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A comparison of DSM and ICD classifications of mental disorder

  • Peter Tyrer
  • Please note an addendum has been issued for this article.
Summary

Most disorders in medicine are classified using the ICD (initiated in Paris in 1900). Mental and behavioural disorders are classified using the DSM (DSM-I was published in the USA in 1952), but it was not until DSM-III in 1980 that it became a major player. Its success was largely influenced by Robert Spitzer, who welded its disparate elements, and Melvyn Shabsin, who facilitated its acceptance. Spitzer pointed out that most diagnostic conditions in psychiatry were poorly defined, showed poor reliability in test-retest situations, and were temporally unstable. The consequence was that the beliefs of the psychiatrist seemed to matter much more than the characteristics of the patient when it came to classification. Since DSM-III there has been a split between those who adhere to DSM because it is a better research classification and those who adhere to ICD because it allows more clinical discretion in making diagnoses. This article discusses the pros and cons of both systems, and the major criticisms that have been levelled against them.

LEARNING OBJECTIVES

  1. Understand the principles and reasoning behind classification in medicine and psychiatry.
  2. Be able to describe the recent history of psychiatric classification.
  3. Be able to compare DSM and ICD classifications of mental disorder.

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Copyright
Corresponding author
Professor Peter Tyrer, Centre for Mental Health, Department of Medicine, Imperial College London, St Dunstan's Road, London W6 8RP, UK. Email: p.tyrer@imperial.ac.uk
Footnotes
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Declaration of Interest

P.T. is Chair of the ICD-11 Working Group for the Revision of Classification of Personality Disorders and has also been a member of the DSM-ICD Harmonization Coordination Group.

Footnotes
References
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American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). APA.
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn revised) (DSM-III-R) APA.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). APA.
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision) (DSM-IV-TR) APA.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5) APA.
Ayuso-Mateos, JL, Nuevo, R, Verdes, E et al (2010) From depressive symptoms to depressive disorders: the relevance of thresholds. British Journal of Psychiatry, 196: 365–71.
Bracken, P, Thomas, P, Timimi, S et al (2012) Psychiatry beyond the current paradigm. British Journal of Psychiatry, 201: 430–4.
Craddock, N, Mynors-Wallis, L (2014) Psychiatric diagnosis: impersonal, imperfect and important. British Journal of Psychiatry, 204: 93–5.
Cuthbert, BN, Insel, TR (2013) Toward the future of psychiatric diagnosis: the seven pillars of RDoC. BMC Medicine, 11: 126.
Dale, RC, Heyman, I, Giovannoni, G et al (2005) Incidence of anti-brain antibodies in children with obsessive-compulsive disorder. British Journal of Psychiatry, 187: 314–9.
Decker, H (2013) The Making of DSM-III:A Diagnostic Manual's Conquest of American Psychiatry. Oxford University Press.
Feighner, JP, Robins, E, Guze, SB et al (1972) Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26: 5763.
Frances, A (2013) Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. William Morrow.
Guze, SB, Goodwin, DW (1971) Diagnostic consistency in antisocial personality. American Journal of Psychiatry, 128: 360–1.
Guze, SB (1975) The validity and significance of the clinical diagnosis of hysteria (Briquet's syndrome). American Journal of Psychiatry, 132: 138–41.
Kendell, RE (1968) The Classification of Depressive Illnesses (Institute of Psychiatry, Maudsley Monograph, No. 18). Oxford University Press.
Kleinman, A (2012) Rebalancing academic psychiatry: why it needs to happen-and soon. British Journal of Psychiatry, 201: 421–2.
Markon, KE (2013) Epistemological pluralism and scientific development: an argument against authoritative nosologies. Journal of Personality Disorders, 27: 554–79.
Spitzer, RL, Endicott, J, Robins, E (1975) Clinical criteria for psychiatric diagnosis and DSM-III. American Journal of Psychiatry, 132: 1187–92.
Timimi, S (2011) Campaign to Abolish Psychiatric Diagnostic Systems such as ICD and DSM (CAPSID) Critical Psychiatry Network UK.
Tyrer, P (2013) Models for Mental Disorder (5th edn). Wiley-Blackwell.
World Health Organization (1992) ICD-10: Classification of Mental and Behavioural Disorders. WHO.
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BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
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A comparison of DSM and ICD classifications of mental disorder

  • Peter Tyrer
  • Please note an addendum has been issued for this article.
Submit a response

eLetters

ICD -10 and DSM-IV Diagnostic Variations

Dr Rajendra Prabhu, Locum consultant Child and Adolescent Psychiatrist
19 September 2014

I read with great interest the author???s discussion of the pros and cons of the ICD and DSM classification systems. Such systems are important in the academic world, legal cases, research, audit and, not least, in clinical psychiatry. However, the ambiguity within the classification system is a problem and there are a number of diagnostic variations, even in the names used in ICD-10 (1) and DSM-IV. (2) The author mentions training sets of raters to achieve high reliability in the diagnosis of DSM-5 ADHD, but suggests that applying the DSM-5 diagnosis (3) has ???some of the uncertainty of roulette???. Theoretically, reliability can be achieved, but the diagnosis in the UK (NICE guidelines) (4) is made using standard questionnaires, clinical history, school observation and other relevant psychosocial history. Can this reliability also have the uncertainty of roulette?

ADHD/HD terminology has undergone significant changes over the past decade. The ICD-10 and DSM-IV list similar set of symptoms. In ICD-10, ADHD is narrowly defined with a minimum of ten symptoms in all three domains required for diagnosis, compared with only six symptoms and a minimum number of symptoms in only one domain in DSM-IV. ICD-10 requires all criteria to be met in two different settings, but DSM-IV requires some impairment in only one setting. This diagnostic variation has affected reported prevalence of ADHD in the USA compared with the UK (5) or where DSM-IV criteria are applied.

Most clinicians worldwide, including those in the UK, favour DSM-IV for its operational criteria and in making diagnoses. Regardless of whether these variations are taken into account in ICD-11 or DSM-5, their diagnostic applicability and the relevance are to be watched.

References:1.World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders.

2.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association, 2004.

3.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-5. Washington, DC: American Psychiatric Association, 2013.

4.National Collaborating Centre for Mental Health. The NICE guideline on diagnosis and management of ADHD in children, young people and adults.

5.The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis Guilherme Polanczyk, M.D.; Mauricio Silva de Lima, M.D., Ph.D.; Bernardo Lessa Horta, M.D., Ph.D.; Joseph Biederman, M.D.; Luis Augusto Rohde, M.D., Ph.D. Am J Psychiatry 2007;164:942-948. doi:10.1176/appi.ajp.164.6.942

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Conflict of interest: None declared

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