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NIMH Rejects New DSM

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Thomas Insel, director of the National Institute of Mental Health has announced that the organization will not use the new edition of the Diagnostic and Statistical Manual for Mental Disorders:

In a few weeks, the American Psychiatric Association will release its new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This volume will tweak several current diagnostic categories, from autism spectrum disorders to mood disorders. While many of these changes have been contentious, the final product involves mostly modest alterations of the previous edition, based on new insights emerging from research since 1990 when DSM-IV was published. Sometimes this research recommended new categories (e.g., mood dysregulation disorder) or that previous categories could be dropped (e.g., Asperger's syndrome).

The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. 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 DSM has 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. (emphasis added).

But with its reliability also in question, the new DSM5 is turning out to be quite controversial.

1 Comment

Sounds like we are headed for the Tower of [Psycho]Babel, where expert witnesses will use the same term and mean different things, with no consensus definition.

The Neuroskeptic post linked at the end of Steve's post is well worth reading. As a dual-diagnosed wordsmith and math nerd, I especially like the phrase "frankly crap kappa." Very nice.

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