The next edition of psychiatry’s diagnostic manual, the DSM-6, is being planned to include biological factors such as genetic risk and signs of inflammation, according to psychiatrist Dr. Anand Kumar, who served on the DSM Strategy Committee and was influential in discussions about the changes. Kumar said the update would add biological context to mental-health diagnosis, in a way comparable to how genes and other factors inform understanding of heart disease or diabetes.
For decades, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has guided psychiatrists by classifying conditions such as major depression, anorexia and post-traumatic stress disorder based purely on clinical observation: interviews, case histories, questionnaires and observation. Dr. Kumar said the DSM-6, currently in planning, would attempt to add biological factors into that framework, a shift he described as long discussed but previously lacking consensus.
He emphasized that for most mental disorders there are still no clear-cut diagnostic biomarkers, no blood test or brain scan that can confirm depression or schizophrenia. Instead, the committee is considering what he called biological factors: pathways and mechanisms tied to a disorder’s development that have not yet crystallized into laboratory tests. He cited immunology as one example, noting that it has been shown to be impactful in about 30% of major depression cases, yet no single test exists to identify immune-mediated depression in practice.
Genetics is another major focus. Dr. Kumar said that unlike single-gene diseases, mental disorders involve hundreds of genes, each contributing a small amount of risk. While no single genetic test can be used today, he said large numbers of genes have consistently been associated with conditions like depression, schizophrenia and anxiety. He argued that complexity should not be a reason to give up, and that genetic profiles are better understood than they were two decades ago.
The only area of psychiatry with definitive biomarkers, he noted, is Alzheimer’s disease, where FDA-approved blood tests for tau and amyloid proteins can help confirm a diagnosis. Earlier methods included brain scans and lumbar punctures.
Dr. Kumar acknowledged the changes will not satisfy everyone, but he said there is broad acknowledgement that the time is ready to begin integrating biology into the manual. He pointed to the concept of comorbidity, the frequent co-occurrence of disorders like depression and anxiety, noting that about 45% of patients with a major mood disorder also have an anxiety disorder, and vice versa. Because these conditions share genetic and psychological risk, he hopes clinicians will be on the lookout for both and tailor treatments more broadly.
Despite the biological emphasis, he stressed that diagnosis will remain clinical. The added biological context, he said, would give busy clinicians a more complete picture, similar to how cardiologists weigh genes, body mass index, diet and environment when assessing heart disease risk. He described the move as a conceptual leap forward for the field, even if imperfect as a first step.
The interview was condensed and edited lightly for clarity, according to Live Science, which spoke with Kumar.
Analysis
Why this matters
- The DSM is the standard reference for mental health diagnosis worldwide, so any shift to include biological markers could change how millions of patients are assessed and treated.
- Adding genetic and immune factors could help explain why disorders like depression and anxiety often occur together, potentially leading to broader, more personalized treatment plans.
- The update signals a gradual move toward precision psychiatry, though it stops short of providing definitive laboratory tests for most conditions.
- The change may alter how clinicians and patients understand the causes of mental disorders, reducing stigma by framing them as biological in nature, similar to physical illnesses.
Background
The DSM has been the primary classification system for mental disorders since 1952, with its fifth edition (DSM-5) published in 2013. Past attempts to include biological measures were stymied by lack of consensus and the absence of reliable biomarkers. The DSM-6 is in early planning stages, and the inclusion of biological factors represents a notable departure from the manual's purely symptom-based tradition.
Key perspectives
- Dr. Anand Kumar: Says adding biological factors like genetics and immunology is a needed and positive step, bringing psychiatry closer to the model used in physical medicine, though he acknowledges it will be imperfect and may not please everyone.
- The DSM Strategy Committee (as reported by Kumar): Is taking a nuanced approach, focusing on biological factors rather than demanding clear-cut biomarkers, but recognizes the difficulty in reaching consensus on what to include.
What to watch
- Whether the DSM-6 planning committee reaches consensus on which specific biological factors to include, given past difficulties.
- Whether future research produces validated blood or imaging tests for conditions like depression or PTSD, similar to those for Alzheimer's disease.
- How clinicians integrate this biological context into daily practice, especially in diagnosing and treating comorbid conditions.
Checked
12 claims in this story checked against 1 source: 12 supported.
Show each claim
- SupportedThe headline says DSM-6 may add biological factors to the diagnostic manual.Latest from Live Science: “For the next version of this "psychiatry bible", the DSM-6, scientists are planning to add other factors into the diagnostic criteria.”
- SupportedThe summary says Kumar served on the DSM Strategy Committee.Latest from Live Science: “Dr. Anand Kumar, a psychiatrist who served for two years on the DSM Strategy Committee”
- SupportedThe summary says genetic and immune factors may inform diagnosis, while diagnosis remains clinical.Latest from Live Science: “The diagnosis is still going to remain clinical, but this provides a biological context”
- SupportedThe story says DSM-6 is being planned to include biological factors such as genetic risk and signs of inflammation.Latest from Live Science: “Some of these biological factors include data from genome-wide association studies of hundreds or thousands of genes that each increase the risk of a mental disorder by a tiny amount. Other biological factors include signs of inflammation or immune-system dysfunction”
- SupportedThe story says Kumar was influential in discussions about incorporating biology into DSM-6.Latest from Live Science: “While Kumar, the head of the Department of Psychiatry at the University of Illinois Chicago, no longer serves on the committee, he was influential in discussions about how biology could be incorporated into the DSM-6.”
- SupportedThe story says the DSM has classified conditions based purely on clinical observation, using interviews, case histories, questionnaires and observation.Latest from Live Science: “have been based exclusively on clinical grounds: You meet certain criteria, and you fall into this category.”
- SupportedThe story says the biological approach was discussed before but lacked consensus.Latest from Live Science: “The idea is not new. It's been discussed in the past, but it was difficult to get a consensus on what goes in and what should not go in.”
- SupportedThe story says there are no clear-cut diagnostic biomarkers for most mental disorders, such as a blood test or brain scan that confirms depression or schizophrenia.Latest from Live Science: “there are no clear-cut diagnostic biomarkers — meaning no blood tests or brain scans that you can look at and say, "This person has a diagnosis of depression," or "This person has PTSD," or "This person has schizophrenia."”
- SupportedThe story says immunology has been shown to be impactful in about 30% of major depression cases, but there is no single test to identify immune-mediated depression in clinical practice.Latest from Live Science: “immunology ... has been shown to be impactful in about 30% of cases of major depression. Yet there is no single biological laboratory test that is currently available that can be used [to diagnose immune-mediated depression] in clinical practice.”
- SupportedThe story says hundreds of genes each contribute a small amount of risk for depression, schizophrenia and anxiety disorders.Latest from Live Science: “There are hundreds of genes, each increasing the risk for depression, schizophrenia and anxiety disorders by a small amount.”
- SupportedThe story says Alzheimer’s disease is the only area of psychiatry with definitive biomarkers and that FDA-approved blood tests for tau and amyloid can help confirm a diagnosis.Latest from Live Science: “In the Alzheimer's disease field there are clear-cut biomarkers. There are now blood tests for proteins called tau and amyloid that have been approved by the FDA [Food and Drug Administration] as biomarkers for Alzheimer's disease.”
- SupportedThe story says about 45% of patients with a major mood disorder also have an anxiety disorder, and vice versa.Latest from Live Science: “about 45%, roughly, of patients diagnosed with a major mood disorder also have an anxiety disorder. And you flip that around: About 45%, roughly, of patients diagnosed with an anxiety disorder ... also have a mood disorder.”
