New Efforts to Overhaul Psychiatric Diagnoses Spurred by DSM Turmoil

~ FmH

‘With the new manual on the eve of its official debut, many experts are already looking beyond it. Some envision a future in which psychiatric diagnoses are based on the underlying biological causes instead of a description of a patient’s symptoms. Others caution that such a single-minded focus on biology ignores important social factors that contribute to mental illness. If there’s any area of agreement it’s this: There has to be a better way.

The DSM is used by doctors to diagnose patients, by insurance companies to decide what treatments to pay for, and by pharmaceutical companies and government funding agencies to set research priorities. The new edition, DSM-5, defines hundreds of mental disorders.

The fundamental problem, according to many of DSM’s critics, is that these definitions don’t carve nature at its joints.

“An obvious, easy example is schizophrenia,” said Peter Kinderman, a clinical psychologist at the University of Liverpool. “If you’re a 52-year-old man who hears voices, you’ll receive a diagnosis of schizophrenia. If you’re a 27-year-old woman with delusional beliefs, you’ll also receive a diagnosis of schizophrenia,” Kinderman said. “Two people can receive the same diagnosis and not have a single thing in common. That’s ludicrous scientifically.”

In most areas of medicine, diagnoses are based on the cause of illness. Heartburn and heart attacks both cause chest pain, but they’re different diagnoses because they have different underlying causes.

‘Two people can receive the same diagnosis and not have a single thing in common. That’s ludicrous scientifically.’

In psychiatry, however, the underlying causes are poorly understood. What doctors now diagnose as schizophrenia may in fact be several disorders with different causes that happen to produce an overlapping set of symptoms. Conversely, two people with the same underlying biology could conceivably end up with two different DSM diagnoses — one with schizophrenia, say, and the other with bipolar disorder…’ (Wired.com)

Although I certainly know how and when to ‘label’ (e.g. to help my patients secure coverage from their insurance companies) I have long been a critic of the DSM, not merely as the 5th edition is released. Diagnostic nihilism is the only way to treat individual patients, given the modern state of psychiatry.