Psychiatric Diagnosis: Where's the Science?
The recent National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) proposal has not received as much attention as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5) draft proposal, but the 2 ideas are linked. NIMH leadership has concluded, as some suggested in 1980 with the DSM-III, that we need 2 sets of diagnostic criteria: one for practice ( DSM-5) and one for research (RDoc). The one for practice can be based on "pragmatic" decisions about diagnostic criteria; the one for research should be "real." Now what does this mean?
The pragmatic DSM-5 is not primarily a scientific document: Criteria are chosen by psychiatric leaders in the task force committees, and in the oversight of the overall DSM leadership, on the basis of what they think is best for psychiatric practice. The NIMH leadership itself has explicitly come to just the same conclusion as I have: The DSM has so many uses that it has limited utility as a scientific assessment of mental illness that could serve as a basis of scientific research.
The problem may be even greater than limited utility, though; it could be that some DSM criteria -- those that are least scientifically valid -- may themselves become a major obstacle to research. If false, they ensure that biological studies will be false.
5/11