725. The future DSM: designing a valid, inclusive, and practical diagnostic manual for biological psychiatry

Abstract

Abstract Background Clinicians across disciplines use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe, diagnose, and plan treatment for mental health conditions. This means that future iterations of the DSM need to incorporate information that captures diverse expressions of symptomatology and distress, thereby addressing one of its criticisms. For instance, changes in level of functioning and quality of life are factors that cause patients with mental disorders to seek help (voluntarily or involuntarily). In addition, scientific and clinical evidence show that life circumstances, socioeconomic, cultural, and environmental factors shape risk, resilience, symptoms, illness course, and recovery. Hence, these factors are central to understanding mental disorders. Aims & Objectives To inform a psychiatric nosology that incorporates information that captures diverse expressions of symptomatology and distress. Method Reviews of the criticisms of the DSM and scientific evidence, as well as expert interviews and deliberations, were used to inform the roadmap for the future DSM. This includes determining whether and how to include the functioning, quality-of-life, social, economic, cultural, and environmental determinants of health, as well as intersectionality. Results The work resulted in the development of a new diagnostic model for the DSM. Functioning, quality-of-life, socioeconomic, cultural, and environmental determinants of health, as well as intersectionality, were determined to be core components. Discussion & Conclusions This presentation will highlight the work of the Functioning and Quality of Life and the Socioeconomic, Cultural, and Environmental Determinants of Health and Intersectionality Subcommittees of the Future DSM Strategic Committee, formed to help inform how the issues of functioning, quality of life, and social, economic, cultural, and environmental factors may be incorporated in the future DSMs in a feasible and clinically useful way. This will involve deliberations on whether some or all of these factors should be central to the diagnostic criteria (e.g., as part of a clinical significance criterion), whether they should be included only as contextual factors, and, where necessary, be included in both contexts. The presentation will also highlight the subcommittee’s efforts to identify and recommend approaches to measure (i.e., potential assessment tools) and to document these factors in clinical assessments in meaningful ways that enhance clinical care and progress, rather than impede it.