NIMH Dumps DSM Diagnosis

In a dramatic announcement, Thomas Insel, the director of the US government agency that provides grants for the study of mental illness, the National Institutes of Mental Health (NIMH), has rejected the “bible” of psychiatric diagnosis, the Diagnostic and Statistical Manual (DSM). The DSM has been used for decades to define psychological conditions such as PTSD, depression, and anxiety, and has become widely used even in areas for which it was never originally intended, such as law, and insurance reimbursement. Insel writes that the NIMH will be “re-orienting its research away from DSM categories.” The fifth edition of the DSM has been more than a decade in the making, and the fifth edition is just weeks away from publication. Says Insel:

“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 DSMhas 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. Patients with mental disorders deserve better.”

Rather than the DSM, Insel writes that the NIMH will use the “Research Domain Criteria (RDoC),” which use genetic, neurological, and cognitive data. According to a statement issued by the board of the International Society for Ethical Psychology and Psychiatry (ISEPP), the “DSM supports the perpetuation of myths about mental, emotional, and behavioral disturbances in individuals which favor pseudoscientific, biological explanations and disregard their lived context. The evolving editions of the DSM have been remarkable in expanding psychiatric labels for alleged “mental illnesses” with no scientifically substantiated biological etiologies. … Adherents of biopsychiatric explanations and pharmaceutical manufacturers are the primary benefactors of public acceptance of this myth. … ISEPP recommends public scrutiny and skepticism regarding the DSM as well as a constructive dismantling of the psychiatric-pharmaceutical complex through which it is continually supported and redeployed.” According to another ISEPP member, “Insel’s statement is also an implicit admission that there is no real theoretical basis for drug treatments for mental illness.”

See also this Scientific American blog post on the issue.