The soon-to-be-released update of the manual used to diagnose mental illness lacks scientific validity, says the director of the National Institute of Mental Health (NIMH). The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not reflect the complexity of many disorders, according to Dr. Thomas R. Insel.
The updated version of the DSM, known as DSM-5, is scheduled to be released later this month. Dr. Insel told The New York Times the manual’s way of categorizing mental illnesses should not be used to guide research.
“As long as the research community takes the DSM to be a bible, we’ll never make progress,” Dr. Insel said. “People think that everything has to match DSM criteria, but you know what? Biology never read that book.”
He said the field of psychiatry needs a new paradigm for understanding mental illness. He noted there is a vast amount that scientists still do not know regarding the causes of these disorders.
In a recent NIMH blog post, Dr. Insel wrote DSM diagnoses are based on a consensus about clusters of clinical symptoms, instead of an 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.”
NIMH has launched the Research Domain Criteria project, which aims to incorporate genetics, imaging, cognitive science and other information to lay the foundation for a new classification system for mental health. He announced NIMH will be re-orienting its research away from DSM categories.
Other critics of DSM-5 have said it will expand the list of what constitutes mental illness and will lead to a needless increase in diagnoses.