An important challenge related to neurobiology became evident during the development of
DSM-5. Rett syndrome, previously listed in
DSM’s autism section, was removed from
DSMwhen the genetic basis underlying its syndromic pathophysiology was elucidated. The decision had important repercussions because in the United States, some payers started denying coverage for the treatment of psychiatric symptoms associated with Rett syndrome.
This precedent for removing a diagnosis from
DSM and de facto from the purview of psychiatry once biological underpinnings become known is concerning, as it might lead to an erosion, if not erasure, of the field as neuroscience advances (
13). For example, as the pathophysiology of Alzheimer’s disease, Lewy body disease, and other late-life neurocognitive illnesses becomes better elucidated, will they be considered strictly in the domain of neurology going forward? And what are the potential implications for patients who would not have access to much-needed psychiatric, psychosocial, or cultural interventions to improve mental health care (
14,
15)?
If biological factors are incorporated into psychiatric classification, psychiatry and the rest of medicine need to avoid a misplaced dualism in which only those disorders for which the underlying pathophysiology has not yet been defined are considered psychiatric (
14).
