Standardized systems for classifying and coding disorders: DSM, ICD

The Diagnostic and Statistical Manual of Mental Disorders¹⁾ (DSM) is a publication of the American Psychiatric Association (APA) that provides a standard classification of mental disorders and the criteria for their diagnosis. It is used by mental health professionals, including psychiatrists, psychologists, and social workers, to diagnose and treat mental health conditions.

The first edition of the DSM, published in 1952, was a relatively small book that contained around 100 diagnoses. It was intended to provide a common language for mental health professionals to use in diagnosing and treating mental disorders. However, the DSM has undergone numerous revisions and expansions over the years, and the latest edition, the DSM-5, contains more than 300 diagnoses.

One of the key features of the DSM is that it is based on a categorical approach to diagnosis, meaning that each disorder is classified as distinct from other disorders. This approach has been criticized by some mental health professionals who argue that it does not accurately reflect the complexity of mental health conditions and may result in the oversimplification of diagnoses.

“The forward to the landmark 1980 DSM III was appropriately modest and acknowledged that this diagnostic system was imprecise. So imprecise that it never should be used for forensic or insurance purposes. As we will see that modesty was tragically short lived.” Bessel Van Der Kolk, The Body Keeps the Score, How Healing Works, Hashimoto Thyroid Cookbook 3 Books Collection Set

Despite its limitations, the DSM has played a significant role in the development of mental health treatment and research. It has helped to standardize the way that mental disorders are diagnosed and has provided a common framework for mental health professionals to use in their practice. However, it is important to note that the DSM is not the only resource available to mental health professionals, and it should be used in conjunction with other sources of information, such as a patient's medical history and personal experiences.

In recent years, there has been increasing attention on the need to revamp the DSM to better reflect the latest scientific research on mental health disorders. Many experts have called for the development of a more dimensional approach to diagnosis, which would take into account the complexity and variability of mental health conditions. It remains to be seen what the future holds for the DSM, but it is clear that it will continue to play a central role in the field of mental health for the foreseeable future.

Some of the major changes that were introduced in the DSM-5, published in 2013, include:

• Changes to diagnostic categories and criteria: The DSM-5 introduced a number of changes to the diagnostic categories and criteria for various mental disorders. For example, the DSM-5 combined several disorders that were previously classified separately, such as Asperger's disorder and pervasive developmental disorder, into a single category called “autism spectrum disorder.”

• Changes to the organizational structure: The DSM-5 introduced a new organizational structure, with disorders organized into a hierarchy based on the level of clinical severity. This was designed to reflect the increasing recognition of the importance of severity in determining treatment and prognosis.

• Changes to the treatment and management of mental disorders: The DSM-5 also introduced a number of changes to the treatment and management of mental disorders, including the recognition of the importance of evidence-based treatments and the integration of physical and mental health care.

• Changes to the cultural and contextual factors: The DSM-5 also recognized the importance of cultural and contextual factors in the diagnosis and treatment of mental disorders, and it included a number of changes to reflect this recognition.

• Changes to the diagnostic process: The DSM-5 also introduced a number of changes to the diagnostic process, including the use of a “dimensional” approach to diagnosis and the use of a new system for identifying and classifying mental disorders called the “International Classification of Diseases, 11th Revision” (ICD-11).

The International Classification of Diseases²⁾ (ICD) is a standardized system for classifying and coding diseases, disorders, and injuries. It is used by healthcare providers, public health agencies, and other organizations to collect and report data on health conditions and to track the prevalence of different diseases.

The first version of the ICD, known as the International List of Causes of Death, was developed by the International Statistical Institute in 1893. It contained just over 500 diagnoses and was primarily used for collecting data on mortality. In 1948, the World Health Organization (WHO) took over the development of the ICD and expanded it to include a broader range of health conditions.

Since its inception, the ICD has undergone numerous revisions, with the latest version, the ICD-11, being released in 2018. The ICD-11 contains over 55,000 codes and is organized into 21 chapters, each covering a different aspect of health and disease. The ICD is updated regularly to reflect the latest scientific knowledge on health conditions and to incorporate new technologies and treatments.

One of the key features of the ICD is that it is used globally, making it possible to compare health data across different countries and regions. This has helped to improve our understanding of the distribution and determinants of different diseases and has enabled the development of effective public health policies and interventions.

In addition to its role in data collection and analysis, the ICD is also used for billing and reimbursement purposes in many countries. It is an essential tool for healthcare providers and public health agencies, and its continued development and evolution will be critical for improving the quality and effectiveness of healthcare around the world.