My New Scientist Home | Opinion | Health | Opinion | Back to article There's no sense in revising the psychiatrist's bible 01 March 2012 by Liz Else Magazine issue 2853. Forget the Diagnostic and Statistical Manual of Mental Disorders – we need a new system based on brain physiology, says psychiatrist Nick Craddock You don't believe we should update the Diagnostic and Statistical Manual (DSM) used to classify mental illness. Why not? “There are many reasons we should pause. The DSM checklist of symptoms is not fit for purpose: its categories don't map onto the emerging science of emotion and cognition, yet the DSM-5 rewriters plan to pull in more areas in the new categories and over- medicalise the situation further. Obviously the people rewriting DSM are not stupid, but the project is the wrong thing now. There are lots of great findings coming out of biology, neuroscience and psychology. We will need a new diagnostic system based on these.” How do you see a non-DSM system of classifying mental illness? “It should be based on brain physiology, and make sense in biological and psychological terms. People think mental health is very different from physical health but I think our understanding of it is similar to where we were 100 years ago with illnesses such as diabetes. Take schizophrenia - people vary so much, but the DSM definition doesn't capture that. In 20 years' time the condition will have a biological and psychological typology. Right now our approach is like a blunderbuss.” What changes in DSM-5 worry you? “Suppose you suffer from severe low mood, lack of energy and lack of self-esteem for two weeks continuously. As things stand, if this happens up to six months after a bereavement, it would be considered normal. For most of us that fits with common sense. DSM-5 drops that exclusion and classifies such an episode as depression. This seems unhelpful, to say the least.” What about the "temper tantrum" category? “DSM-5 plans to bring in -Disruptive mood dysregulation disorder- which refers to an onset of temper outbursts before age 10. The thinking is this may be a prelude to later bipolar disorder. However, I believe we need much more firm evidence for the benefits of doing this before labelling children with such a diagnosis.” Do you have any other concerns? “There's likely to be a move to include people with mild delusions, hallucinations or disorganised speech into the psychosis category as -an attenuated form with intact reality testing-“. This underlines the overwhelming criticism of DSM - we need more research to distinguish correctly between normal and abnormal states before it is clinically justified to add a new diagnosis like this.
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