Open letter regarding the reform and revision of diagnostic systems

“We … recommend a paradigmatic revision of the empirical and conceptual frameworks used to think about mental health. A classification approach that pursues the neo-Kraepelinian goal (now nearly half a century old) of establishing biomarkers for individual conditions or symptoms would not constitute such a paradigm shift but rather an attempt to revitalize the current paradigm.”

The Task Force on Diagnostic Alternatives has written an open letter to key players in several current and in-development psychiatric diagnostic systems and related research frameworks.

For the sake of simplicity, the extract below omits footnote references, but these can been seen by following the link provided. The letter begins:

“In 2011, the British Psychological Society (BPS) and the Society for Humanistic Psychology responded to the American Psychiatric Association’s proposals for what would become the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Both professional bodies expressed concern that:

…clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation…

That concern, among others, appeared in an Open Letter to the DSM-5 that was endorsed by over 15,000 mental health professionals and other individuals, as well as by over 50 professional organizations, including 15 additional divisions of the American Psychological Association.

Since then, we have seen the development of various diagnostic systems and related research frameworks. Among them are the National Institute of Mental Health’s new research framework, the Research Domain Criteria(RDoC) project, which aims to develop “new ways of classifying mental disorders based on behavioral dimensions and neurobiological measures,” and the Hierarchical Taxonomy of Psychopathology(HiTOP); as well as the ongoing revisions of the World Health Organization’s International Classification of Diseases and Related Health Problems (ICD) and the American Psychiatric Association’s DSM.

Whilst there is much to be welcomed in these initiatives, we have scientific, conceptual and ethical concerns about each of them. The diagnostic categories proposed by these frameworks — the DSM, the ICD and newly proposed models such as the RDoC project — are based largely on social norms about what constitutes ‘normal’ or desirable behavior or experience. Their definitions inevitably rely on subjective judgments, which are themselves grounded in cultural norms. As Thomas Insel has pointed out, despite billions of dollars of research investment, no biomarkers, confirmatory physical ‘signs’ or pathognomonic evidence of biological causation have been discovered for the putative pathologies represented by the category labels within these systems. Many researchers have pointed out that psychiatric diagnoses are plagued by problems of reliability, validity, prognostic value and comorbidity. Significantly, diagnostic categories do not consistently predict response to medication or other interventions …”

You can read more from here.

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