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ICD-11 should not repeat the mistakes made by DSM-5

  • Allen J. Frances (a1) and John M. Nardo (a2)

Summary

Having two systems of psychiatric diagnosis creates unnecessary confusion therefore it would be desirable to achieve increased consistency between ICD-11 and DSM-5. Unfortunately, however, DSM-5 has included many controversial suggestions that have weak scientific support and insufficient risk–benefit analysis. As a result ICD-11 should learn from the DSM-5 mistakes rather than repeating them.

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Copyright

Corresponding author

John M. Nardo, MD. Email: jnardo@ellijay.com

Footnotes

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Declaration of interest

None.

Footnotes

References

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1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder (4th edn) (DSM-IV). APA, 1994.
2 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
3 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder (5th edn) (DSM-5). APA, 2013.
4 Frances, A. Whither DSM-V? Br J Psychiatry 2009; 195: 391–2.
5 Frances, A. The first draft of DSM-V. BMJ 2010; 340: c1168.
6 Batstra, L, Frances, A. Diagnostic inflation: causes and a suggested cure. J Nerv Ment Dis 2012; 200: 474–9.
7 Kraemer, HC, Kupfer, DJ, Clarke, DE, Narrow, WE, Regier, DA. DSM-5: how reliable is reliable enough? Am J Psychiatry 2012; 169: 13–5.
8 Regier, DA, Narrow, WE, Clarke, DE, Kraemer, HC, Kuramoto, SJ, Kuhl, EA, et al DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses. Am J Psychiatry 2013; 170: 5970.
9 The Lancet. Living with grief. Lancet 2012; 379: 589.
10 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder (3rd edn) (DSM–IIII). APA, 1980.
11 Parker, G, Fink, M, Shorter, E, Taylor, MA, Aiskal, H, Berrios, G, et al Issues for DSM-5: whither melancholia? The case for its classification as a distinct mood disorder. Am J Psychiatry 2010; 167: 7.
12 Friedman, RA. Grief, depression, and the DSM-5. N Engl J Med 2012; 366: 1855–7.

ICD-11 should not repeat the mistakes made by DSM-5

  • Allen J. Frances (a1) and John M. Nardo (a2)

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ICD-11 should not repeat the mistakes made by DSM-5

  • Allen J. Frances (a1) and John M. Nardo (a2)
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eLetters

DSM relevance outside the USA

Prakash S. Gangdev, Psychiatrist
29 July 2013

American psychiatry was influenced by psychoanalytic theories of pathology and treatments and now by pharmacotherapy based treatments. However, the DSMs were developed by the Americans, for the Americans, and of the Americans. It was not developed by any outsider contributions. Contextual variations and market forces account for variations in Americanand other systems. There is no expectation from them or no requirement forthe rest of the world to follow or even acknowledge the DSMs. Any such attention, endorsement, or use outside of the US is optional and may be inappropriate. DSM V is not akin to the definition of democracy and nothing may be lost by ignoring it, and nothing substantial may be gained by using it.

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Conflict of interest: None declared

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DSM-5 & ICD-11 should define states or conditions

David Kingdon, Professor
29 July 2013

Frances and Nardo entreat ICD-11 not to repeat the mistakes made by DSM-5 but fail to identify the key problem in both: they are trying to achieve incompatible objectives in attempting to define mental states, disorders, and illnesses.

Classification systems should not judge but describe - does the system for flora identify weeds? Weeds, like mental disorders or illnesses, are a matter of context, degree, opinion and purpose. ICD-11 and DSM-5 should describe mental states or conditions. This need not extend their remit or even change their content by much especially if categories were broader and simpler [1] though happiness or contentment might be usefully added. It is then appropriate for psychiatrists, amongst others, to say for which states evidence-based treatments are available and develop them where unavailable and needed.

Society, albeit assisted by the medical profession, will decide in what circumstances someone is 'ill' and the 'sick role' made available with access to welfare benefits, etc, although it may be better served in this function by using disability measures rather than diagnoses.

Reference List

1. Kingdon D, Afghan S, Arnold R, et al. A diagnostic system using broad categories with clinically relevant specifiers: lessons for ICD-11. Int J Soc Psychiatry 2010;56(4):326-35

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Conflict of interest: None declared

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