Research Plan Hints at DSM-V's Future. (from Syndromal to Etiologic)

Article excerpt

The American Psychiatric Association hopes its new research agenda for the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders will help rectify some of the problems that have plagued DSM-IV, and begin a revolutionary change in the way psychiatric problems are diagnosed.

Right now, said Dr. Michael First, a coeditor of the Research Agenda for DSM-V, the research necessary for those kinds of changes, although promising, is still very limited. If, over the next 5-10 years, researchers focus on the validity of psychiatric diagnosis and the etiology of mental illness, DSM diagnostic criteria could evolve from syndromal to etiologic.

"The DSM is a reflection of the state of the art of psychiatry," Dr. First said, "and at this point, it's a measure of the limitation of our knowledge. We still rely on symptoms for diagnosis. But ultimately, the goal is to learn the causes of these disorders. Our ope is this agenda will stimulate research in specific areas and bring an entirely new database to future editions of the DSM."

The DSM-III, published in 1980, reflected a surge of research in psychiatry. Considered a landmark departure from the previous manuals, it imposed a descriptive diagnostic method based on observable and reportable symptoms.

But the DSM-IV published in 1994, was based on literature reviews, which, while extensive, offered to clinicians little new knowledge about the underlying etiology or pathophysiology of mental disorders.

In 1999, APA leaders sponsored a research-planning conference, foreseeing that the coming explosion of genetic, psychiatric, and neurobiologic research could be the basis of another landmark DSM revision. The conference resulted in the creation of six workgroups, each of which addressed an area crucial to improving the manual: developmental science, culture and psychiatric diagnosis, gaps in the manual's treatment of personality and relational disorders, nomenclature issues, neuroscience and genetics, and disability and impairment.

"This was kind of a fresh-start approach," said Dr. First of Columbia University New York. …