Moving past the DSM-5 in neuroscience
Bach, B., Sellbom, M., Skjernov, M., & Simonsen, E. (2017). ICD-11 and DSM-5 personality trait domains capture categorical personality disorders: Finding a common ground. Australian & New Zealand Journal of Psychiatry, 52(5), 425–434.
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The three types of personality disorders with both DSM-5 ICD-11 Domains (Bach et al., 2017)
There is also the problem of some overlap between the symptoms (See camouflage blog). A lot of DSM disorders happen together more often than you'd expect by chance, and this complicates accurate diagnosis and the development of targeted treatments. Finally, emotion based symptoms suffer from diagnostic cutoffs. Diagnostic cutoffs (like the number of symptoms or how long they've lasted, for many disorders often lack strong backing from research evidence, raising concerns about both over-diagnosis and under-diagnosis.
The unfortunate truth is that there is a considerable divide between neuroscience and psychology. In the medical field, more than 600 neurological conditions are acknowledged and treated, including Muscular Dystrophy, Huntington’s Disease, Rett’s Syndrome, Bell’s Palsy, and Locked-In Syndrome. To properly address these diseases at the core, it is important that neuroscience and psychology work together.
To overcome these challenges, researchers and institutions are investigating alternative frameworks that merge neuroscience with psychopathology:
At the moment, the National Institute of Mental Health (NIMH) has initiated the Research Domain Criteria (RDoC), a significant effort to shift research focus away from DSM classifications. RDoC seeks to establish a scientific understanding of mental disorders grounded in observable behaviors and neurobiological indicators, spanning from genes to neural circuits to self-reports. Additionally this RDoC employs a dimensional framework, departing from "all-or-nothing" classifications to comprehend mental health issues along a continuum. Ultimately, the RDoC seeks to apply quantitative analysis to psychology through systematic neuroscience research. One of its final goals is to identify effective biomarkers ,derived from neuroimaging, that can establish a foundation for more objective, brain-based diagnoses, similar to how an EKG is used for heart conditions.
Introduction
Research in neuroscience concerning psychiatric disorders typically depends on disease definitions derived from the prominent Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) having been published earlier this year. Intended solely as a diagnostic instrument, the DSM-5 treats various disorders as separate entities but nevertheless, the distinctions between these disorders are frequently not as clear-cut as the DSM-5 implies.
To improve the connection between psychology and neuroscience, i.e. to move past focusing exclusively on the major neurodivergent symptoms, it is important to address the natural limitations mentioned in the previous blog post. While I advise reading the previous section, I will also try to summarize the problems.
First of all, current symptom-based neuroscience, especially the DSM-5 portions, mainly relies on clusters of clinical symptoms for diagnosis, which is similar to diagnosing infectious diseases just by looking at a fever (a common symptom) instead of the actual cause. This method often doesn't match the true biological realities of brain disorders. Additionally, there is a lack of research regarding biomarkers. Although major progress has been made in genetic and neuroscience studies, there are still very few dependable biomarkers that help improve DSM-5 diagnoses.
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