Improvements in defining mental illness

By Hayley Thompson
November 21, 2018

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Mental disorders today are characterized by the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short. This handbook is used by health care professionals in the United States and around the world. It includes numerous descriptions, symptoms and other criteria needed for diagnosing and assessing mental illnesses.

In 2013, DSM-5 was released. The former version of DSM was released roughly two decades ago. Since then, there has been an abundance of new knowledge and studies on mental disorders. This new edition added several diagnoses that weren’t previously part of the manual including binge eating disorder and hoarding disorder.

Each category in the DSM handbook has its own checklist. If you check off over half of the listed criteria, you are placed in that category. A DSM disorder makes it easier for doctors because it provides labels. These labels help them communicate about their patients, refer patients to specific treatment programs and supply billing codes for insurance companies.

“Over the years, I have had to adapt to the changing versions of the DSM,” Dr. Bill Dibiase of the psychology department said. “I probably have a bit more cynical view of the use of the DSM and its categories than clinicians do, mainly because the more recent versions of the DSM were influenced as much by insurance companies.”

Therapy is a very effective way to treat mental illness. Photo by Wellness Corporate Solutions

The DSM-5 can be a very useful tool. However, only those qualified with specialized training should diagnose and treat mental illnesses. Diagnosis includes piecing together a considerable amount of components from the person’s whole life. It requires an excellent understanding of brain chemistry and human growth and development.

“You should definitely seek out a medical professional before you try to diagnose yourself because it could likely be a misdiagnosis,” junior psychology major Kelsey Crnkovic, said. “However, the DSM-5 is a good source to find out more about your already determined diagnosis.”

The DSM’s narrow categories can make it difficult for an accurate diagnosis.

“There’s no question that there is value in categorizing the varieties of psychological problems people can have, but the categories themselves should not become barriers to actually understanding the problems. The narrower the categories become, the greater the potential for squeezing people into those categories without understanding the disorder,” said Dr. Dibiase. He explained that this can lead to choices for therapy that are driven by the category rather than the problem that the person is having.

The nature of mental illness is that it cannot be classified neatly into a box. The DSM system is completely inconsistent with that notion. DSM’s confined categories of mental illness make it difficult for an effective diagnosis and productive treatment.

“Everybody deals with their mental illness in different ways. You can’t always assume that everyone will react to it the same way,” junior psychology major Kaitlyn Pedota, said. “The DSM system makes it hard to define each specific emotional disorder over a large scale of people.”

Three years after the release of DSM-5, a new study was created. The Hierarchical Taxonomy of Psychopathology, HiTOP, was published on March 23, 2017. Fifty leading researchers studying mental illness came together to create this framework. This new model is a result of 20 years of research and conquered many of the problems that the DSM possessed.

Many of the disorders in the DSM handbook have similar checklists. Due to this, it is not always clear which label will fit the patient best.

“Extreme anxious thoughts can make someone think to much and, in return, worsen the depression ,” Brian Beeker. Photo by Ink Media

For example, let’s say an individual is depressed. They may be struggling to concentrate, having a hard time falling asleep and trouble enjoying life. If they no longer have trouble falling asleep, they may not meet enough of the criteria anymore. This means they will not receive a diagnosis and cannot access treatment covered by their insurance. If the individual starts to frantically worry along with their depression symptoms, they may be diagnosed with anxiety disorder rather than depression.

Characteristics of DSM categories are decided by a committee of experts. By relying on a committee to define mental illness, it’s resulted in a system that does not reflect the true nature of mental disorders. If a practical approach is taken in creating the structure of mental illness, the system will be completely different.

If you analyze the data when it comes to mental disorders, you will notice transparent patterns in they way they emerge. Depression is often linked to anxiety because depression generally causes anxiety. This type of co-occurrence is very common and not easily defined by the DSM.

An illustration representing an anxious brain. Photo by Elisa Riva

“As someone is depressed, anxiety usually builds up over time. Extreme anxious thoughts can make someone think too much and, in return, worsen the depression,” freshman political science major Brian Beeker said.

Dozens of studies have analyzed co-occurrence patterns. These studies assembled six broad domains. These domains include internalizing, disinhibition, antagonism, thought disorder, detachment and somatoform. An individual’s stance in these areas will help predict their current mental health as well as the type, number and severity.

The more detailed structure in this framework allows professionals to identify which of the individual’s symptoms are the most severe or distressing for them. It captures the severity in each aspect of one’s mental illness on every dimension. This hierarchical framework beats the limitations of the DSM handbook and is far more consistent with the true nature of mental illness.

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Hayley Thompson

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