PhD/PsyD Opinions on NIMH withdrawing support for DSM-5

[PsychMajorUndergrad18]

Hello Everyone,

Read this article: https://www.psychologytoday.com/blog/side-effects/201305/the-nimh-withdraws-support-dsm-5

This topic may have probably been debated and discussed upon multiple times but I would like to hear everyone's opinion being that I just found out about this recently.

---

Members don't see this ad.

 

[473912]

This helps explain the idea that "Neuropsych is the future", something I've heard several times. That seems to be a lean. Or perhaps the MDs wanting to head psychology moreso. Either way, Interesting article. I wonder how NIMH feels about the international mental illness guides... the name of which escapes me.

 

[futureapppsy2]

This helps explain the idea that "Neuropsych is the future", something I've heard several times. That seems to be a lean. Or perhaps the MDs wanting to head psychology moreso. Either way, Interesting article. I wonder how NIMH feels about the international mental illness guides... the name of which escapes me.

You mean the ICD-10? It covers both physical and mental health.

 

[473912]

You mean the ICD-10? It covers both physical and mental health.

That's the one, yeah. Thanks.

 

[WisNeuro]

Meh, old news. Not a fan of the updated DSM, and most healthcare systems (VA included) already use ICD. Although they need to roll out new versions a teensy bit faster. The DSM isn't as much of a bible of the field as much as it is a poorly researched cookbook.

 

[AcronymAllergy]

I'll readily admit that the DSM-5 is an improvement over the 4 with respect to the switch to "mild/major neurocognitive disorder due to XXX." But even then, the coding guidelines are inefficient at times, particularly for the multiple etiologies monicker. Outside of that, meh.

As for NIMH, I appreciate the goal of trying to develop a diagnostic system that has validity. But I don't know that focusing so heavily on lab values and the like is the best way to do that. I mean, do we really think we'll find a biomarker for "adjustment disorder" or "phase of life problem?" I can understand wanting to attempt to identify associated factors for increased risk of developing types of mental illness, identifying potential points of intervention, etc., but I personally don't know that we're ever going to be able to boil things down to just biomarkers.

 

[WisNeuro]

I agree, even for certain mental disorders that have some biomarker evidence, there will be so much individual variation, I can't imagine cut scores and the like. "Sorry, you aren't really depressed according to your serotonin and nor-epinephrine."

 

[AcronymAllergy]

I agree, even for certain mental disorders that have some biomarker evidence, there will be so much individual variation, I can't imagine cut scores and the like. "Sorry, you aren't really depressed according to your serotonin and nor-epinephrine."

Exactly. And even then, it may or may not directly affect treatment. So we identify someone as "depressed" based on various biomarker levels; that still doesn't necessarily tell us the behavioral, interpersonal, etc., ways in which the condition is being manifested; what sorts of associated behavior patterns might have developed as a result and could be good focuses of intervention; etc.

 

[WisNeuro]

Exactly. And even then, it may or may not directly affect treatment. So we identify someone as "depressed" based on various biomarker levels; that still doesn't necessarily tell us the behavioral, interpersonal, etc., ways in which the condition is being manifested; what sorts of associated behavior patterns might have developed as a result and could be good focuses of intervention; etc.

Pssh, that stuff doesn't matter. Just have them open their mouths, chuck a handful of different SSRI/SNRI's at them, whatever sticks, prescribe that.

 

[473912]

Pssh, that stuff doesn't matter. Just have them open their mouths, chuck a handful of different SSRI/SNRI's at them, whatever sticks, prescribe that.

The DSM is created by the American Psychiatric Association, right? They're already MD's educated in the way of thinking you both are alluding to. I don't mean to constantly look at this through an adversarial lense, but I can't help but try to think of who ultimately benefits and that leads to the why. Do you think pharmaceutical companies have a hand in this?

 

[WisNeuro]

Yes, it is by the Psychiatric APA. But, there are a minority of PhD's on some of the work groups, so there is some psychology representation. It's just very political at times and the categorical system doesn't play out all that well in the real world. As far as pharma, not directly as far as I am aware, but they have their hands in a lot of pots, one could assume some degree of influence in a lot of areas if you look hard enough, but not directly in this instance.

 

[AcronymAllergy]

The DSM is created by the American Psychiatric Association, right? They're already MD's educated in the way of thinking you both are alluding to. I don't mean to constantly look at this through an adversarial lense, but I can't help but try to think of who ultimately benefits and that leads to the why. Do you think pharmaceutical companies have a hand in this?

Have a hand in NIMH rejecting DSM-5? Eh, possibly, but it's not the first theory that sprang to mind. Rather, it just seems as though NIMH has decided biomarkers and the like are the "wave of the future," or at least that research in this area has lagged behind other health subdisciplines. Thus, they want to use a diagnostic/coding system that reflects this focus and spurs associated research better than the DSM-5's symptom cluster-oriented structure.

 

[Ollie123]

The DSM is a tool of convenience for the sake of having a common clinical parlance and due to our wacky insurance system. Its a necessarily evil and its been a long time since I've heard of anyone being "pro-DSM" from a scientific standpoint. Reliable...but not valid.

I'm a fan of RDoC, though am admittedly biased since it aligns perfectly with my research program. I do think it needs more emphasis on behavior (and environment in general for that matter since I'm not sure how much I buy into the notion that environment will have a detectable effect on lower units of analysis given current technology). Iactually don't make too much of the units of analysis in general but I like the way they have broken down the systems. Overall though, I think its pretty clearly a step in the right direction scientifically. It will absolutely need continued refinement moving forward in a variety of ways. At some point, we needed to break the mold of say...thinking of depression/anxiety as independent disorders that happen to overlap much of the time. At least its a start.

 

[Therapist4Chnge]

I haven't bothered to pick up the DSM-V…as making the transition from the ICD-9 to ICD-10 is going to suck enough. I really dislike the "new" coding system of ICD-10. Hello insurance reimbursement delays...

 

[QAsPsych]

I was very excited when I saw that NIMH was not backing the DSM, and then rather disappointed to see they plan to replace it with something worse/nonexistent. Pharmaceutical companies are hugely involved in the crafting of DSM, so I doubt they're "behind" the split at all. I do see it somewhat as a turf war, but not so much between psychology/psychiatry as between those who align with two different perspectives on mental illness.

 

[Fan_of_Meehl]

I remember reading a lot of articles while working on my dissertation (which involved computer-assisted cognitive therapy for depression) from some of the hardcore biological reductionist types (e.g., Donald Klein) who spoke with damn near 100% certainty predicting that, within the next decade or so, all of the biological underpinnings of depression were sure to be worked out and biological treatments for depression would eclipse psychotherapeutic approaches in practice.

That was mid-late 1990's.