Magazine article Clinical Psychiatry News

DSM-IV Failings Spawn Wish List for DSM-V. (Patient-Focused, Evolving System Wanted)

Magazine article Clinical Psychiatry News

DSM-IV Failings Spawn Wish List for DSM-V. (Patient-Focused, Evolving System Wanted)

Article excerpt

ASPEN, COLO. -- Widespread dissatisfaction with the current diagnostic classification scheme embodied in DSM-IV emerged as a recurrent theme at a psychiatry conference sponsored by the University of Colorado.

"The categorical boxes that we have may be helpful in some regards but are very limiting in others. When patients don't fit inside one of these silos, we get confused," observed conference director Dr. Michael Weissberg, professor of psychiatry at the university.

A major failing of DSM-IV, added Dr. Steven L. Dubovsky, is that it's essentially nothing more than a collection of cross-sectional signs and symptoms with a little discussion about course.

"It's a list of symptoms. So what? Everybody's got symptoms of one kind or another. One failing of our current diagnostic thinking is to say that a list of symptoms equals an illness. That's not necessarily true. ... I honestly don't think that most of our categorical diagnoses mean that much," said Dr. Dubovsky, professor of psychiatry at the university.

"Psychiatry has lagged behind other medical fields in terms of its stage of science," according to Dr. Paula Riggs, a psychiatrist at the university. "We've been hanging out a long time in the observational, descriptive phase of science. ... Our diagnostic categories are reminiscent of medical textbooks" from the early 20th century.

Dr. Dubovsky said he'd like to see DSM-V incorporate new ways of defining psychiatric illnesses that permit modification of diagnosis depending upon level of impairment. He would also like to see some guidance as to the responsiveness of illnesses to specific therapies.

Dr. Robert N. Emde said that he's fairly convinced the DSM-V will bring major changes in psychiatric diagnosis.

"Our diagnostic system is meant to be evolving. It's going to change, I think, rather drastically," predicted Dr. Emde, professor of psychiatry and director of the program for early developmental studies at the university.

The new system will be increasingly dimensional. It will pay more attention to individual assessment of factors, including impairment of functioning, cultural features of diagnosis, and developmental factors.

"Levels of development are important for expression of disorders and are absent from DSM-IV. [Attention-deficit hyperactivity disorder] has the same criteria for diagnosis at age 8 and in adolescence," noted Dr. Emde.

He added that he'd also like to see the next version of the DSM devote increased attention to the role of intimate relationships in providing context in diagnostic classification, but he is less optimistic that this will happen.

Dr. John Talbott observed that DSM-IV doesn't take comorbidity into account, despite the fact that comorbidity is the norm in psychiatric illness. …

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