For the First Time, the Next DSM Will Integrate Biology and Biomarkers Into Psychiatric Diagnosis
核心洞察
The American Psychiatric Association plans to introduce biology into the next edition of the DSM, marking the first time the manual will integrate neurobiology into psychiatric diagnosis.
No scientifically valid biomarkers currently exist for any psychiatric condition except certain proteins used to diagnose Alzheimer's disease (搜索), reflecting psychiatry's lag behind other medical fields.
Three advances show particular promise: an FDA-approved blood test for Alzheimer's amyloid (搜索) and tau (搜索) proteins, C-reactive protein (搜索) as a potential depression subtype marker, and polygenic risk scores for genetic risk.
The "bible" of clinical psychiatry—the Diagnostic and Statistical Manual of Mental Disorders (DSM)—is one of the most widely used psychiatry reference books in the world, relied upon by clinicians to diagnose patients and by scientists to guide research. Despite its broad influence, the DSM has never integrated biology into its diagnoses of mental illness, largely because the underlying biology was considered too preliminary for inclusion in such a widely used clinical manual. Now, the American Psychiatric Association has announced that the next edition of the DSM will be released in the coming years, and one of its major plans is to modernize the manual by introducing biology.
The most recent version, the DSM-5 released in 2013, has attracted significant criticism from clinicians and researchers, including concerns that its lack of objective biological measures risks medicalizing human suffering and reducing the validity of psychiatric diagnoses. The author of the source material served as a member of the DSM's strategic committee between May 2024 and August 2026 and contributed to the subcommittee tasked with integrating neurobiology into the manual.
What Are Biomarkers?
Biological factors are mechanisms that may be involved in the development of a disease but have not yet crystallized into something that can be quantifiably measured in the lab; these factors can be physiological, genetic, or biochemical. In contrast, biological markers—biomarkers—are characteristics that can be objectively measured and used to evaluate a biological process, including how well someone is responding to a particular treatment. Biomarkers can be collected through blood tests, imaging scans, and other methods that reveal factors associated with a specific disease.
Biomarkers are widely used across medicine. For example, hemoglobin A1C levels are used to diagnose and monitor diabetes, cholesterol levels to determine cardiovascular risk, and CT scans to measure the size of a tumor.
Why Psychiatry Lacks Biomarkers
There are currently no scientifically valid biomarkers for any psychiatric condition, with the exception of certain proteins used to diagnose Alzheimer's disease (搜索). The primary reason for this gap between psychiatry and the rest of medicine is that knowledge about the biological basis of mental disorders lags behind other medical disorders.
The biological changes underlying mental illness are subtle, and current technologies are unable to easily capture them. Serious mental illnesses are, at their core, brain disorders with significant psychological and social components. A family history of mental illness and trauma are primary risk factors for major mental disorders, and these strong environmental influences make it challenging to precisely separate the influences of biological factors from psychosocial considerations.
Researchers also conceptualize psychiatric disorders not as discrete illnesses but as behavioral syndromes—constellations of signs and symptoms that overlap one another. For example, anxiety and mood disorders have overlapping signs and symptoms, and patients often meet criteria concurrently for both sets of disorders; the same is true of schizophrenia (搜索) and bipolar disorder (搜索) with psychosis. Characterizing each of these disorders as discrete conditions in the DSM is an oversimplification because they cluster together due to shared genetic and environmental factors. Conditions such as major depressive disorder (搜索) and schizophrenia likely have several subgroups that superficially resemble each other but develop through different mechanisms and pathways, making a single biomarker that reflects multiple processes simultaneously unrealistic.
Nobel Prize-winning psychiatrist and neurobiologist Eric Kandel famously wrote that "the last frontier of the biological sciences … is to understand the biological basis of consciousness and the mental processes by which we perceive, act, learn and remember." He believed that solving this "ultimate challenge" requires merging cell biology with psychology to explain human behavior and consciousness in purely biological terms.
Three Promising Advances in Neurobiology
Although research is ongoing, there have been meaningful advances in the neurobiology of mental health since the publication of the DSM-5. Three advances appear particularly promising.
The first are biomarkers for Alzheimer's disease (搜索). Until recently, diagnosing Alzheimer's required a medical history and exam as well as postmortem evidence of two abnormal proteins associated with the disease, called amyloid (搜索) and tau (搜索). In March 2025, the Food and Drug Administration (搜索) approved a blood test to detect specific forms of these proteins and help confirm a diagnosis of Alzheimer's. This represents the first instance of a biomarker for a disorder that affects both the brain and behavior.
The second are immune factors. The immune system has been implicated in several medical conditions, including mood disorders such as depression. C-reactive protein (搜索) (CRP) is a molecule that the liver makes in response to injury and infection. Approximately 30% of patients with depression have high CRP levels, suggesting that it may serve as a biomarker to identify a subtype of patients who may respond better to certain types of treatment than those with lower CRP levels.
The third are genetic risk factors. Certain genes are associated with an increased risk of developing a mental disorder. These risk genes differ from disease genes, which directly cause a disorder. Researchers have linked multiple risk genes to several mental disorders, and the effect each genetic variant has on developing a mental disorder is cumulative. Bundling these individual genetic variants into a polygenic risk score could offer a more comprehensive estimate of disease risk. While genetic biomarkers are not yet ready for use in the clinic, integrating genetic and psychosocial risk factors can help psychiatry transition into the era of precision medicine.
The Future of the DSM
In 2013, psychiatrist Henry Nasrallah conducted an online survey of colleagues visiting the webpage of the journal Current Psychiatry, of which he was editor-in-chief. He wrote that 65% of respondents predicted the DSM-6 would include laboratory tests to diagnose psychiatric disorders, and he believed they might be right. Thirteen years later, researchers are finally working to introduce biology to the DSM, one finding at a time.
The DSM is not perfect, but it offers a common language and conceptual framework for mental health clinicians to help support patients and their families over the long haul of mental illness. As science reveals the complexity of mental disorders, incorporating neuroscience into the DSM as research advances is expected to provide clinicians a more scientific and broader perspective on mental health. One day, patients may be able to walk into the clinic with results from genetic tests, brain scans, and blood work that their health team can use to provide more precise diagnoses and personalized treatment.