Eduard Vieta
Professor of Psychiatry at the University of Barcelona, Head of the Psychiatry and Psychology Department at Hospital Clínic in Barcelona, and researcher at the Biomedical Research Centre in Mental Health (CIBERSAM)
At the time, I was invited to participate in one of the DSM-5 Task Force committees — the Psychosis committee, which examined the scientific evidence underlying bipolar disorder and schizophrenia — and I can see that many of the changes proposed back then (2007–2008), which ultimately were either not included or only partially incorporated into DSM-5 (2013), will now appear in the new DSM. In my view, the most important change — aside from the name itself, which aspirationally replaces ‘statistical’ with ‘scientific’ without losing the acronym — is that the DSM fully embraces the concept of Precision Psychiatry (incidentally, the first mention of this concept in the scientific literature appeared in a paper I published in 2015). To achieve this paradigm, biomarkers and symptom dimensions are now being introduced in an unequivocal and official manner. The emphasis on functioning and quality of life is also highly significant.
The DSM will continue to be a product essentially originating in the United States, even though, as in previous editions, it includes a small number of external advisers, and it will remain a practical tool that is open to criticism (and frequently criticised). Nevertheless, it exerts an enormous influence on both the clinical practice of mental healthcare and research. The direction of change is the right one and, although certain sectors will continue to criticise the ‘medicalisation’ of psychological suffering (in part due to an ideological stance that denies neurobiology and applies an unscientific form of social reductionism), I believe this represents a step forward in improving the validity and reliability of psychiatric diagnosis.