The Controversial DSM-5
by Ned Wicker
From some 30 years the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) has been the standard diagnostic criteria dealing with addiction and other mental disorders. Recently the DSM-IV-TR has given way to a new way of thinking and with that some controversy.
The DSM-5 is the new standard and takes a step back from the DSM-IV, not trying to pinpoint an exact diagnosis, but rather puts every kind of mental disorder imaginable on a spectrum.
Every condition will be categorized from MILD to SEVERE
The DSM-IV, for example, tried to categorize every condition and when something did not fit a specific category, it was listed as NOS (not otherwise specified). Contrast that to the DSM-5 which gets away from the general classification by recognizing the co-morbidity of nearly every case—that is there is more than just one factor contributing to the person’s condition.
DSM-5 focuses finding ALL mental disorders rather tha focusing on one
DSM-5 contends that where you find depression you might also find anxiety, where there is attention deficit hyperactivity disorder (ADHD) there might also be substance abuse. The old NOS was not popular as a diagnostic tool, because it merely lumped the unknown into a pile. It was however convenient for the practitioners because it made billing categories much EASIER.
This is the first major overhaul in 30 years and soon there will be an electronic version available and updates are promised as the new standard rolls out. But like we mentioned, it does have it’s controversy. For example, who owns it? The DSM-IV was the domain of psychiatrists, who certainly have a legitimate dog in the fight, but what about counselors and other medical professionals?
Some believe it goes too far too fast
Some people are claiming the DSM-5 went too far in redefining mental disorders. Hansberger’s Syndrome, a kind of pervasive developmental disorder (PDD), which are conditions that involve delays in the development of many basic skills, like the ability to socialize, communicate, and use imagination, has been left out entirely. The definition of substance abuse has changed and many claim it’s too much at one time.
As for ownership, the medical community, outside of psychiatrists, is left out. Some in that community are asking “where is the biology?” While psychiatry is not an exact science, there are those who believe that science can answer more questions, if not all questions, when it comes to mental disorders and addiction.
NIMH hates new DSM-5
There are some who hate the DSM-5. For example National Institute of Mental Health (NIMH) head Thomas R. Insel, M.D., hates it and promises to come up with his own, science-based version. He aims to base diagnosis on science and biology, not observation.
The Research Domain Criteria Project (RDCP) supports the need to bring science into the diagnostic equation. They contend:
“The assumption of DSM-5 is that everyone’s mental status falls on a spectrum. This spectrum goes from typical to pathological. They contend that everything in mental health, including addiction, falls on that spectrum. It contends there will be a dimensional scale for virtually all disorders, including addiction.”
Mild, Moderate and Severe are the three categories. Some categories cut across all other diagnosis, eg. Anxiety and Suicide. Anxiety and suicide are no longer separate, they cut across other diagnosis, so what we see is not so much a list of conditions, but a tapestry of human behavior.”
“Yet, what may be realistically feasible today for practitioners is no longer sufficient for researchers. Looking forward, laying the groundwork for a future diagnostic system that more directly reflects modern brain science will require openness to rethinking traditional categories.”
“It is increasingly evident that mental illness will be best understood as disorders of brain structure and function that implicate specific domains of cognition, emotion, and behavior.”
“This is the focus of the NIMH’s Research Domain Criteria (RDoC) project. RDoC is an attempt to create a new kind of taxonomy for mental disorders by bringing the power of modern research approaches in genetics, neuroscience, and behavioral science to the problem of mental illness.”
The new DSM will affect all metal disorder diagnosis including addiction diagnosis and over time should give us a better understanding of ALL of the issues effecting the mental status of patients. The work the NIMH is doing should help us to better UNDERSTAND mental disease from a biological prospective.