A global consortium — co-led by a Stony Brook University mental health expert — is calling for a new approach to diagnosing mental conditions, a push for a paradigm shift in how these illnesses are classified and understood.
Roman Kotov, an associate professor of psychiatry at Stony Brook, along with 50 psychologists and psychiatrists from around the world, wants institute changes that would upend the status quo.
Kotov and his collaborators call the current model of diagnosis and classification contained within the mammoth Diagnostic and Statistical Manual of Mental Disorders V — the DSM-5 — hopelessly flawed.
In the United States, the 947-page DSM-5 serves as the written authority on psychiatric diagnoses and therapeutic recommendations. It is often referred to as the bible of psychiatry and is the text relied upon by clinicians who diagnose patients and recommend treatment, as well as by scientists who are investigating new therapies — and causes — of mental health disorders.
The American Psychiatric Association, which publishes the manual, did not respond to Newsday’s inquiry Monday about the proposed change. The manual was most recently updated in 2013, 20 years after its previous edition.
“It is quite unwieldy,” Kotov said Monday, calling the DSM-5 Byzantine and as intricate as the U.S. tax code.
“You can get lost in the complexity of its contents and still not find a compelling or accurate way to conceptualize your patient,” Kotov said.
This isn’t the first time that the DSM-5 has come under fire. Before its publication four years ago, some advocates and mental health professionals who help and treat autistic children were outraged by changes that were to appear in the manual. Key among the changes was the elimination of certain subcategories of autism spectrum disorders, which advocates said would result in making diagnoses more difficult for some children.
Kotov and consortium members have developed a new model for all mental health conditions with an aim of making diagnoses, classification and treatment far more accurate. They call the system HiTOP, which stands for Hierarchical Taxonomy of Psychopathology. The new approach is published in the current issue of the Journal of Abnormal Psychology.
HiTop not only better defines mental health conditions, Kotov said, but also lays a stronger foundation for precision therapy.
The research team behind HiTOP said their approach better classifies a wide range of psychiatric disorders based on mounting scientific evidence, including genetic findings, that underlie impaired mental functioning. A substantial amount of evidence has accumulated over the years, the researchers said, suggesting the need for major changes in how mental illnesses were cataloged.
The DSM-5, they said, offered only modest changes that led to dissatisfaction in the research community.
Kotov’s co-chief investigators at the University of Minnesota and the University of Notre Dame in Indiana agreed that it was time for a better model.
David Watson, the Andrew J. McKenna Family Professor of Psychology at the University of Notre Dame, was on the team that made revisions to the massive DSM-5 before its 2013 release. Watson, however, is now a member of the consortium and supports the HiTOP model.
“Quite frankly, we were not satisfied with the revisions that were made,” Watson said. “We felt the DSM-5 was far too conservative and failed to recognize and incorporate important scientific evidence regarding the nature of psychopathology.”
He said HiTOP differs from the DSM-5 by abandoning its categorical approach, which means a specific diagnosis is given only when the patient meets specific criteria. With the new HiTOP model, not only is diagnostic criteria less complicated, but there is also a way to assess the patient’s degree of severity.
Monika Waszczuk, an assistant professor of psychiatry at Stony Brook, applauded the new HiTOP approach.
“I look at this from the research perspective and its statistical power for analysis,” Waszczuk said. “It is a much better approach from the research side of things.”