The National Institute for Mental Health has launched a plan replace the DSM-5 with a new “Research Domain Criteria (RDoC)” project. Stating that the DSM is little more than a dictionary, that the DSM criteria are unreliable, and that those diagnosed with mental disorders “deserve better,” NIMH Director Thomas Insel made the announcement this past week. With its 1.5 billion dollar budget, NIMH is the major source of mental health research in the United States.
“The National Institute of Mental Health is to be applauded for taking on the monolith that the DSM has become,” says American Counseling Association Chief Professional Officer David Kaplan, “as we have needed a more developmental, systemic and ecological alternative for a long time. However, we need to have a healthy skepticism as NIMH has traditionally focused on the biological causes of mental health issues and so the Research Domain Criteria project may just be replacing one problem for another. ACA will monitor this and provide input to NIMH as the project develops.”
Updated: ACA DSM-5 Task Force chair analyzes NIMH’s decision
Paul Peluso, associate professor of counselor education at Florida Atlantic University and chair of ACA’s DSM-5 Proposed Revision Task Force believes that, in order to fully understand NIMH’s controversial decision and Director Thomas Insel’s comments, one must look at three things: the “context, history and timing.”
“What is surprising about this is that these comments come from the director of the NIMH,” Peluso continues. “From the beginning, the APA and NIMH were collaborating on the creation of DSM-5. In 1999, some of the leaders of APA met with the director of NIMH to discuss a new version of the DSM. … Thirteen conferences were held between 2004 and 2008 [regarding the DSM]. This begs the question, if NIMH was so involved in this planning stage, and sponsoring conferences with the expressed purpose of finding ‘scientific evidence,’ then the current director’s statements seem to indicate that this goal was not successfully met. Again, further evidence of dissatisfaction — at best — of the current DSM.”
Lastly, Peluso says, it is important to note the timing of Insel’s announcement.
“The DSM-5 is scheduled to be released on May 22 at the annual conference of the American Psychiatric Association. According to the NIMH website, the RDoC has been in its current draft form since 2011. In addition, APA voted to approve DSM-5 in December of 2012. Despite this, Dr. Insel posted his comments on April 29, 2013, just ahead of the DSM-5’s publication. Given that this plan has been in preparation for two years, one has to conclude that the timing of this critique and declaration of a new research direction has to be suspicious.”
Putting together the context of Insel’s statements, the history behind NIMH and APA’s relationship and the timing of the release of the decision, Peluso thinks the “NIMH is issuing a serious vote of ‘no confidence’ in DSM 5.”
Updated: ACA President-Elect finds announcement has positives and negatives for counselors
ACA President-Elect Cirecie West-Olatunji has mixed reactions to news of NIMH’s proposed RDoC and what it could mean for the counseling profession.
“The new statement by NIMH regarding use of the DSM is promising and laudable while also posing challenges for clinicians,” she says. “The positive side of their position is that a major entity in mental health is providing a critical analysis of the usefulness of the DSM, particularly within a contemporary context. Further, NIMH is offering a viable alternative. And, while other scholars and organizations have previously offered alternative nosologies for diagnosing clients, having a major organization such as NIMH take a critical stance is significant and encouraging.”
However, West-Olatunji has her reservations regarding the RDoC.
“The danger lies in focusing exclusively or primarily on biological factors,” she continues. “Other concerns, those that are humanistic and environmental in nature, can also provide valuable information about clients’ presenting problems. Moreover, there is just as much danger of over-pathologizing clients, particularly those who are marginalized, within the approach offered by the NIMH.”