Feds To Move Away From DSM
(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.
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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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