Diagnostic and Statistical Manual of Mental Disorders & International Classification of Diseases (DP IB Psychology)

Diagnostic & Statistical Manual of Mental Disorders (DSM-5)

What is the DSM-5?

• The DSM-5 stands for the Diagnostic and Statistical Manual which is now in its fifth edition (hence the -5 in the title), having last been published in 2013 and updated in 2022

• The DSM-5 is a diagnostic tool used by any medical professional who is qualified to give a diagnosis pertaining to a mental disorder e.g. doctors, clinicians, psychiatrists

• The DSM-5 is published by the American Psychiatric Association (APA) who, at given intervals, review and revise the current edition and make recommendations as to what should be removed from or added to the next edition

• Some behaviours or conditions which appeared in previous editions of the DSM have since been removed from more recent editions e.g. homosexuality (removed in 1973); gender identity disorder (removed in 2012)

• Some behaviours or conditions which did not appear in previous editions of the DSM have since been added to the DSM-5 e.g. hoarding disorder and binge eating disorder (both were added in 2013)

Hoarding is now considered to be a disorder according to the most recent version of the DSM-5.

How is the DSM-5 different to previous versions of the DSM?

• Previous versions of the DSM (which you may be familiar with via your study of Psychology) used five axes to categorise the different dimensions of mental disorder classifications e.g. Axis I grouped clinical disorders such as anxiety, schizophrenia and depression together

• The DSM-5 has removed the five axes in a bid to simplify and streamline the manual and the means by which a mental disorder can be diagnosed

• Medical experts had complained that there was very little difference between some of the axes which, they argued, could lead to confusion, unreliable diagnoses and, potentially, the patient receiving the wrong treatment for their condition

• The DSM-5 uses a single axis system i.e. it has combined axes 1-3 into a single axis that accounts for mental and other medical diagnoses specifically related to brain dysfunction or illness

• The DSM-5 removed the distinct categories it had previously used for mental health diagnoses, medical diagnoses, and personality disorders

• The DSM-5 is organised into three sections:

  • Section I: DSM-5 Basics: a guide for medical professionals on how the manual should be used

  • Section II: Diagnostic Criteria & Codes: the largest section in the manual which comprises types, definitions and explanations of conditions/disorders

Section III: Emerging Measures & Models: information and guidance as to how to apply specific diagnostic tools, the ways in which culture may affect diagnosis and an insight into which conditions/disorders may be included in future editions

Evaluation of the DSM-5

Strengths

• The most recent revisions to the DSM-5 reflect social change and socially sensitive issues e.g. the removal of gender identity disorder means that individuals who do not conform to traditional gender roles/identity are not classified as abnormal/mentally ill

• The DSM-5 acknowledges that cultural differences must be considered when making a diagnosis which should ensure that ethnocentricity and universality do not interfere with diagnosis

Limitations

• As is the case with all diagnostic manuals there is the risk that being given a diagnosis of mental illness can lead to stigmatisation and ‘labelling’ of the individual as ‘abnormal’

• The DSM-5 uses broad categories to determine the type of disorder and how it should be treated which tends to lose the individual and the complex nature of their condition in the process which means that it may lack validity

International Classification of Diseases (ICD11)

What is the ICD-11?

• The ICD-11 stands for the International Classification of Diseases which is now in its eleventh edition (hence the -11 in the title), having last been published in 2022 

• The ICD-11 is a diagnostic tool used by any medical professional who is qualified to give a diagnosis pertaining to both physical and  mental disorders e.g. doctors, clinicians, psychiatrists

• The DSM-5 is published by the World Health Organisation (WHO) who, at given intervals, review and revise the current edition and make recommendations as to what should be removed from or added to the next edition

• The ICD-11 does not just focus on mental disorders: its scope includes physical illnesses and conditions such as Covid-19

• The ICD-11 works on a global scale (the DSM-5 is only focused on North America), looking at the causes of, the extent of and the consequences of disease and morbidity rates across the world

• The ICD-11 uses the data it has gathered to inform worldwide health initiatives and research into disease (both physical and mental)

How is the ICD-11 different to previous versions of the ICD?

• Changes to ways in which diseases, disorders and causes of death are coded mean that the ICD-11 provides a more refined and detailed tool for the classification of both physical and mental illnesses than in previous versions

• This refinement to the coding system means that illnesses can be classified and recorded more specifically and precisely

• The ICD-11 has been translated into 43 languages and makes more allowance for cultural variations than did previous versions

• The ICD-11 takes into account the growing importance of digital technology and so it has been designed with user-friendly software and a platform which can be accessed globally

• Some behaviours or conditions which appeared in previous editions of the ICD have since been removed from the ICD-11 e.g. acute stress disorder; personality disorders (these have been combined into just ‘personality disorder’ singular)

• Some behaviours or conditions which did not appear in previous editions of the ICD have since been added to the ICD-11 e.g. gaming disorder and prolonged grief disorder 

Evaluation of the ICD-11

Strengths

• The global scale of the ICD-11 means that it has wider generalisability and application than the DSM-5

• The inclusion of physical illnesses along with mental illnesses means that the link between both mind and body is acknowledged hence it takes a more holistic approach than the DSM-5

Limitations

• The inclusion of physical illnesses along with mental illnesses could, conversely, mean that the manual is ‘diluted’ in its approach to diagnosis i.e. it is trying to cover too many bases all at once

• The removal of ‘personality disorders’  from the ICD-11 could result in a patient being misdiagnosed e.g. they may present with antisocial personality disorder but their diagnosis would be more generalised under ICD-11 criteria which could result in them receiving insufficient treatment for their disorder