National Institute For Mental Health Abandons DSM Just As American Psychiatric Association Prepares Massive Update
from the good-for-them dept
The American Psychiatric Association's infamous DSM or Diagnostic and Statistical Manual of Mental Disorders is often called "the Bible" of classifications for mental illnesses, but it's perhaps almost as famous for its problems than for any usefulness. The list of criticisms and controversies over the DSM are pretty long, and there are significant concerns about the fact that it's not scientific, and that it falls sway to both extreme biases of psychiatrists and their overall profession as well as general cultural biases. The most famous bit of controversy, of course, is that it used to include homosexuality as a mental disorder -- which should be an indication of how trustworthy the book is (i.e., it's not, at all). More recently, the discussion to possibly include internet addiction (or, more officially "Internet Use Disorder" or IUD) in DSM-5 caused a fair bit of mocking.That's why it's great to see that the National Institute of Mental Health has declared that it's effectively abandoning the DSM just as the APA releases the long awaited DSM-5. After highlighting many of the problems with the DSM, it notes:
But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.” The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.As others have noted, this is a "potentially seismic move" since the NIMH is so central to funding so much research concerning mental health.
That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.
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Filed Under: dsm, mental health, nimh, research
Companies: american psychiatric association
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A couple of good articles from The Verge; first one goes into some detail on DSM criticisms.
http://www.theverge.com/2013/4/19/4243060/dsm-5-bible-of-psychiatry-mental-health-revisio ns-spark-boycott
The Verge - 2013-05-03 - Federal institute for mental health abandons controversial 'bible' of psychiatry
http://www.theverge.com/2013/5/3/4296626/nimh-abandons-controversial-bible-of-psychiatry
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When that is said, psychiatrists already had a bad reputation compared to other doctors, so accepting biomarkers instead of "psychological tests" or "yes/no questionaire" is a tremendous improvement for my trust.
Btw: This move is probably gonna revolutionize the treatment of what was known as "major depressive disorder" since it has been a public secret that the symptoms cover a variety of biochemical imbalances with several unrelated underlying conditions. When it comes to other diagnoses it is gonna be a lot more hairy. The pop-diagnosies of Asperger's or ADHD are gonna be almost impossible to keep up since everyone gets a benefit from ADHD medicin while nobody can see the exact symptoms for the highest functioning end of the autism spectrum.
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Insurance speed bump
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Why does mental diagnosises exist?
Is it relevant to treat?
In the end, it is just not a mental disorder. It can be a personality disorder, though, but the psychitric diagnosis is used for the patients treatment and since it is irrelevant for other mental illnesses or perception of reality, it is not gonna help a patient to have that label.
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Where's the fun in that?
One of our favorite games back in college was sitting around with a bunch of inebriated friends while a graduate psych major "referee" went through the DSM (III at the time) trying to see which of us could "scientifically" claim to be the 'provably' craziest among us.
How can they just walk away from such a terrific form of entertainment?
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Often clinical experience is far ahead of the science behind what works and why. I'm familiar with trauma based disorders and I need to read more, but those disorders, such as the most common ones reported by veterans, run the risk of being thrown under the bus even though clinical treatment (not a pill) has been shown highly effective.
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Ok - who's sane then?
As 'abnormal' is thus defined, what is left must be 'normal' right?
(Other analysis - what is the most common and least common behavior cited?)
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as for internet addiction, I would actually venture to suggest that it does occur. They aren't taking about people who simply use the internet a lot, but that's entire lives are the internet. Specifically, it mentions ignoring kids or a spouse in favor of spending time on the net. For example, I've heard of gamers who spent so long on a game that they starved (I can't remember if it was to death or not)
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"Internet Use Disorder" or IUD
Book Use Disorder or BUD
Car Use Disorder or CUD
Air Conditioning Use Disorder or ACUD
Indoor-plumbing Use Disorder or IpUD
sorry, lunchtime, no more UDs as I have to get to my personal favorite "Food Use Disorder" ... or FUD? :-)
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