THE PSYCHOLOGIST NEWS RE: DSM-5 - JUNE 2013 - Never far from controversy, the publication’s imminent arrival was overshadowed by a double-whammy of criticism from NIMH + the Division of Clinical Psychology (BPS)

THE PSYCHOLOGIST June 2013 ISSUE

NEWS

As this month’s issue of The Psychologist

was headed to the printers, the American

Psychiatric Association were just days

away from publishing the eagerly

anticipated fifth edition of their

diagnostic code, the DSM-5. Never far

from controversy, the publication’s

imminent arrival was overshadowed by

a double-whammy of criticism – from the

director of the National Institute of

Mental Health (NIMH), the world’s

largest funder of mental health research,

and from the Society’s own Division of

Clinical Psychology (DCP).

Writing on his official blog, NIMH

Director Thomas Insel lamented the fact

that diagnostic categories in psychiatry

continue to be based on symptom

clusters, not on underlying biological

causes. ‘Patients with mental disorders

deserve better,’ he said, adding that his

organisation ‘ will be re-orienting its

research away from DSM categories.’ He

explained that for the last 18 months the

NIMH has been running a project called

Research Domain Criteria, which aims to

‘transform diagnosis by incorporating

genetics, imaging, cognitive science,

and other levels of information to lay

the foundation for a new classification

system.’

Headed by clinical psychologist

Bruce Cuthbert, the motivation for the

decade-long Research Domain Criteria

project is the frequent finding that

biomarkers for mental illness do not

match psychiatric diagnostic categories

that are based on patient symptoms. For

instance, an NIH-funded study published

earlier this year reported that the same

four genetic variations were associated

with five different psychiatric diagnoses

– autism, ADHD, depression, bipolar

disorder and schizophrenia (see April

News).

Commentators were divided as to the

significance of Insel’s intervention.

Vaughan Bell of the Institute of

Psychiatry called it a ‘potentially seismic

move’. Hank Campbell, founder of the

Science 2.0 website, said the NIMH had

delivered a ‘kill shot to DSM-5’.

However, others were left wondering

what all the fuss was about. It is well-

documented that the original aim of

DSM-5 was to replace the old category-

based diagnostic system with a new

dimensional format based on underlying

biological risk factors, but the project

was abandoned for lack of adequate data.

In a press statement, DSM-5 chair David

Kupfer said the promise of biological

markers for mental disorders had been

anticipated since the 70s, but that we’re

still waiting. Meantime, he said DSM-5

‘represents the strongest system

currently available for classifying

disorders.’

Professor Francesca Happe, Director

of the MRC Social, Genetic and

Developmental Psychiatry Centre at the

Institute of Psychiatry and a member of

the neurodevelopmental disorders work

group for DSM-5, appeared to back

Kupfer’s view when she told us: ‘At the

beginning of the DSM-5 process, they

asked everyone to consider whether

neurobiological information, including

genetics and anything you can think of

on the biological side, could be used to

aid diagnosis in any of these conditions,

and the resounding answer was no,

or at least “not yet”.’

Meanwhile, the DCP issued

a statement attacking DSM-5 from

a different direction, for being too

biologically based and for minimising

‘psychosocial factors in people’s

distress’. The Division’s statement

(tinyurl.com/dcpdsm5) calls for a

‘paradigm shift’ in the diagnosis of

mental health problems, for an approach

‘that is multi-factorial, contextualises

distress and behaviour, and

acknowledges the complexity of the

interactions involved in all human

experience.’ It follows a similar

statement published by the British

Psychological Society last year.

However, challenging the DCP

statement in The Observer, Sir Simon

Wesseley, Professor of Psychological

Medicine at the Institute of Psychiatry,

wrote that ‘Psychiatry is the study of the

brain and the mind. Psychiatrists look at

the whole person, and indeed beyond

the person to their family, and to

society.’ He concluded that DSM ‘isn’t

the system of classification that we use

over here in any case. In practice, most

UK mental health professionals will

barely notice much difference... most of

those in the business of helping those

with mental disorders will be less

concerned with what is in and what is

out than with the reality of underfunded

and overstretched services. The idea that

we are part of a conspiracy to medicalise

normality will seem frankly laughable as

we struggle to protect services for those

whose disorders are all too evident

under any classification system.’

CJI

The Society’s Division of Educational

and Child Psychology is holding a one-day

event on 28 June: The Medicalisation of

Childhood: Time for a Paradigm Shift.

See www.bps.org.uk/decpjune28

Also, Simon Wesseley is running a

conference on DSM-5 at the Institute of

Psychiatry in London on 4 and 5 June:

(tinyurl.com/cgt56xr). Speakers include

DSM-5 Chair Dr David Kupfer, and

Honorary BPS Fellow, Professor of

Clinical Psychology David Clark CBE