DSM and ICD (Clinical)

Question 1

What is the DSM 5? (5 AO1)

Answer 1

• a diagnostic statistical model of mental disorders
• DSM 4 was published in 2000
• DSM 5, updated in 2015
• the DSM 5 was created to harmonise with the ICD 10 which meant the removal of the multi-axel system and the introduction of the three sections (1:how the DSM 5 is organised, 2:diagnostic criteria and codes for disorders list, 3:emerging models of measuring =)
• section three of the DSM 5 was created to allow for self-assessment by the patients and takes into account cultural issues

Additional Info:

• pre-DSM 5 was a multi-axial tool (1:clinical disorder, 2:personality disorders and retardation, 3: medical and physical conditions, 4: psychosocial and environmental factors, 5: general assessment of functioning)
• was changed historically over time, for example, as a response to Rosenhan’s experiment

Question 2

What is the ICD 10? (5 AO1)

Answer 2

• includes information on all diseases
• devised by the WHO and can be accessed on the internet
• contains section F for mental disorders
• coding works like this: letter for general category, then digit for subcategory, then further categorisation (e.g., F32.0 is mild depression)
• a similar diagnostic format to the ICD allowing the technician to go from general to specific classifications of disorders following a clinical interview (medical records may be consulted)

Question 3

Evaluate: reliability of these classification systems? Include evidence, and think of patient, disorder, culture and between systems

Answer 3

General
*unreliability can come from the patient, the disorder, the culture of the clinician or the manual (expand your points using the information below)
+DSM 5 has taken away categories (link to development over time)
+DSM 5 aligned with ICD so tools become more harmonised
-subjective (see notes on ‘Patient’)
-culture of professional affects diagnosis (see notes on ‘Culture on Clinician’)
-not good inter-rater reliability (see notes on ‘Between Diagnostic Systems’)

Patient

• Ward et al (1962) showed that disagreements in diagnosis was due to inconsistency of the information provided by patients
• problems with patient unreliability may occur due to memory issues, denial, guilt, or the patient may have an illness that can lead to disorganised thoughts, psychotic and/or manipulative tendencies

Disorder
*Reiger et al (2013) found that diagnosis of schizophrenia using the DSM 4 was only 0.28. (1 being best diagnosis and 5 being average) However, DSM 5 has taken away categories for schizophrenia (link to increased validity of diagnosis)

Culture of Clinician
*UK vs US study found that British psychiatrists were twice as likely to diagnose depression while American psychiatrists were twice as likely to diagnose schizophrenia when watching the same videotaped interviews

Between Diagnostic Systems
*Nicholls et al (2000) showed that neither ICD or DSM demonstrates good inter-rater reliability for the diagnosis of eating disorders in children — only a 0.64 reliability between raters using DSM and 0.36 using ICD