NIMH funding to shift away from DSM categories

It's been portrayed as a clash of mental health titans. In April, just weeks before the American Psychiatric Association released the long-awaited fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the National Institute of Mental Health said that the federal agency will move away from funding research based on DSM categories.

The DSM — the so-called bible of mental health professionals — has long been the primary tool for diagnosing and classifying mental illnesses. But in a blog post, NIMH Director Thomas Insel, MD, said that it was time to "re-orient" away from the DSM's symptom-based categories. Instead, the institute is developing a new framework called Research Domain Critera (RDoC) that replaces the DSM diagnoses with broader research categories that incorporate behavioral and neuroscience evidence.

The press and bloggers quickly labeled the announcement an "abandonment" of the DSM.

In response, the American Psychiatric Association and NIMH released a joint statement in May attempting to clarify NIMH's move. The organizations said that the DSM remains the gold standard for clinical diagnosis, but "what may be realistically feasible today for practitioners is no longer sufficient for researchers."

So, while clinicians will continue to diagnose and treat mental health disorders based on DSM categories, the goal is that the new RDoC-based research that NIMH funds will eventually be incorporated into future versions of the DSM.

"All medical disciplines advance through research progress in characterizing diseases and disorders," the statement said. "DSM-5 and RDoC represent complementary, not competing, frameworks for this goal."

Bruce Cuthbert, PhD, a psychologist and head of NIMH's Division of Adult Translational Research and Treatment Development, says that the change is also more nuanced than original reports reflected. The change will happen gradually, and NIMH will continue to fund some research based on DSM categories.

The goal, he says, is not to limit researchers, but to give them the freedom to address research questions beyond the constraints of DSM categories, in ways that integrate behavior and neuroscience.

Finally, Cuthbert points out that the new framework will affect mainly the agency's translational research. NIMH also funds service and intervention research, most of it conducted in clinics. "That work will continue to be within the DSM system for some time," Cuthbert says.

—Lea Winerman