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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.