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Monday, 6 May 2013
FOR THE SAKE OF A BALANCED DEBATE BETWEEN PSYCHOLOGY AND PSYCHIATRY : DSM-5 Task Force Chair Discusses Future of Mental Health Research in the light of the NIMH rejection as a research tool and admits the biological markers are still a distant dream. Courtesy of the APA website + JOIN THE DSM-5 DEBATE AT OLD TRAFFORD BELOW
Statement by David Kupfer, MD
Chair of DSM-5 Task Force
Discusses Future of Mental Health Research
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The promise of the science of mental disorders is
great. In the future, we hope to be able to identify disorders using biological
and genetic markers that provide precise diagnoses that can be delivered with
complete reliability and validity. Yet this promise, which we have anticipated
since the 1970s, remains disappointingly distant. We’ve been telling patients
for several decades that we are waiting for biomarkers. We’re still waiting. In
the absence of such major discoveries, it is clinical experience and evidence,
as well as growing empirical research, that have advanced our understanding of
disorders such as autism spectrum disorder, bipolar disorder, and
This progress will soon be recognized in the
fifth edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5). The new manual, due for release later this month, represents the
strongest system currently available for classifying disorders. It reflects the
progress that we have made in several important areas.
A revised chapter organization signals how disorders may relate to
each other based on underlying vulnerabilities or symptom characteristics.
Disorders are framed in the context of age, gender, and cultural
expectations, in addition to being organized along a valuable developmental
lifespan within each chapter.
Key disorders were combined or reorganized because the relationships
among categories clearly placed them along a single continuum, such as
substance use disorder and autism spectrum disorder.
A new section
introduces emerging measures, models and cultural guidance to assist clinicians
in their evaluation of patients. For the first time, self-assessment tools are
included to directly engage patients in their diagnosis and care.
DSM, at its core, is a guidebook to help clinicians
describe and diagnose the behaviors and symptoms of their patients. It provides
clinicians with a common language to deliver the best patient care possible.
And through content such as the new Section III, the next manual also aims to
encourage future directions in research.
Efforts like the National Institute of Mental
Health’s Research Domain Criteria (RDoC) are vital to the continued progress of
our collective understanding of mental disorders. But they cannot serve us in
the here and now, and they cannot supplant DSM-5. RDoC is a complementary
endeavor to move us forward, and its results may someday culminate in the
genetic and neuroscience breakthroughs that will revolutionize our field. In
the meantime, should we merely hand patients another promissory note that
something may happen sometime? Every day, we are dealing with impairment or
tangible suffering, and we must respond. Our patients deserve no less.
The American Psychiatric Association is a
national medical specialty society whose physician members specialize in the
diagnosis, treatment, prevention and research of mental illnesses, including
substance use disorders. Visit the APA at www.psychiatry.org.