A massive reference book of mental health conditions known as the “Bible” of psychiatry is about to change.
The fifth and current edition of Diagnostic and Statistical Manual of Mental Disorders (dsm) lists approximately 300 specific conditions that mental health care providers can diagnose and treat. But this dictionary of disorders has long been a lightning rod for criticism — specifically, the way it categorizes mental illnesses, which experts have said is not scientifically valid.
Today dsmPublisher of the American Psychiatric Association (APA), Plans announced To solve these problems Changing the way books work. The Future DSM Strategic Committee proposes that dsm Change your guidance to diagnosis and focus your attention on more objective measures of illness – “biomarkers” that may indicate mental illness. The changes will completely reshape future iterations of the manual.
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“We have to do this right, so it may take a little time, but we will try to do it as quickly as possible because the field is ready for it,” said APA psychiatrist Nitin Gogate at a recent press conference about the changes.
Overhaul, mentioned in Five papers were published today In American Journal of Psychiatry, Reflects the APA’s optimism that the DSM can be redrafted to become more scientific. The committee has also suggested changes in dsmis named so that the “S” stands for “scientific” rather than “statistical”. But some experts don’t think these changes will do much to improve the manual.
Psychologist Ashley Watts says, “I’m not sure (this new model for diagnosis) would have any strong utility at this point.” “I worry that by trying to please everyone, we make no one happy.”
The proposed changes would allow mental health professionals to give more nuanced diagnoses. Currently, people are diagnosed with named conditions, such as major depressive disorder or bipolar I disorder, with very specific criteria – partly because health insurance requires these for accurate billing. But providers may not have enough information available to make the correct diagnosis; An emergency room doctor treating someone experiencing a psychotic episode does not have the ability to know whether their diagnosis should be schizophrenia, bipolar I, or something else.
“Clinicians often find themselves forced to give a specific diagnosis, even if there is very little certainty,” said psychiatrist Maria Oquendo, who led the committee, at the press conference, “and this is ultimately unhelpful to patients.”
new plan dsm This will allow doctors to diagnose people at different levels of specificity. It will also make room for gathering more information about individual patients. This includes relevant details about their life (such as their socioeconomic status, medical conditions and quality of life), other mental health symptoms (such as anxiety or lack of pleasure) and biological characteristics (such as genetics).
dsm The committee has made it clear that the model it is proposing will evolve based on feedback from physicians, scientists, patients and their families before the new version of the manual is released.
The inclusion of biomarkers is perhaps the most controversial potential change. Scientists have not yet found reliable biological signatures that indicate whether someone has a particular mental illness. The closest we’ve come to Alzheimer’s disease; Doctors can now examine people through blood tests.
APA researchers clearly state in new documents that there are no other established biomarkers for dsm Diagnoses, but they want to be able to include them if the manual is available.
“The question now is not really whether the biomarkers are involved or not dsm But how to actually present them in a way that is rigorous, transparent, ethical and clinically useful,” said psychiatrist Jonathan Alpert, a member. dsm Subcommittee on Biomarkers at the press conference.
Watts doubts that biomarkers will ever be useful to doctors in diagnosing mental illness, assuming they can even be found. Pinpointing biomarkers would involve expensive and sometimes invasive tests that wouldn’t necessarily provide anything better than doctors using their current practice of diagnosing people based on behavior, she says.
Steve Hyman, former director of the National Institute of Mental Health and outspoken critic dsm, It seems unlikely that scientists will ever find biomarkers for the conditions listed in the manual. One reason for this is that dsmDisorder categories may not reflect how mental illness actually works. Third edition of the manual, DSM-III, Published in 1980, it draws boundaries across the spectrum of mental illness based on the way people’s symptoms cluster together. In the 1990s, psychiatrists were optimistic that these limitations would also be reflected in brain scans and genetics research. But this did not happen.
There are very few clear “clusters” of illnesses around which boundaries can be drawn, which has led many experts to suggest that our models of mental health conditions should be based on a spectrum of symptoms rather than specific named disorders. However, such a model would be challenging to implement in doctor’s offices. Even Watts, who helped develop a one-dimensional alternative to dsm Called the Hierarchical Taxonomy of Psychopathology (HiTOP), there are “some misunderstandings” about how it would work in practice.
Watts and Hyman both think so dsmThe categories have hindered scientists in trying to understand what causes mental illness. For example, when participants are recruited for a study based on dsmcriteria for schizophrenia, they may miss Real Relationships of Bipolar Disorder This can be important to understanding what is really going on.
Scientific research about mental illness has already begun to fall apart. dsm. Once we know enough about the underlying biology, the two can be reintegrated, Hyman says. He says, “It’s going to take a long time – I always say, I’d rather be dead – but in time” the two can be brought back together.
