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