it does not have to be from the DSM. The coding of a case tells the story, so to speak, to the insurance company in a succinct, standardized, universally-accepted way. Therein lies much of the problem; the DSM is not universally-accepted nor standardized. It is largely useless to researchers.

    Much of the rest of the modernized world is already using ICD-10 and will soon be using ICD-11. The US is still using ICD-9-CM and there are many options on the table at this point. In my opinion, the APA needs to sit back down and the DSM needs to return to being the glossary that it is until they can come up with a manual that is based on scientific evidence and free themselves from their enormous conflicts of interest.

  6. Nanaymie Kasmira Godfrey says:

    I applaud the NIMH stance with one caution…. While there are real causes that change the neural functioning of the brain, focusing on the brain alone does not do anything PREVENTATIVE to stop the increasing numbers of people suffering with mental health and other disorders. We need to emphasize the role of trauma (diagnostic or not), and stress in the neural changes that we see in individuals. Then we need to change the social structures that create and maintain stressful living conditions for more and more of our citizens. Until we seek real social causes and stop blaming individuals afflicted, we do NOTHING to alleviate suffering!!!

  7. Julie gosling says:

    Seems like moving from one brand of colonisation to another? – Any danger in the foreseeable future of losing the ghastly label ‘mental disorder’ or ‘mental illness’ ??? I live in hope ….

  8. Lori Owen says:

    I managed to get my Bachelor of Social Work degree in 1996. I worked with domestic violence victims with a variety of psychiatric disorders including Mental Retardation. I worked at Denton County MHMR as well as my internship at Denton State School working with Mental Retardation. I got to work with Schizoprenics, bi-polar, depression, anxiety disorders, etc. I found the DSM very useful. Could it be better, probably. Does it need to be redone, of course. My question is why get rid of it BEFORE we have another system in place?

  9. Mimi Stiegel says:

    I do not believe this article is factual in stating the Federal Government will not support the new DSM5 which is scheduled to appear 5/22/2013 (2nd release date postponed from March). The Feds are politically connected with the APA and the pharmaceutical industries for huge profits. No way would they not endorse the psychiatric industry to diagnose and treat mental disorders with more drugs, despite absolutely no scientific evidence. Do the research.

  10. Mary says:

    As a special education teacher, I relied on the DSM descriptions to help me “reach and teach” the children on my caseload. I am not an expert in psychology or medicine so this manual helped me understand terms and strategies in evaluations and IEP’s. It’s not exactly “user-friendly” for educators. I hope the change is positive.

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