NIMH criticizes DSM-5

[Jim__]

An excerpt:

In a few weeks, the American Psychiatric Association will release its new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This volume will tweak several current diagnostic categories, from autism spectrum disorders to mood disorders. While many of these changes have been contentious, the final product involves mostly modest alterations of the previous edition, based on new insights emerging from research since 1990 when DSM-IV was published. Sometimes this research recommended new categories (e.g., mood dysregulation disorder) or that previous categories could be dropped (e.g., Asperger’s syndrome).1

The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. 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.
  

more...

[bemildred]

1. +1. nt

[MannyGoldstein]

2. Thank Goodness

Perhaps a meeting of Psychology and Science is in the making.

[jonthebru]

3. And THEN they will come for your guns!

Just kidding, their criticism is valid.

Mental health treatment is very subjective and often not diagnosed or not diagnosed properly. Then the practitioner throws pills at the problem.
That is not to say people shouldn't seek treatment or that we as a culture shouldn't accept people with mental illness as positive members of society.

[bemildred]

4. It's all based on opinion, that's the problem.

There is nothing wrong with that as such, sometimes informed opinion is the best you can do, but humility is required, it's not math, and it's not science either, unless you can some up with a lot more than they have in most of these "diagnoses".

And then there is the fondness for drugs, of course, which can be very helpful, but again humility and some sense of caution are required, not "well let's try this and see what happens."