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NIMH Will Drop Widely Used Psychiatry Manual

NIMH director says the DSM lacks biological validity in its diagnoses: “Patients with mental disorders deserve better.”

Just weeks before the American Psychiatric Association is expected to publish its new edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, the director of National Institute of Mental Health’s director announced via blog post that his institution will be “re-orienting its research away from DSM categories.”

The DSM is a manual for diagnosing and classifying mental disorders and is widely used by doctors and researchers. As Thomas Insel writes in his post, the goal of the manual is to “provide a common language for describing psychopathology.” The problem, however, is a “lack of validity.” He writes:

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.

The alternative, Insel writes, is a new NIMH project called Research Domain Criteria (RDoC), which will incorporate genetics, imaging, cognitive science, and other information into diagnoses. Mental health researchers are taking on more molecular- and cellular-focused tools , such as those based on DNA analysis or brain scans, in the hopes of improving diagnoses and treatment (see “The Hunt Is On for Biological Signs of Post-Traumatic Stress Disorder” and “Why Obama’s Brain-Mapping Project Matters”).

The blogged announcement could be a sign that psychiatry research will continue to move in this direction. According to a post by MindHacks blogger Vaughan Bell, a clinical and research psychologist at King’s College London:

The fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.

For social-media friendly neuroscientists and psychologists, the announcement comes as a welcome surprise. According to a blog post by neurobiologist Russell Poldrack of the University of Texas at Austin :

This is great news, as it has become clear (particularly from recent genetic research) that diagnostic categories, while being statistically reliable, do not have a great deal of biological reality.

But it may be awhile before this announcement trickles down into a psychiatrist’s office, according to Bell:

It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.

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