Abandoning The Psychiatry 'Bible'?

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The Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders

In a few weeks, the American Psychiatric Association releases the latest edition of what's long been called the psychiatry "bible." The Diagnostic and Statistical Manual of Mental Disorders (DSM) is what doctors use to define and diagnose mental disorders. You've probably already heard some of the controversy over the updates in the DSM-5, including getting rid of the diagnosis of Asperger's syndrome and adding hoarding as a disorder.

We can now add another controversy to the mix. In a blog post on April 29, the director of the National Institute of Mental Health — the federal agency that invests $1.5 billion a year into mental health research — says "NIMH will be re-orienting its research away from DSM categories." Instead of looking at symptoms, the agency wants to develop a more precise diagnostic system based on biological markers: "genetic, imaging, physiologic and cognitive data."

Some are saying this represents a fundamental rift between NIMH, the primary agency responsible for mental health research, and the American Psychiatric Association, the main professional organization of psychiatrists.

Dr. David Kupfer, chair of the DSM-5 task force, released a statement on May 3, that read in part:

Efforts like the National Institute of Mental Health’s Research Domain Criteria (RDoC) are vital to the continued progress of our collective understanding of mental disorders. But they cannot serve us in the here and now, and they cannot supplant DSM-5. RDoC is a complementary endeavor to move us forward, and its results may someday culminate in the genetic and neuroscience breakthroughs that will revolutionize our field. In the meantime, should we merely hand patients another promissory note that something may happen sometime? Every day, we are dealing with impairment or tangible suffering, and we must respond. Our patients deserve no less.

Dr. Suzanne Koven, a primary care doctor at Massachusetts General Hospital, who also writes the "In Practice" column for The Boston Globe, is among those in the medical community with concerns.

"An institution as powerful and influential as the NIMH saying that they reject [the DSM's] validity is huge news - no question about that," Koven told Radio Boston. "The way this quarrel between the APA and the NIMH may end up sort of filtering down, is in questioning the way we have been looking at mental illness for decades now. And we may not know quite as much about how to categorize people who are in psychological distress as we think we do."


Dr. Bruce Cuthbert, director of NIMH's Division of Adult Translational Research and Treatment Development. He and NIMH director Thomas Insel are leading the Research Domain Criteria Project (RDoC).

Dr. Paul Summergrad, incoming president of the American Psychiatric Association. He's chairman of the Department of Psychiatry at Tufts University School of Medicine, and Psychiatrist-in-Chief at Tufts Medical Center.


New York Times: Psychiatry’s Guide Is Out of Touch With Science, Experts Say
Scientific American: No One Is Abandoning the DSM, but It Is Almost Time to Transform It
Science Magazine: NIMH Won't Follow Psychiatry 'Bible' Anymore

This segment aired on May 9, 2013.


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