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Revision of the classification of mental disorders in ICD–11 and DSM–V: work in progress

  • Norman Sartorius
Summary

This editorial summarises the work done to prepare ICD–11 and DSM–V (which should be published in 2015 and 2013 respectively). It gives a brief description of the structures that have been put in place by the World Health Organization and by the American Psychiatric Association and lists the issues and challenges that face the two organisations on their road to the revisions of the classifications. These include dilemmas about the ways of presentation of the revisions (e.g. whether dimensions should be added to categories or even replace them), about different versions of the classifications (e.g. the primary care and research versions), about ways to ensure that the best of evidence as well as experience are taken into account in drafting the revision and many other issues that will have to be resolved in the immediate future.

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Copyright
Corresponding author
Professor N. Sartorius, 14, chemin Colladon, 1209 Geneva, Switzerland. Email: sartorius@normansartorius.com
Footnotes
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See pp. 14–19 and 20–22, this issue. The ICD and DSM revisions have also been discussed in the November 2009 issue of the British Journal of Psychiatry by Assen Jablensky (pp. 379–381), Michael First (pp. 382–390) and Allen Frances (pp. 391–392). Ed.

Declaration of Interest

None.

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 (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). APA.
American Psychiatric Association (1995) Diagnostic and Statistical Manual of Mental Disorders Fourth Edition: Primary Care Version (DSM–IV–PC). APA.
Kupfer, DJ, Kuhl, EA, Narrow, WE et al (2009) On the Road to DSM–V. The Dana Foundation (http://bit.ly/o5b6z).
Regier, DA, Kuhl, EA, Narrow, WE et al (2009) Research planning for the future of psychiatric diagnosis. European Psychiatry; in press.
Sartorius, N (1991) The classification of mental disorders in the Tenth Revision of the International Classification of Diseases. European Psychiatry; 6: 315–22.
Skodol, AE, Bender, DS (2009) The future of personality disorders in DSM-V? American Journal of Psychiatry; 166: 388–91.
Stengel, E (1960) Classification of mental disorders. Bulletin of the World Health Organization; 21: 601.
World Health Organization (1974) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Eighth Revision of the International Classification of Diseases (ICD–8). WHO.
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases. WHO.
World Health Organization (1992a) Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD–10). WHO.
World Health Organization (1992b) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO.
World Health Organization (1993) The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. WHO.
World Health Organization (1996) Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD–10 Chapter V Primary Care Version. Hogrefe & Huber.
World Health Organization (1998) Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD–10 Chapter V Primary Care Version (2nd edn). WHO.
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BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
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Revision of the classification of mental disorders in ICD–11 and DSM–V: work in progress

  • Norman Sartorius
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eLetters

Mutually exclusive classifications?

Kelly A. Latta, journalist
27 January 2010

Regarding the controversial construct of neurasthenia the editorial conflicts with the official documentation. The term neurasthenia began appearing in the literature in the late 1800s and was dropped from the DSM in 1980. The term Chronic Fatigue Syndrome (CFS) did not come intoofficial use until 1988. Nor is CFS listed by the WHO ICD-10 as an infectious disease or underthe rubric of neurasthenia. It is classified exclusively as an organic brain disease. The official listing is:

The chronic fatigue syndrome is indexed in Volume 3: The AlphabeticalIndex to G93.3: Chapter VI: Diseases of the nervous system (G00-G99) > Other disorders of the nervous system (G90-99) > G93 Other disorders ofbrain > G93.3: Postviral fatigue syndrome; Benign myalgic encephalomyelitis.] As is the case with many diseases a clear aetiology is unknown at this time although there are a number of associations some of them infectious at least in some subgroups.

There is a "fatigue syndrome" under F48.0, however, it is not the chronic fatigue syndrome the author appears to be referring to, as the WHO considers the categories of F48 and G93 to be mutually exclusive.

As noted elsewhere in this issue, however, there can be neuropsychiatric co-morbidity in organic diseases of the brain and psychosocial overlays in some patients in all biological diseases - infectious or not. REFERENCES: World Health Organisation: Tenth Revision of the International Classification of Diseases. World Health Organisation, Geneva, 1990
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Conflict of interest: None Declared

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