By Maia Szalavitz / May 07, 2013

Just weeks before psychiatry’s new diagnostic “bible”—the DSM 5— is set to be released, the world’s major funder of mental health research has announced that it will not use the new diagnostic system to guide its scientific program, a change some observers have called “a cataclysm” and “potentially seismic.” Dr. Thomas Insel, the director of the National Institute on Mental Health, said in a blog post last week that “NIMH will be re-orienting its research away from DSM categories.”
The change will not immediately affect patients. But in the long run, it could completely redefine mental health conditions and developmental disorders. All of the current categories — from autism to schizophrenia — could be replaced by genetic, biochemical or brain-network labeled classifications. Psychiatrists, who are already reeling from the conflict-filled birth of the fifth edition of the Diagnostical and Statistical Manual of Mental Disorders, are feeling whipsawed.
Insel, for his part, is lobbying for a more comprehensive approach. For scientific purposes, he argues, the DSM may have outlived its usefulness. He writes:
Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain… Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response…Patients with mental disorders deserve better.