National Institute of Health to abandon DSM-5

[jemagirl (imported)]

In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.

In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.

This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.

As a result the NIMH will now be preferentially funding research that does not stick to DSM categories:

Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.

As an alternative approach, Insel suggests the Research Domain Criteria (RDoC) project, which 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.

Of course, this ‘component part’ approach is already a large part of mental health research but the RDoC project aims to combine this into a system that allows these to be mapped out and integrated.

It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.

It is also true to say that 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. In fact, until now, the RDoC project has largely been considered to be an experimental project in thinking up alternative approaches.

The project was partly thought to be radical because it has many similarities to the approach taken by scientific critics of mainstream psychiatry who have argued for a symptom-based approach to understanding mental health difficulties that has often been rejected by the ‘diagnoses represent distinct diseases’ camp.

The NIMH has often been one of the most staunch supporters of the latter view, so the fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.

Hmmm..... What do you think this means for the eunuch community?

http://www.nimh.nih.gov/about/director/ ... osis.shtml

http://mindhacks.com/2013/05/03/nationa ... g-the-dsm/

[janekane (imported)]

I happen to be a person who, for professional engineering continuing education purposes, sometimes attends conferences of mainly psychiatrists, psychologists, and psychiatric social workers, such as, for example, the Fall Conferences of the Erikson Institute in Stockbridge. Massachusetts. Last year's conference, which I attended, was focused on the relationship of trauma, and war trauma in particular, with moral injury.

Some time ago, I came up with my own sense of the DSM, back in the days of the DSM-III-R, and updated that sense with the arrival of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. It is important to note that "DSM-IV" is a registered trade mark.

Alas, I am a licensed Wisconsin Registered Professional Engineer, and my license prohibits my using deception in my engineering work. While this may put my work in seeming conflict with the theories-in-use of

the American Psychiatric Association,

I am licensed as an engineer and am not licensed as a physician or surgeon; therefore, such provisions as pertain to licensed professions other than engineering that would be ethical violations in engineering get set aside in my work.

In order for me to relate to the DSM-IV(R)-TR without deception, in my mind, I usually think of it, as I have mentioned at some of those Fall Conferences, as the "Damning and Stupefying Mishmash of Malevolent Dichotomies, Fourth Exacerbation, Trashing Reality."

In 1987, the year the DSM-III-R was published, the grapevine brought to my attention a story, perhaps not true, of a person who, at a presentation by Robert L. Spitzer. M.D., who was the Chair of the Workgroup to Revise DSM-III, and was also a member of every Advisory Committee on Diagnostic Categories, asked Spitzer what diagnostic category best fit a person who would do the work Spitzer did for the DSM-III-R. The grapevine story, as I now recall it, had it that Spitzer did not reply to that question.

My view of what this may really mean for "the eunuch community" ?

We are normal people.

[janekane (imported)]

Normal people normally need help from other normal people, for it is normal to need help; therefore, such services as normal, and therefore, normally diverse, people need are properly provided according to individual circumstances and need.

Therefore, needed services can become provided to people, not because people who need needed services are more or less needy than others, because all people need needed services according to each person's actual needs...

Once it is recognized that diversity is necessary for life to exist, diversity will not longer be misunderstood as a violation of the nature of life; diversity will become understood as an essential core aspect of life itself.

Exit, off the stage of life, prejudice?

Exit, off the stage of life, stigma?

Exit, off the stage of life, shame?

Exit, off the stage of life, blame?

Exit, off the stage of life, guilt?

Exit, off the stage of life, abuse?

[Skudster (imported)]

Is DSM 5 available for download somewhere, I have been looking but havn't found it anywhere yet. If it is out there could you post it here. Thanks

[jemagirl (imported)]

Is DSM 5 available for download somewhere, I have been looking but havn't found it anywhere yet. If it is out there could you post it here. Thanks

I take it that you mean post the link, right?

[JesusA (imported)]

DSM-5 has not yet been published. It's supposed to be available at the end of next week. There has been a great deal of discussion about it, mostly by people who have not yet seen any part of it. Once it is published, it will be a very thick and very expensive book – probably not available for download without significant cost for some time. The APA is very jealous of its rights.

[janekane (imported)]

The dsmfive is supposedly to become available, if I recall correctly, on May 22, 2013 at a price of U.S. $199. I trust that "dsmfive" is not a trademark infringement...

However its World Health Organization equivalent, the ICD-11 (International Classification of Diseases) is to be available "for free" and is likely to have the same diagnostic system with a different set of codes. The last I heard, the ICD-11 may be out in 2015.

The last I heard, and I may not have heard right,

the American Psychiatric Association

ear

ned most of its keep through pu

blishing, especially the Damning and Stupefying Mishmash... (did I do a "naughty"?)

There are those, so I have heard, who assert that the only value of the code books is getting paid. Not all of what I have heard is necessarily reliable or accurate.

[kristoff]

Much of what I read in the draft version of the classifications that was posted on line about a year ago would be pretty contentious at the least. I can understand why the NIMH is taking a distant view. I do too in several areas.