Downplaying The DSM

The director of the National Institute of Mental Health (NIMH), Thomas Insel, announced last week that the NIMH will no longer rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM), a longtime guidebook for psychiatry:

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…. Patients with mental disorders deserve better.

Dr. Russ Poldrack offers a detailed description of the NIMH’s new focus, the Research Domain Criteria (RDoC) project. Vaughan Bell summarizes:

RDoC… aims to uncover what it sees as the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences. For example, difficulties with regulating the arousal system might be equally as involved in generating anxiety in PTSD as generating manic states in bipolar disorder.

[T]his won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day. …[The] RDoC is currently little more than a plan at the moment – a bit like the Mars mission: you can see how it would be feasible but actually getting there seems a long way off.

Adopting a religious analogy, Neuroskeptic concludes that the switch from the DSM to the RDoc is less a “revolution” than a “reformation”:

The DSM is more like the Catechism of psychiatry. The RDoC is a rival one.

This is why it’s wrong to see this as a paradigm shift. The NIMH proposals don’t mean a revolution in either research or treatment. Although researchers applying for NIMH grants will have to adapt the language of their pitches, framing it in terms of domains rather than disorders, I suspect that what they do with the money will be much the same.

Previous Dish on the DSM here.