Psychiatric Diagnosis and Classification - ResearchGate

56 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION
DSM-IV led by Allen Frances) and ICD-10 workgroups led by Norman
Sartorius) were convened and coordinated by Darrel Regier under the
sponsorship of ADAMHA. These workgroups, guided by emerging epidemiological
and clinical research findings from studies using most of the
above instruments, were able to obtain consensus on the overall framework
of the diagnostic system and on the great majority of explicit criteria for
specific disorders. The few remaining discrepancies in criteria are being
subjected to empirical tests to determine the impact of such differences on
prevalence and service use rates [44, 45].
Finally, testing for the clarity, clinical utility, and reliability of the diagnostic
criteria for both DSM-IV and ICD-10 took place in international field
trials, which greatly increased the acceptability and use of both diagnostic
systems. The ICD-10 field trials followed a similar approach to that used in
the early DSM-III trials to assess acceptability, clinical utility, and reliability
of ratersÐinvolving over 200 centers in 50 countries [46, 47]. The exceptional
congruence between DSM-IV and ICD-10 has permitted the development
of a cumulative body of knowledge that has greatly advanced research
on both psychosocial and pharmacological treatments for these disorders.
STRENGTHS OF THE DSM SYSTEM
The numerous strengths of the DSM system, particularly since the publication
of DSM-III, have been covered in the historical narrative presented in
the previous sections, and will be summarized here. Undoubtedly the most
important strength of the DSM system is its widespread acceptance by
clinicians, researchers, administrators, and others as a common language
for describing psychopathology. This acceptance comes as a result of several
factors. The ``atheoretical'' stance of the DSM-III helped to ensure that
diagnostic criteria would not be tied to any particular school of thought
regarding aetiology, allowing use by persons with different clinical experience
and traditions. Diagnostic criteria, based solely on descriptive phenomenology,
were specified with a greater degree of precision than with
previous diagnostic systems, increasing the reliability of diagnosis between
diagnosticians in various settings. Efforts to improve congruence with the
ICD system, and the translation of DSM into multiple languages have
facilitated international use of the system.
Beyond providing a readily usable common language for mental disorders,
the DSM has several other strengths. The precise, descriptive diagnostic
criteria in DSM-III and its successors have contributed to a new era
in psychiatric research through the development of reliable structured
and semi-structured research instruments. Another strength of the DSM,
particularly the DSM-IV and its text revision DSM-IV-TR), was the com-