Since its very conception, the DSM-5 has been strongly criticized by psychologists, psychiatrists and researchers from different currents and therapeutic approaches. At that time I was finishing my degree and I naively believed that the criticisms came only from Psychoanalysis, because the nature of said manual goes against the foundations of said theory. However, I quickly learned that the rejection of the DSM-5 was stronger than I thought and that many scientific approaches considered it too conservative and limited in incorporating relevant evidence about the nature of psychopathology.
We at published several articles about the , and we even made a complete note on the decision of the . If you want more complete information, I recommend the of the ACBS and the paper .
It seemed that the criticism had fallen on deaf ears and that acceptance of the DSM-5 would increase when it was published. But it was not like that. Now a group of 50 psychologists and psychiatrists from different parts of the world have just published a new diagnostic proposal that attempts to respond to the deficiencies of the DSM and perhaps one day replace it.
The new proposal is called Hierachical Taxonomy of Psychopathology (HiTOP) and according to its authors, this new diagnostic system differs mainly from the DSM in two factors:
The first difference The diagnostic nature of the DSM only applies when patients meet a specific number of diagnostic criteria. On the other hand, the HiTOP not only takes into account the diagnostic criteria but also evaluates the severity of the symptoms and the clinical picture.
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This is how David Watson, co-author of HiTOP, explains it:
“If you meet the DSM diagnostic criteria for major depression, you are diagnosed as depressed. If you don’t meet these criteria, however, then you are simply classified as not depressed.” “In contrast, the HiTOP conceives psychopathology as something continuous, that is, of a three-dimensional nature.”
According to its authors, this new system allows us to recognize the existence of mental health problems that do not meet the requirements of the DSM and also offers patients more personalized and specific treatment.
The second difference It is found that the HiTOP uses the most recent evidence on psychopathology instead of grouping mental disorders according to clinical assumptions as the DSM does.
This is how Watson explains it:
“For example, generalized anxiety disorder, panic disorder, and specific phobia are classified as “anxiety disorders” in the DSM, since they all involve symptoms related to fear and anxiety.” “In contrast, most people who are diagnosed with general anxiety disorder also meet criteria for major depression. Consequently, in HiTOP, generalized anxiety disorder is classified as more similar to major depression than to specific phobia.”
The authors of the new nosological classification consider that the system is now ready to be used in clinical consultations, but they are also aware that it will take a long time for the HiTOP to be widely used like the DSM.
It is clear that clinicians and researchers did not sit idly by in the face of the authority and power that the DSM has within clinical settings around the world. Now we have to carefully analyze the new proposal and know in detail what it really offers beyond the statements of its authors. That’s why I leave here the one that was published last week in the magazine Journal of Abnormal Psychology.
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