As an A level Psychology student you are no doubt intellectually curious about the world of Psychology beyond the specification. Here at Tutor2U, the Psychology team love nothing more than a podcast to tell us about the latest developments in our subject area. A recent episode of 'Science Quickly' from Scientific American was about forthcoming changes to the Diagnostic and Statistical Manual of Mental Disorders (the DSM) and is the focus of this week’s Psychology in the News.

When you visit a doctor with a physical illness, diagnosis tends to follow a clear path. You might have a blood test or a scan, there is a measurable result. But what happens when the condition is psychological? How does a medical professional decide whether you have schizophrenia, bipolar disorder, depression? The answer lies in the methods we have for classifying mental disorders. The International Classification of Diseases (ICD), which covers all health conditions globally (and is developed by the World Health Organisation) and the DSM (published by the American Psychiatric Association) which focuses only on mental health and is primarily used in the USA.

The DSM currently lists nearly 300 recognised mental health conditions and governs how clinicians diagnose them, how scientists research them, and how patients access treatment. In the words of Scientific American's Allison Parshall, it is ‘the bible, the founding document of psychiatry’. Last month, the APA announced it may be time for a radical overhaul, and two concepts you will recognise sit at the heart of the debate: reliability and validity.

Reliability means consistency. If two psychiatrists independently assess the same patient, do they reach the same conclusion? The DSM was largely designed with this in mind, and structured diagnostic criteria have helped improve agreement between clinicians over the decades.

Validity means accuracy. Does the diagnosis correspond to something genuinely real in the biological world? This is where the problems begin. As Parshall explains, the DSM's categories may be reliable without being valid. Clinicians might consistently agree that a patient has schizophrenia, but that agreement does not mean the diagnosis reflects a distinct biological reality.

When brain scanning and genetic sequencing became available in the 1990s, researchers hoped that existing diagnostic categories would be confirmed by clear biological patterns. That is not what happened. There is no single genetic variant that causes schizophrenia, and no brain scan that definitively confirms depression. Instead, research has revealed enormous biological overlap between conditions the DSM treats as separate. Schizophrenia and bipolar disorder, for instance, both commonly involve psychosis (an example of symptom overlap) and share far more genetically than the categorical model suggests. The diagnostic categories, as Parshall puts it, may be ‘a little bit made up’.

The APA's proposed revisions would allow greater flexibility, letting clinicians diagnose more broadly where appropriate, and include contextual factors such as physical health and life circumstances. However, a similar overhaul was attempted in the 2000s, faced significant backlash, and was abandoned.

What is certain is that simply scrapping the DSM is not an option. It gives clinicians a shared language, and for many people, having a label for their experience brings real relief and access to support. Whether the proposed changes improve validity in practice remains to be seen.

Reference: Psychiatry’s rule book faces a major rethink https://www.scientificamerican... (accessed 5.3.26)

ANSWER THE FOLLOWING QUESTIONS!

1. What is the DSM and who publishes it?

2. What is the difference between reliability and validity in the context of psychiatric diagnosis?

3. Why did advances in brain scanning and genetic research in the 1990s pose a problem for the DSM?

4. What changes is the APA proposing to the DSM, and why might they face difficulties?

5. Why is simply getting rid of the DSM not considered a realistic option?