Director: Nat'l Inst. of Mental Health will walk away from DSM criteria

[HereSince1628]

that lack biological validity. The basic approach to nosology of mental illness (the taxonomy or categorization of mental illness) is unsupportive/incompatible with contemporary neurobiological research.


X-posted from Mental Health Information.

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http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml
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...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. 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 or the quality of fever. 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. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system. Through a series of workshops over the past 18 months, we have tried to define several major categories for a new nosology (see below). This approach began with several assumptions:
A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,
Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,
Each level of analysis needs to be understood across a dimension of function,
Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.

It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data. In this sense, RDoC is a framework for collecting the data needed for a new nosology. But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.”2 The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories.

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[HiPointDem]

1. does this mean all the psych drugs for fake conditions go away too?

'oppositional defiant disorder' etc

[HereSince1628]

2. I can't/won't comment on fakeness, it does seem to put the neurobiologists

the people who consider mental illness related to biological structure and function into a preferred position for NIMH sponsored research.

In that sense it probably does promote future roles of molecular biology and pharmacology in mental health.

[HiPointDem]

3. they'll probably find neurobio rationalizations for the same drug treatments & the conditions

will be just as fake...

premenstrual dysphoric disorder...

[HereSince1628]

4. "Maybe" the same drugs but "probably not" to the fake conditions concern

Seems to me, your concern about fakedness of mental illnesses may be better addressed as more diagnoses are based on detectable neurobiological signs--the biomarkers the director comments on in his statement. There is already in evidence results to suggest that conditions labelled under the DSM as belonging to diverse groups of mental illnesses are actually genetically related.


Philosophically, the NIMH's position seems to be that mental illness, at least the mental illness NIMH will do research on under this director, is conceived to be dysfunction or dysregulation related to the structure and function of the "circuits" of the brain. Because signaling along those circuits partly involves activity of neurotransmitters that can be influenced by pharmaceuticals, I think the future of mental health treatment will in all probability continue to involve drug treatments some of which may be in current use.

I would think that from the perspective of a neurobiological philosophy there would also be impacts on how non-pharmaceutical treatments are designed and interpreted.