Top U.S. psychiatrist says he will move away from forthcoming DSM-5

‘Patients with mental disorders deserve better,’ writes Dr. Thomas R. Insel

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Alex E. Proimos / Flickr

Alex E. Proimos / Flickr

The American government’s top psychiatrist is questioning the forthcoming fifth version of the Diagnostic and Statistical Manual of Mental Disorders, which is sometimes referred to as the psychiatric’s bible.

Dr. Thomas R. Insel, director of the National Institute of Mental Health, told The New York Times that the manual, which will be published in coming weeks, has a scientific “lack of validity.”

He went on to say that the manual is the best tool that physicians have at this time, but that is doesn’t reflect how complex many mental disorders are. “As long as the research community takes the DSM to be a bible, we’ll never make progress,” Insel told The New York Times. “People think that everything has to match DSM criteria, but you know what? Biology never read that book.”

Insel’s comments to The New York Times come a week after he wrote a blog post, saying that the National Institute of Mental Health will move away from DSM-5 — which he likens to a “dictionary” rather than a bible.

Instead, he writes, the National Institute of Mental Health is focusing on a new project: the Research Domain Criteria (RDoC), which will find ways to use genetics, imaging and cognitive science methods for diagnosis.

At present, mental health diagnosis focuses largely on symptoms, which isn’t good enough. Insel writes: “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. Patients with mental disorders deserve better.”

Insel’s blog post, and The New York Times article, are renewing the debate about the DSM-5, shortly before it is published. This version will be the latest update to the DSM since 1994. It may also be the most debated, something Maclean’s senior writer Anne Kingston reported on in a feature story published in March.

Particularly, there is concern that the DSM-5 adds new medical diagnosis, which make it seem that nearly everyone is at risk of some mental-heath disorder. Some of the more controversial additions include:

  • Disruptive mood dysregulation disorder: describes as a condition affecting children between the ages of six and 12 who exhibit persistent irritability and “frequent” outbursts, three or more times a week for more than a year.
  • Minor neurocognitive disorder: describes minor memory lapses, such as forgetting where you put your keys.
  • Binge-eating disorder: describes anyone who overeats at least once a week for three consecutive weeks.

The DSM also made headlines for removing the diagnosis of Asperger’s syndrome, and placing Asperger’s under the larger category of “autism spectrum disorder.”

Read Anne Kingston’s full story here.