Wednesday, May 8, 2013


In a blog post published on April 29, 2013, Dr. Thomas Insel, Director of the National Institute of Mental Health ("NIMH"), challenged one of the cornerstones of modern psychiatric practice:  the Diagnostic and Statistical Manual of Mental Disorders ("DSM").  The new, fifth edition, of the DSM ("DSM-5") will be released at the May 18-22, 2013, Annual Meeting of the American Psychiatric Association in San Francisco, California.  According to Dr. Insel, the practices reflected in the DSM-5 compare poorly to those in other medical specialties:
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.
According to Dr. Insel, "Patients with mental disorders deserve better."  They may soon get it.  Dr. Insel describes a new initiative aimed at improving the scientific rigor of psychiatry:
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.
Although none of these approaches promise immediate cures, together they may help psychiatry to get up off the couch.