Rethinking the Classification of Mental Illness

The new Diag­nos­tic and Sta­tis­ti­cal Man­u­al of Men­tal Dis­or­ders (DSM-5) is sched­uled to be released in May 2013. This recent Dana Foun­da­tion arti­cle points out the need of a fun­da­men­tal­ly dif­fer­ent approach based on the new ways researchers use to study and under­stand men­tal illness.

The prob­lem with the DSM-IV, our cur­rent shared diag­nos­tic lan­guage, is that a large and grow­ing body of evi­dence demon­strates that it does a poor job of cap­tur­ing either clin­i­cal and bio­log­i­cal real­i­ties. In the clin­ic, the lim­i­ta­tions of the cur­rent DSM-IV approach can be illus­trat­ed in three salient areas: (1) the prob­lem of comor­bid­i­ty, (2) the wide­spread need for “not oth­er­wise spe­cif­ic (NOS)” diag­noses, and (3) the arbi­trari­ness of diag­nos­tic thresholds.

What­ev­er the ulti­mate approach to the DSM‑5, it is crit­i­cal that the sci­en­tif­ic com­mu­ni­ty escape the arti­fi­cial diag­nos­tic silos that con­trol so much research, ulti­mate­ly to our detriment.

Key ques­tions: How can we give the research com­mu­ni­ty not only per­mis­sion but also encour­age­ment to rethink the clas­si­fi­ca­tion of psy­chopathol­o­gy? How can we encour­age sci­en­tif­ic inno­va­tion while ensur­ing that clin­i­cians can still com­mu­ni­cate with patients and families—and also with insur­ance com­pa­nies, schools, and courts?