July 1st, 2013

DSM-5 stirs some controversy

After more than 10 years of discussions, committee meetings and revisions, the American Psychiatric Association finalized the DSM-5 and released it at the annual meeting in May. Although the project involved a cross-section of experts in psychiatry, psychology and science, the manual has been met with both open arms and skepticism from a variety of mental health professionals as well as some individuals in the general public.

Two weeks before release of the DSM-5, broadcast and print media headlines proclaimed widespread criticism of the manual and announced that the National Institute of Mental Health (NIMH), which funds a significant amount of mental health research, intended to withdraw support for the new version. But according to Bruce Cuthbert, Ph.D., director of NIMH’s Division of Adult Translational Research and Treatment Development, the issue demands some clarification. He says, “We are not withdrawing support, but reorienting research away from the DSM. We won’t stop funding, but there will be a transitional period.”

Cuthbert explains that for the past 10 to 15 years, there has been growing evidence that for research purposes, the DSM does not match with genetics, neuroscience and behavioral science findings. “We are trying to get a better understanding of mental health by studying major behavioral systems and related brain circuits,” he says.

In response to the demand to do a better job of measuring behavior, NIMH developed the Research Domain Criteria (RDoC) in February 2009, a long-term project that involves studies that will help build the research literature. “It’s the implementation of the NIMH strategic plan and a work in progress, not a competing system with the DSM,” says Cuthbert, “but it will inform how to revise the DSM and the International Classification of Diseases in the future. We see it as part of the movement toward precision medicine.”

In a statement by the American Psychiatric Association, David Kupfer, M.D., chair of the DSM-5 task force, acknowledges that mental health professionals “…hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity.” He notes that such discoveries have not yet taken place. “It is clinical experience and evidence, as well as growing empirical research that have advanced our understanding of disorders such as autism spectrum disorder, bipolar disorder and schizophrenia.”

Kupfer adds, “DSM, at its core, is a guidebook to help clinicians describe and diagnose the behaviors and symptoms of their patients. It provides clinicians with a common language to deliver the best patient care possible.”

Cuthbert reaffirms the NIMH’s commitment to support the DSM, with RDoC as a supplementary instrument. “We have not changed our position that the DSM is the most useful clinical instrument available,” he says, and hopes to dispel any misconceptions that mental disorders are not real. “We believe, in fact, that mental illness is a serious disorder and that effective treatment is available.”

The American Psychological Association does not have any comment at this time, according to Audrey Hamilton, public affairs associate.

By Phyllis Hanlon

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