Biology Based Diagnosis of Mental Illness – "Brain Disorders"
A few months ago I published a paper I had written back in graduate school about The Transition Toward More Biology Based Methodology of Diagnosis in Mental Health. The gist of this paper was essentially that while we are not quite there yet we are certainly headed towards biology and physiology playing a much larger role in psychological diagnosis.
Dr. Thomas Insel, the current director of the National Institute of Mental Health, has made his thoughts on the subject fairly clear in recent years (I actually even cite an essay of his in my last article on this topic) However, he recently published an article to his NIMH Directors blog cementing the position of the institution on this coming transition.
Here are some key excerpts:
“The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity.”
“Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.”
“This approach began with several assumptions:
- A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,
- Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,
- Each level of analysis needs to be understood across a dimension of function,
- Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.”
“That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system.”
“What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.”
This is huge for a number of reasons. This article, rightfully so, points out the shortcomings of traditional (and current) methods of diagnosis in our field. Keep in mind that currently it is possibly for 2 patients to be diagnosed with the same extremely complex disorder requiring 5 of 9 diagnostic criteria to be met and it is entirely possible for these two patients to share only one symptom. Quite a sobering realization about our current methodology. Interestingly, one of the biggest hurdles in this transition will likely be due to insurance issues rather than technical or scientific issues. Currently insurance companies require diagnosis from the Diagnostic and Statistical Manual (DSM) for treatment and compensation. Restructuring research away from DSM categories is going to lead to some pretty significant conflicts in the near future without some strong mandates about how the insurance companies are going to have to behave during this transition.
If you find this topic interesting I suggest watching Dr. Insel’s recent TEDx video, it is about 13 minutes long but definitely worth it.
Let me know what you think in the comments!