It’s DSM-5, not DSM-V: Why little differences matter in the mental disorders manual
23.05.13
The new edition of the Diagnostic and Statistical Manual of Mental Disorders was released last week, following weeks of controversy prior to its release. The change of the name alone – from DSM-V to DSM-5 – caused tension in the psychiatric community. But the really big question for the new DSM-5 is its ongoing validity as a diagnostic tool, which has been questioned by some leading professionals in the mental health community.
Just ahead of DSM-5’s highly anticipated release the National Institutes of Mental Health director Tom Insel wrote in his NIMH blog that the Research Domain Criteria (RDoC) – a new project being explored by NIMH – could eventually replace DSM as the go-to diagnostics manual for mental health disorders. Insel later released a joint statement with APA (American Psychological Association) President-Elect Jeffrey Lieberman, emphasising DSM-5’s continued validity as “the best information currently available for clinical diagnosis of mental disorders”, alongside the International Classification of Diseases.
While the joint APA and NIMH statement stands by the DSM-5 as a diagnostic tool, it also makes it clear that it is time for a change: “Looking forward, laying the groundwork for a future diagnostic system that more directly reflects modern brain science will require openness to rethinking traditional categories.” The statements points to the RDoC project as one example, characterising it as an “attempt to create a new kind of taxonomy for mental disorders by bringing the power of modern research approaches in genetics, neuroscience, and behavioral science to the problem of mental illness.”
Why Change is Needed in the Field of Mental Health Diagnosis
With initiatives like RDoC, the hope is that in the future we will be able to diagnose brain-related disorders using biological and genetic markers, rather than using symptomatic means of diagnosis, just as is being currently done for a number of bodily illnesses, notably certain types of cancer. This would be useful in the realm of mental illnesses because, among other reasons, different mental disorders can share similar symptoms like fatigue or anxiety – making it tricky to diagnose and define treatment.
Getting to the point envisioned by RDoC is going to be a long, difficult, and costly task, however. It’s one of those frustrating situations where nobody is to blame and there’s no use in pointing fingers – the brain is, simply put, a very difficult organ to study, an issue discussed recently in EFPIA’s blog post about the troubled state of brain research. What we can do is realise this gap now and raise awareness of the problem that will allow for a push in fostering brain research and pave the way for much-needed R&D in this field. Positive steps are being taken, as evidenced by various projects of the Innovative Medicines Initiative (EUROPAIN, NEWMEDS, EU-AIMS) and the US government’s recently launched BRAIN initiative. But we have a long way to go.
Will there come a day when DSM-5 can be considered obsolete? Will we look back and laugh at how simplistic our view of brain illnesses was? I hope so; I don’t say this to discredit the manual as it stands now, as it remains an invaluable resource. But I believe, with the new advances in science and technology, we can do better. If we want to advance, we must be open to change, recognise advances for the improvements they are, and not be afraid to implement them. For now, a simple change to the DSM-5’s title is a small but symbolic step, signalling the openness to change that we need to move forward.
