Darren Haywood, PhD, BPsych (Hons), Dip. Fit Postdoctoral Research Fellow on Cancer Survivorship, et al. had published an article in the Cancer Letters, 28th March 2024, summary of which is featured below.

Is It Time to Discard the Diagnostic and Statistical Manual of Mental Disorders (DSM) in Psycho-Oncology?

Authors: Darren Haywood, Roman Kotov, Robert Krueger, Aidan Wright, Miriam Forbes, Evan Dauer, Frank Baughman, Susan Rossell, Nicolas H. Hart.

Introduction

• Cancer survivors, defined as people with a current or previous diagnosis of cancer, face a significantly higher prevalence of mental health conditions when compared with the general population.
• These elevated rates of mental health conditions are prevalent across many domains, including anxiety disorders, mood disorders, eating disorders and many others.
• The dominant way to conceptualise mental health within cancer survivorship is through a traditional diagnostic approach, where people either meet or do not meet the criteria for a particular disorder, for instance, Major Depressive Disorder, primarily using the Diagnostic and Statistical Manual of Mental Disorders (DSM)

Key Issues

• In recent years researchers have encountered significant validity concerns with the traditional diagnostic approach, using the DSM.
• Many people that meet the diagnostic criteria of one DSM disorder, meet the diagnostic criteria of others.
• There is also a large symptom overlap of different DSM disorders, and there are an overwhelming number of different combinations of symptoms one might have to be diagnosed with the same disorder.
• Therefore, the study and treatment of a single discrete and constant disorder is impossible.
• There are also many DSM-listed symptoms, such as fatigue, changes in weight, or sleep (listed symptoms of Major Depressive Disorder), which are common side effects of cancer and cancer treatments, and not necessarily characteristic of a mental health issue. This greatly impacts diagnosis and can result in over, or even underdiagnosis.

A potential way forward

• To counter these issues, in recent years there has been the development of a new way to conceptualise mental health, called the hierarchical dimensional approach.
• This approach views mental health, not as categories, but as dimensional lower and higher-level domains.
• The Hierarchical Taxonomy of Psychopathology (HiTOP) brings together the literature of the hierarchical dimensional approach into a single hierarchical structure.
• HiTOP offers an exciting potential to mitigate the issues of the DSM within cancer.

Is it time to discard the DSM in psycho-oncology?

• The authors claim that while the HiTOP offers exciting potential within cancer, before we discard the DSM validation and trial of HiTOP within cancer populations are required.

Read further.

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