Not long ago, Childhood Obesity News considered two of the major structures under which medical professionals sort diseases. Many healers are not totally on board with either of these taxonomical schemes, but insurance companies and other bureaucracies insist upon them. Worldwide, 60 percent of psychologists use a diagnostic classification system. As we noted, the hallmarks of a good one are simplicity, reliability, and ease of use. The professional who uses the system makes important decisions about the management and treatment of patients’ health problems. A system with fewer categories is preferred—if they are the right ones.
Sections of the Diagnostic and Statistical Manual of Mental Disorders were vigorously disputed during revisions for the current edition, DSM-5. We are, of course, particularly interested in the parts that cover eating disorders and other conditions impacting childhood obesity. The National Institute of Mental Health (NIMH) believes that the DSM-5 diagnoses are inadequate because they are “based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” If NIMH has its way, the Diagnostic and Statistical Manual will no longer be the “gold standard.” The agency has announced its intention to no longer support DSM-based research.
It has been determined that fewer than half of the psychologists are in the DSM camp. However, 60 percent of them are said to routinely consult the International Classification of Diseases and Related Health Problems (ICD). Both publications have been referred to as bibles, but really the term should apply to a book that has a fair claim to being the only one in its class.
Also there is the Research Domain Criteria (RDoC) project, a new government-approved research framework that incorporates genetics, imaging, and cognitive science. NIMH director Dr. Thomas Insel explains:
Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior… Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment…RDoC is nothing less than a plan to transform clinical practice by bringing a new generation of research to inform how we diagnose and treat mental disorders.
Some mental health specialists prefer a very un-system-like system called case formulation, in which each patient suffers from a unique condition. Dr. Adam Blatner says,
A good formulation should be a kind of story, weaving together many threads…The organization of a formulation would depend on whether the patient is suffering from chronic or acute symptoms, or both. Similarly, is the patient involved in complex family interactions or do the symptoms seem to be confined primarily only to the individual? Are there significant associated medical conditions or dysfunctions at the level of cortical neurotransmitters? Are the stressors obvious and significant or minimal and elusive?
Dr. Pretlow’s paper, “Treatment of child/adolescent obesity using the addiction model: A smartphone app pilot study,” will soon be published by the journal Childhood Obesity (and also online, of course.)
Watch this space!
Source: “Psychologists’ perspectives on the diagnostic classification of mental disorders: Results from the WHO-IUPsyS Global Survey
Source: “Director’s Blog: Transforming Diagnosis
Source: “The Art of Case Formulation
Image by Scott Dexter