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Government Mental Health Group Ditches Controversial Diagnosis Guide

The Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association (APA), has been around in one form or another since the 1950s. It contains standardized definitions and a common language for the treatment of mental disorders, and it’s set to release its fifth edition — the first updated issue of the tome since 1994 — later this month. Count the National Institute of Mental Health (NIMH) as one group that’s canceling its subscription.

The DSM is sometimes described as the “bible” of the mental health field. It can take at least a decade to produce updates to the manual that incorporate shifts in medical research. But in a blog post on the NIMH website, the federal organization argues that, when it comes to the well-being of mental health patients, the DSM simply isn’t cutting it:

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. […]

Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.

The case against using the DSM boils down to the APA’s lack of clinical and longitudinal studies in crafting it — a major shortcoming that mental health advocates argue relegates the DSM to a semantics-based publication, with little connection to the needs and realities of actual mental health patients. Consequently, many updates to the DSM are more reflective of changes in sociopolitical thinking, rather than underlying scientific realities. For instance, one of the “updates” included in the DSM-V strikes kinky sex habits and queer behaviors such as S&M;, fetishism, and transvestism from being considered “mental disorders of abnormal or unusual attraction.”

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NIMH instead calls for a holistic — and scientific — approach to constructing an alternate diagnostic “Bible” that is “based on the biology as well as the symptoms” and maps the “cognitive, circuit, and genetic aspects of mental disorders [to] yield new and better targets for treatment.”