As breakthroughs begin to become more and more common in the world of mental healthcare, the Diagnostic and Statistical Manual of Mental Disorders–sometimes referred to as the “bible” of psychiatry–is beginning to lose many of it’s followers.
Just weeks after a study by the Psychiatric Genomics Consortium reported findings of a genetic link between five major mental disorders, the latest version of the DSM is coming under fire because of diagnoses that lack a basis biological findings. Instead, the diagnoses are still based on consensus about clinical symptoms.
For decades the American Psychology Association produced publication has been the go-to guide for psychiatrist around the world. But with the fifth entry of the manual set for a May 22 release date, critics are saying the methods used to create the DSM are out of date.
The most high profile critic of the DSM-5 is Dr. Thomas Insel, the Director of the National Institute of Mental Health–the nation’s leading agency in mental illness. Last month Dr. Insel announced that the NIMH has moved away from the DSM and launched the Research Domain–or RDoc–Criteria project that will look to use genetics, imaging, cognitive science and other means to diagnose and classify different mental disorders.
“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,” Dr. Insel said in a statement published to the NIMH website. “…Patients with mental disorders deserve better.”
Many experts are worried because the diagnoses highlighted by the DSM are used for a number of different things such as insurance, special education and disability benefits. Also, errors in diagnoses can lead to overmedication, undermedication and underfunding.
“The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology,” Dr. Insel said. “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.”
DSM-5 features several revisions and reclassifications to common conditions. Mental retardation, for instance, has been renamed “intellectual disability,” while autism now has the label “autism spectrum disorder.”
Despite plenty of criticism, the DSM-5 is receiving some praise for an “alternative model” for personality disorder diagnoses found in Section III of the newly revised manual. The new model is similar to the methods highlighted by recent research by the Journal for Psychiatry Practice. Although the main body of DSM-5 still features the same criteria for personality disorder as DSM-IV, the inclusion of the alternative model is a step forward.