If it ain't broke, don't fix it...
While this age-old adage may apply to a bumper fixed with duct tape or your shabby-yet-operable Motorola flip phone, opponents of the publication of DSM-5 would disagree. For those unfamiliar with the text, the Diagnostic and Statistical Manual of Mental Disorders, fifth-edition (DSM-5) is a manual published by the American Psychological Association to classify and diagnose mental disorders. The fifth edition was published in May of 2013 and was intended to be a comprehensive collection of 21st century mental disorder diagnostics. Many changes were made to the new edition, making the DSM-5 a point of contention in the world of mental health. While the DSM-5 wasn’t necessarily broken, there was an overwhelming call for revision, with some even calling for an entirely new paradigm to fix the misdiagnosis and ambiguity.
In an article in The New York Times titled “Psychiatry’s Guide Is Out of Touch With Science, Experts Say,” Pam Belluck and Benedict Carey wrote on the health community’s reaction. The overall consensus was that it is time for a change. The director of the National Institute on Mental Health, Dr. Thomas Insel, was very outspoken on the future of DSM in accordance with mental health research. Instead, he supports a newfounded, comprehensive approach to diagnosis called the Research Domain Criteria (RDoC). Since the brain is a litany of complicated systems (most of which we are still researching), it is impossible to rely on a clear-cut diagnostic system. Instead, RDoC is intended to find an individual’s specific problem via psychological and biological avenues to arrive at a particular problem instead of simply a classification. Former director at the NIMH gave credit to the creators of the DSM. He elaborated saying:
They chose a model in which all psychiatric illnesses were represented as categories discontinuous with ‘normal.’ But this is totally wrong in a way they couldn’t have imagined...Many people who get one diagnosis get five diagnoses, but they don't have five diseases--they have one underlying condition.
At a lecture for a neuroscience seminar at Loyola University Chicago, Dr. Stewart Shankman from the University of Illinois at Chicago spoke on the shift from DSM to RDoC. Overall, he agrees with the need to transition away from DSM and the other published papers on this topic but dives into the specifics of RDoC that are key to a successful model. In his publication in the International Journal of Psychophysiology, he emphasizes the drastic amount of work necessary to complete this design. Since the DSM-5 is already an established foundation for diagnostics, he argues that it is an uphill battle to disturb the status quo and transition the mental health community to a dimensional based system.
The world of mental health is ever-changing, and it is making waves. The current method of mental health diagnostics, DSM-5, is an incredible tool and essential for universalization of health care. However, technological advancements and new research is generated at remarkable rates, so our tools for diagnosing need to keep up as well. So, like that antique flip-phone you’re still sporting, just because it isn’t broken doesn't mean that it isn't time to replace it.
References:
Shankman, S.A., Gorka, S.M., Psychopathology research in the RDoC era: Unanswered questions and the importance of the psychophysiological unit of analysis, Int. J. Psychophysiol. (2015),
Article: New York Times - Psychiatry’s Guide Is Out of Touch With Science, Experts Say
Further reading: Time Magazine - Mental Health Researchers Reject Psychiatry’s New Diagnostic ‘Bible’
http://healthland.time.com/2013/05/07/as-psychiatry-introduces-dsm-5-research-abandons-it/
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