But for the next version of this "psychiatry bible", the DSM-6, scientists are planning to add other factors into the diagnostic criteria.
Live Science spoke to Kumar about how this update to the DSM could change the way mental disorders are understood and potentially help improve treatment.
Anand Kumar: Up to this point, the distinctions between the different major groups — who has clinical depression, or what we call major depression; who has an eating disorder; who has PTSD, etc. — have been based exclusively on clinical grounds: You meet certain criteria, and you fall into this category. If you meet some other criteria, you fall into another category.
The idea is not new. It's been discussed in the past, but it was difficult to get a consensus on what goes in and what should not go in. That's still going to be tricky, but at least there's a broad acknowledgement that the time is ready to start introducing biology into the DSM.
KHC: What sort of biological markers have you seen that we can actually correlate with these disorders?
The committee talked about how, in addition to biological biomarkers, there's a concept of biological factors. What I mean by that is biological pathways and mechanisms that have a role in the development of a particular disorder, but the findings have not crystallized into a laboratory test.
In the Alzheimer's disease field there are clear-cut biomarkers. There are now blood tests for proteins called tau and amyloid that have been approved by the FDA [Food and Drug Administration] as biomarkers for Alzheimer's disease. Meaning, if you have a clinical picture and a mental-status exam consistent with intellectual decline, you must have a positive biomarker test to be categorized as having definitive Alzheimer's disease.
A neuron, in blue, is surrounded by a plaque of amyloid-beta protein, in yellow, which causes the symptoms of Alzheimer's disease. Tests can be used to detect biomarkers for Alzheimer's disease. (Image credit: JUAN GAERTNER/SCIENCE PHOTO LIBRARY via Getty Images)
But that degree of precision, for lack of a better term, is not available in the other branches of psychiatry. Nonetheless, there are clues that other pathways and mechanisms are involved.
Most people think of genetics as an abnormal gene or a mutation — meaning a gene switches or changes and confers increased risk — as one mutation causing one disease. That's how most people in the general public think about mutations: They cause disease.
With mental disorders, the situation becomes immensely more complicated. It's not just a few genes here and there. There are hundreds of genes, each increasing the risk for depression, schizophrenia and anxiety disorders by a small amount.
It may seem overwhelming, but genetic profiles are better understood today than they were 20 years ago. So that's something else this committee is thinking about and I think should take into account going forward: to somehow incorporate that into the diagnostic categories.
AK: I don't think so, because if you think about genetics, it's not going to be introduced as a biological test.
It's complex, many genes are involved, and it produces a better characterization of this. The diagnosis is still going to remain clinical, but this provides a biological context, very much like, say, diabetes or heart disease.
That degree of classification is missing today in mental health and psychiatry. We hope this is a first step in correcting, if you will, those conceptions about what causes these disorders.
AK: I can give you one possible example. I'm reaching a bit.
That is not coincidental. It's not something that we just somehow find. A lot of these disorders share genes.
Patients with anxiety may also be diagnosed with a mood disorder. (Image credit: MementoJpeg via Getty Images)
I think when clinicians classify them together, not as the same disorder but as sharing a lot of psychological as well as genetic risk, clinicians should be on the lookout for both. A patient with a mood disorder, for example, could either now or at some later point develop an anxiety disorder. Or someone with an anxiety disorder is at risk for substance abuse.
KHC: What do you think is the most unique aspect, from your perspective, of this upcoming DSM-6?
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It's not going to be perfect, but it's going to be a first step. I think introducing the idea that genetics, immunology and other factors are very important in the causation of mental disorders, and explain some of the phenomena that we previously could not find an explanation for, is — I hate to use the word "leapfrog" — but that's kind of what it is.
This interview has been condensed and edited lightly for clarity.
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