Do We Really Need Another Classification System in Psychiatry?
With the introduction of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) in 2013, the NIMH (National Institute of Mental Health) announced that it would be devising its own classification system, the RDoC (Research Domain Criteria). Huh? This is crazy- we need another classification system in psychiatry like we need a hole in the head.
We already have a classification system, why do we need another one? It’s not like we have any biological markers that we can use clinically to use in this so-called research classification system that the NIMH is proposing.
Dr. Thomas Insel, the NIMH director, states that although the DSM-5 has reliability (clinicians are classifying symptom clusters the same way), it lacks validity (the classifications do not have evidence that they are real diseases–Insel, 2013).
But the RDoC is even worse off than the DSM, as showing a symptom cluster to be valid as a disease entity (diagnosis) needs longitudinal studies to show that the disease holds up over time and has a predictable clinical course (prognosis).
At least the DSM has decades of longitudinal studies from which to draw upon. The RDoC is just in its infancy. But even though the DSM has such a head start, most of its ‘diagnoses’ have no longitudinal studies to validate them as disease entities.
What’s the Solution?
Here’s the solution. Forget about the DSM-5 and ignore the RDoC.
Go and get a copy of Goodwin & Guze’s Psychiatric Diagnosis (North & Yutzy, 2010). This textbook contains the best validated psychiatric diagnoses, of which there are only about a dozen that have the follow-up studies and family studies to validate their very existence as bonafide diseases.
Without such evidence, psychiatric diagnoses are just mere labels, with no real meaning.
We should only be utilizing the best validated psychiatric diagnoses clinically, while leaving the ones not validated to researchers who can continue to see if a psychiatric diagnosis should continue to be studied because of positive signals from longitudinal and family studies, while throwing out the ones that are not validated over time.
The problem with the DSM is that it continues to keep the diagnoses that are not validated, giving the false appearance that all the classifications in the DSM are real disorders, rather than just labels.
Goodwin & Guze’s Psychiatric Diagnosis, now in its 6th edition, has updates every few years to reflect the latest longitudinal and family studies, and it prints which psychiatric diagnoses are the best validated, and hence the most ‘real’ diagnoses.
According to Psychiatric Diagnosis, the following psychiatric diagnoses have the longitudinal and family studies to validate them as real disease entities:
- Mood (affective) disorders
- Schizophrenic disorders
- Panic disorder and phobias
- Post traumatic stress disorder (PTSD)
- Obsessive compulsive disorder (OCD)
- Eating disorders
- Somatization disorder (hysteria)
- Antisocial personality disorder (sociopathy)
- Borderline personality disorder
- Drug dependence
- Delirium and dementia (acute and chronic brain syndromes–North & Yutzy, 2010).
If your psychiatrist is diagnosing you with something other than the disorders listed above, they are not validated. In other words, if your psychiatric diagnosis is not listed above, it is just a label, until the studies can show otherwise.
Insel, T. (2013). Director’s Blog: Transforming Diagnosis. National Institute of Mental Health. Retrieved on August 9, 2015, from http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml
North, C.S., & Yutzy, S.H. (2010). Goodwin & Guze’s Psychiatric Diagnosis (6th edition). New York, NY: Oxford University Press.
Question mark photo available from Shutterstock
Carandang, C. (2015). Do We Really Need Another Classification System in Psychiatry?. Psych Central. Retrieved on July 23, 2017, from https://pro.psychcentral.com/do-we-really-need-another-classification-system-in-psychiatry/009268.html