Why the National Institute of Mental Health Dropped the DSM

The Diagnostic and Statistical Manual of Mental Disorders (DSM), known as the "bible" of psychology and psychiatry, has been around for more than half a century. The DSM, published by the American Psychiatric Association, provides the standards that psychologists and psychiatrists use to diagnose and treat patients. Nearly everyone involved in the world of psychology, from doctors to drug companies to lawmakers, relies on the DSM.

But you can now remove the National Institute of Mental Health (NIMH) from that list. The NIMH is rejecting the system of diagnosis that the DSM promotes — a "consensus about clusters of clinical systems," according to Thomas Insel, director of the NIMH. Insel contrasts that subjective system with the "objective laboratory measure[s]" that are used for other diseases.

Insel wants to see researchers combine "genetic, imaging, physiologic and cognitive data" in their studies to diagnose patients across standard categories. This means that clinicians won't be constrained by traditional definitions of particular disorders in diagnosing patients.

As an alternative, the NIMH is creating the new Research Domain Criteria Project (RDCR). The RDCR is an entirely new classification system, planned to take a decade or more to create, that will form a new perspective from which to view mental disorders and diseases. (See NIMH: Grants for Mental Health.)

So what does this change mean for prospective grantees? Well, for one thing, those seeking funding will have to take a similarly broad view when investigating treatments or potential cures. No longer will researchers be able to look only into a particular diagnosis, such as schizophrenia. Instead, they'll have to evaluate each of their patients across those diagnoses and form unique evaluations.

The NIMH provides an example, imagining a study that looked at all patients in a mood clinic rather than only those that meet the exact diagnosis criteria for major depressive disorder. The key word is biomarkers; NIMH is looking for studies that will lead to objective, physical attributes that can be used to diagnosis patients with mental disorders.

To get ahead of the game, grantseekers should look for ways to play into this new focus. Studies that make connections between previously disconnected disorders will likely be favored, as will those that simply ignore the DSM's previous boundaries. Above all, use this new freedom to search for better outcomes for patients.