Psychiatric Diagnosis and Classification - ResearchGate

20 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION
country is obliged to report basic morbidity data to WHO using its categories,
whereas the DSM is a stand-alone classification of mental disorders
designed, at least in the first instance, for use by American health professionals.
For a variety of political and financial reasons, both classifications will
continue to produce new editions or revisions and in some respects to compete
with one another. Radical changes are much more likely to be introduced
by the APA than by the WHO, mainly because the former only has to
persuade its own Board of Trustees, whereas the latter has to persuade the
representatives of over 200 different countries at a formal Revision Conference.
It is, of course, confusing to have two rival classifications, particularly
because many of the differences between them are trivial, and in some cases
accidental. On the other hand, the existence of two parallel nomenclatures
and sets of explicit definitions does help to emphasize that most of psychiatry's
illness concepts are still provisional and their definitions arbitrary. It is
likely that both parent organizations will try to reduce the number of minor
differences between their respective classifications in future revisions, and
where irreconcilable conceptual differences are involved this will at least
stimulate research to elucidate the advantages and disadvantages of the
rival concepts or definitions. It is unlikely that any other national or international
body will produce another comprehensive classification of mental
disorders, but individual research groups may well produce novel concepts
and definitions for specific purposes and should not be discouraged from
doing so. Innovation is essential to progress and sooner or later radical
changes are going to be needed.
The Immediate Future
When the time comes to produce the next versions of the DSM and ICDÐ
and the APA is already contemplating a DSM-VÐboth the APA and the
WHO will be confronted with a dilemma. The revision process is bound to
generate requests to alter the explicit criteria defining many individual
disorders and a variety of reasons will be citedÐto improve reliability, to
reduce ambiguity, to improve discrimination between related syndromes, to
reduce variation in treatment response or outcome, to eliminate redundant
criteria or phrases, and so on. In many cases these reasons, viewed in isolation,
will seem cogent. On the other hand, all definitional changes have
disadvantages: they are confusing to clinicians; they create a situation in
which the relevance of all previous clinical and epidemiological research to
the disorder as it is now defined is uncertain; and they involve tedious and
sometimes costly changes in the content and detailed wording of diagnostic
interviews and in the algorithms used to generate diagnoses from clinical