Looking back towards the future: is it time to change the DSM approach to psychiatric disorders? The case of depression.

With plans underway for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the debate between proponents of a theoretical, descriptive approach of mental disorders versus an etiologically based classification system has been revitalized. This paper critically reviews findings from three related research areas that have begun to question the theoretical, descriptive approach to mental disorders of DSM-III and its successors: (a) research concerning the underlying assumptions of DSM, (b) findings from treatment research, and (c) recent biopsychosocial research. Research on depression is used as a paradigmatic example, but the extent to which these findings may generalize to other disorders is also discussed. Strengths and weaknesses of the current DSM approach versus a more etiologically based classification system are considered. This review shows that although an etiologically based classification system of mental disorders seems more promising than a purely descriptive approach, the time seems not yet ripe for such a radical shift in psychiatric diagnosis. Further research oriented towards developing a more etiologically based approach to diagnosis is urgently needed, taking into account research, clinical, and policy implications that such a change in the diagnosis of mental disorders would bring.