DSM V, RDoC and Diagnostic Approaches in Addiction Research and Therapy

The upcoming implementation of the Diagnostic and Statistical Manual (DSMV) has led to a renewed debate about current and future diagnostic approaches. Issues include discussing the pros and cons of categorical versus dimensional approaches and the related subject of descriptive versus causal diagnostic criteria. Traditionally, the DSM has focused on a “theory-free” descriptive diagnostic system, largely ignoring the fact that etiology is a core component of a disorder [1]. These concerns have been less central to addiction specialist. The issue of categorical versus dimensional approaches has led to little discussion, more so the issue of etiological factors underlying the “new” non-substance dependences (gambling, computer game). The new DSM V diagnostic entity “substance use disorder” eliminates the need to decide between the diagnosis of abuse or dependence, thus simplifying substance use disorder diagnosis [2]. The situation is different for other areas in the mental disorder field. A number of researchers have argued that DSM constitutes a roadblock for a better understanding of mental disorders [3]. They feel that scientific findings overall have had too little impact on the DSM. A discrepancy though can be made out between researchers and service providers. Researchers need an approach that is inviting to empirical calibration and readily adapts to new scientific knowledge. Service providers on the other hand need a diagnostic system that is stable, reliable, easy to apply, and informative for treatment. The National Institute of Mental Health (NIMH) recently introduced the “research domains criteria” (RDoC) as a response to the shortcomings of the current diagnostic system. The RDoC include negative and positive valence systems, the arousal systems, as well as cognitive and social processes [4]. This approach is an attempt to “carve nature at its joints” and free research from the “roadblock DSM”. However, given the different needs of researchers and service providers, it is unlikely that service providers will readily embrace the new approach. Therefore, in order for the new approach to be successful, the RDoC and the DSM need to be used concurrently. This means for these approaches to be complementary it is pivotal to establish a structure that clarifies the link between these two systems.