Definitions and Familial and Biological Basis
Case Study: The Diagnostic and Statistical Manual of Mental Disorders (continued) According to Dr. Thomas Insel, director of the NIMH, the problem with the DSM is that it classifies men- tal disorders by clinical symptoms, which he thinks are not sufficient for diagnosing disease:
While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reli- ability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. (Insel, 2013)
Dr. Insel pointed out the difference between having a shared definition so that various people are talking about the same thing, which is reliability, and being logically or factually correct (evidence based), which is validity.
The NIMH is the major funding source for research in mental health and mental illness for the entire United States and much of the world. An important goal of the NIMH is to transform diagnosis of mental illness so that it is based on biology, not on symptoms or subjective criteria. This goal can be achieved by incorporating cognitive science, genetics, imaging, and other information into the Research Domain Criteria, which is envisioned as a 10-year project (Insel & Lieberman, 2013). In other words, DSM-5 may be flawed when it comes to applying it to research, but it is still the best tool available for diagnosing mental disorders.
Some changes in DSM-5 include classifying attention deficit hyperactivity disorder (ADHD) as a neu- rodevelopmental disorder instead of a disruptive disorder. Also, several criteria within posttraumatic stress disorder (PTSD), trauma, and stress-related disorders, are now more explicit about what con- stitutes a traumatic event and specifically include sexual assault and a new preschool PTSD subtype. Changing the classification of ADHD has social implications: It removes the negative implication from this disorder and places it in a more neutral, developmental context. Similarly, by recognizing that sexual assault is by definition a traumatic event, the DSM-5 validates the impact of such events on people’s lives.
Neurodevelopmental Disorders Neurodevelopmental disorders are changes in the normal growth and development of the ner- vous system, resulting in slowed maturity in behavior, communication, or ability to focus. This section concentrates on two neurodevelopmental disorders: autism spectrum disorders (ASD) and ADHD.
Autism Spectrum Disorders Children with ASD have an unusual way of communicating with people and their environment. They may have trouble with social interactions and communication and may be unusually inter- ested in a particular subject; they also may show restricted, repetitive patterns of behavior.
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