Entering the diagnostic debate: some professionals want new approach in DSM-V.(Diagnostic and Statistical Manual of Mental Disorders)(Cover Story)

The fifth edition of the mental health field's Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is still years away from publication, but the wish list for modifications, deletions, additions and a general change in approach is growing longer.

In interviews with Behavioral Healthcare Tomorrow, several of the principal players in crafting psychiatry's main diagnostic reference repeatedly used one hot phrase: the "dimensional approach."

"In the research field there has been a lot of talk about dimensional approaches to diagnoses as opposed to the categorical system," says Michael B. First, M.D., professor of clinical psychiatry at Columbia University and director of the DSM-V Prelude Web-Based Project. "The categorical system is a yes-no decision. A lot of researchers have pointed out that a better way to look at everything is in a continuum."

Much of the unhappiness with the current DSM-IV approach to having separate disorders, says First, stems from the fact that patients either meet criteria for three or four different disorders, which clearly doesn't seem to make sense, or don't meet criteria for any one, but have traits reflective of several personality disorders. With a dimensional approach, First says, any of these personality disorders could be evaluated using a scale.

"If we had a dimensional approach you'd be able to say a patient's personality is on five different dimensions," says First. "You have high, medium and low, on the five different dimensions. That may be a better way of describing personality, because it doesn't first of all indicate that they have five different disorders; it would indicate that they have a personality disturbance with these dimensions. It doesn't set a hard boundary between normal and abnormal."

He adds that instead of saying there's a cutoff of normal …