Today is officially Mental Health Day. The American Psychological Association (APA) has asked all of us who blog on mental health related issues to participate by publishing a blog that relates to mental health. According to the APA, Congress designated May as Mental Health Month in 1949 to raise public awareness of the issues.
So, what exactly should I write about? I am a researcher, not a clinician, so the topic that immediately came to mind was the controversy over the soon-to-be-published and much anticipated DSM 5. I’ve written elsewhere about this topic here.
All editions of the DSM have provoked their share of controversies. Are we over-diagnosing conditions and pathologizing normal behaviors? Or are we under-diagnosing conditions and preventing people from obtaining the treatment they need? This edition has its share–do we need a category for “attenuated psychosis syndrome” or will this result in the use of antipsychotic medications with all of their substantial side effects by normal people? Should we worry about the fact that the number of participants in the DSM process with financial ties to the pharmaceutical industry has jumped from 14% to 70% from DSM IV to DSM 5? Is the price of the DSM 5 ($199) too steep?
For me, the biggest news is the rejection of the DSM 5 as a source for researchers by non other than the National Institute of Mental Health (NIMH). Thomas Insel, director of NIMH, had this to say: “…the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” Instead, the NIMH has launched its own “Research Domain Criteria Project” (RDoC) to move away from a symptoms-based approach, like that of the DSM, to a more causal approach emphasizing similarities in genetics, brain circuits, and cognitive processes among different types of psychological disorders.
It seems to me that this apparent rejection of the DSM 5 by NIMH really caught the attention of the American Psychiatric Association (another APA), which publishes the DSM and depends on the sales of the book for the majority of its income. On May 13, NIMH issued a press release that seemed more conciliatory. The press release says “DSM-5 and RDoC represent complementary, not competing, frameworks for this goal.”
Another player in this mix is the World Health Organization’s ICD system, which is also in the process of a revision slated for publication in 2015. Unlike the DSM, the ICD system is freely distributed. While the ICD is promoted to a worldwide audience, the DSM is used primarily in the United States. In recent revisions, the DSM and ICD committees have worked more closely together to work out inconsistencies.
It will be interesting to watch as these diagnostic systems go into effect. As a researcher and a neuroscientist, I’m already liking what I’m reading about RDoC. When we find that the candidate genes associated with bipolar disorder and schizophrenia are quite similar, it makes no sense to have one disorder described in one place in the DSM and the other in a completely different section in the manual.
Hopefully, the end result of the discussion about classification systems will be improved care for the people with the disorders. I personally think we have a very long way to go in this direction, and I welcome any efforts that lead to less stigma and better outcomes.
5 Comments
mrabie · May 18, 2013 at 3:34 pm
Reading about the controversies of the DSM 5, I kept thinking how similar these issues are to the pharmaceutical industry. When it comes to our medical health, we all take it seriously. However, the industry is only focused on capital gain. I have recently watched a documentary about the concern of “disease maundering”, which is the medicalization of something that is just a part of everyday life. Consumers will watch a movie on TV and by the end of that movie they will believe that they have some kind of disorder. In terms of the DSM, I think the systems should be specific enough to avoid disease maundering. Instead of over-diagnosing conditions, the conditions should be realistic. For example, at some point in their lives, everyone has trouble with sleeping. For the conditions of insomnia, the consistency of the lack of sleep should be specific.
lcolon · May 18, 2013 at 4:43 pm
I agree, I believe we still have a very long way in perfecting the system of classification for mental disorders. This reminds me of a comment my first psychology professor said, more so it was a disclaimer, that as we learn about mental disorders and matters of the brain we should not self-diagnose ourselves with said disorders. I believe this disclaimer relates to the discussion of systems of classification because many people resort to the internet and type in the symptoms they believe they may be suffering from. Furthermore, I believe that in today’s society although more people are accepting and aware of mental disabilities they are now becoming more prone to these symptoms because they are not fully specific. For example, there are also more children diagnosed with ADHD/ ADD today then there were in previous decades. Many believe that the reason for this is because hyper activeness is a symptom of this disorder while a child may be naturally hyper, his/her behavior may be seen as a symptom vs. character.
ncamat · May 19, 2013 at 11:20 pm
I don’t know all of the specifics of the DSM 5 but the one thing that stood out to me in this post was, “Are we over-diagnosing conditions and pathologizing normal behaviors? Or are we under-diagnosing conditions and preventing people from obtaining the treatment they need?”. I feel like if behavior isn’t disrupting normal everyday life then there is no need for a diagnosis, but then again, who is to judge what is normal or not in another individual’s life. I also have to wonder what are the criteria for an illness to make it into the DSM. Are they merely correlations? Have the behaviors been adequately observed? Also, if the disorder does not impact the individual’s everyday life then what good comes from the clinician telling their patient?
bmgibbs · May 22, 2013 at 10:36 am
I thought that you made a lot of good points in regards to the controversy over the new DSM 5. There were one in particular that stood out to me especially. It was the fact that the percentage of people participating in the DSM 5 process increased from 14% to 70% since the DSM 4. That is a shockingly large increase! To me, that seems a bit questionable and makes me wonder if the APA and the new DSM 5 are just trying to get more diagnoses of psychological disorders in order to push more prescription drugs on people to raise profits for pharmaceutical companies. I know that could be seen as a hasty conclusion, but I think it should definitely be taken into consideration when reviewing the DSM 5. I do, however, hope that that is not the case at all. But in today’s world, we have to be aware of peoples’ intentions and their possible biases in order to think critically and decide what’s right for ourselves.
n_angel · May 24, 2013 at 11:04 am
I am not a clinician, nor do I have a degree in Psychology, yet I can’t help but wonder if there are to many chefs in the kitchen. As you hinted on and bmgibbs commented on, it appears the APA is trying to push more drugs for simply the purpose of making money. I can’t help but wonder if it is all a bit political and not so much about helping define disorders. I heard rumors today that binge eating 12 times in three months is now considered a mental disorder and would like to learn the support behind that and what justifies that as a mental disorder. Overall, before I can make some real opinions on it I would like to see a copy of it, yet at the price of almost 200$ I doubt that will be happening any time in the near future.