Psychiatric Diagnosis and Classification - ResearchGate

40 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION
and first version of DSM, there has been a constant effort to get closer. ICD-8
and DSM-II, ICD-9 and DSM-III and ICD-10 and DSM-IV have displayed
greater similarityand consistencythanks to the international collaboration.
The ICD and DSM in their current forms are both descriptive, nonaetiological
classifications with operationallydefined criteria and rulebased
approaches to generating diagnoses. The efforts to harmonize the
two classifications have left minor differences between the two systems.
Currentlythese systems are not entirelyhomologous, but in a large majority
of criteria theyare identical or differ in non-significant ways. Differences are
most marked in the case of near-threshold, mild or moderate conditions.
Discordance is particularlyhigh with categories such as post-traumatic
stress disorder and harmful use or abuse of substances [37±40].
The Australian national mental health survey[37] that compared the two
diagnostic systems revealed that the disagreements between the systems lead
to widelyvarying estimates of burden from different mental health conditions.
In other words, these differences do matter. It showed that though the
intention of the two sets of criteria for several of the disorders appeared to be
verysimilar, trivial differences in the words used or in the number of symptoms
often accounted for the dissonance. These differences are needless and
best avoided. A more substantial reason for difference appeared to be the way
the exclusion rules are used bythe two classifications. There is a need to agree
on a common set of principles that will dictate these exclusion rules.
On the other hand, substantive differences between ICD and DSM also
exist. ICD uncouples disabilityfrom diagnosis. ICD does not put personality
disorders or physical disorders in a different axis.
Both the ICD and DSM have been subjected to extensive field testing and
are in wide use. Prior to the next revisions of these classifications, after
removing the non-essential differences in the two classifications, the
remaining conceptual distinctions should be identified and subjected to
further empirical testing in order to reduce the dissonance. Ideally, this
testing would be carried out in an international manner, since this is the
mandate of the WHO. It would be desirable to then further harmonize the
two classifications, so that diagnoses in which there are conceptual agreement
have identical criteria and, where differences exist after examination
of the empirical data, users should be informed about the differences in the
concepts and about the best practical resolution of the differences perhaps
depending on the purpose as gathered from the foregoing studies.
Future Research Agenda to Inform Classification Revision
The major strides that have been undertaken in neuroscience and molecular
genetics provide exciting new opportunities for refining our classification