NIMH “throws shade” on APA weeks before new DSM

Only a few weeks ago, blogs were heralding the impending arrival of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which provides standard language and criteria for mental illnesses and is currently used as the gold standard for psychiatric diagnoses. The DSM-V is scheduled to be released by the American Psychiatry Association on May 22nd, with some pretty interesting changes. This edition will include binge-eating, hypersexuality, and hoarding as new disorders, and Asperger’s Syndrome will be dropped as a diagnosis. Some herald the DSM-V as the newest “bible” of psychiatry. At the National Institute of Mental Health (US), it will likely be used as a paperweight.

According to Thomas Insel, the director of the National Institute of Mental Health (NIMH), they have been developing their own classification system. They hope that theirs will better serve patients. As Insel wrote on his official NIMH blog: “Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.”

The RDoC project has been in the works since 2010, yet there still seem to be no specific definitions, only major categories. Two factors may have contributed to the NIMH’s decision to bring the RDoC back into the limelight: the release of the DSM-V in a few weeks, and Obama’s recently-announced BRAIN initiative. This initiative — in a country where Congress is perceived as trying to usurp scientists at federal grant agencies, a country that once claimed the infamous Todd Akin as a member of its House Committee on Science, Space and Technology* — has been welcomed as an oasis for neuroscientists. (More than a few people in my building at McGill have expressed excitement.) It’s no surprise that research psychiatrists might want to go for a share of it.

It seems apparent that this will have almost no immediate impact on practising psychiatrists. As Isnel remarks, “RDoC, for now, is a research framework, not a clinical tool. This is a decade-long project that is just beginning.” However, the long-term impact of disconnecting research from clinical practice is unclear. The entire point of the DSM, which Insel acknowledges, was to ensure that clinicians are all on the same page – literally and figuratively speaking. Will the RDoC cause a massive disconnect between clinical psychiatrists and their peers in academic research? Will this new dichotomy in classification systems prevent translation of research to clinical applications? To answer these questions, we’ll have to wait and see.

* For the record, I’m an American, so I’m allowed to take cheap pot-shots at Congress.

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