Mental health is an integral part of overall well-being. When healthy we can socialize with others, study, work and generally cope with day to day life.
With 1.590m people in contact with specialist NHS mental health services in 2012/13, of which 6.6% spent time in hospital; mental illness is a detrimental public health and economical issue that presents many challenges for countries, governments, communities and sufferers. According to the World Health Organisation (WHO), globally 1 in 4 people suffer from mental disorders in both developed and developing countries (2013).
Diagnostics is determining the nature and etiology of an illness by observing and studying the symptoms of a patient. In essence, this is the first step forward to achieving efficient treatment.
The question is how, why and by who are these people diagnosed?
Currently, the two main Psychiatric ‘Bibles’ as some people would say are the International Statistical Classification of Diseases 10th edition (published in 1992) and the Diagnostic and Statistical Manual of Mental Disorders 5 (published in 2013).
The WHO’s ICD-10 an international standard diagnostic classification that lists many illnesses, symptoms and the etiology of some diseases. Mental and Behavioural Disorders can be found in Chapter V tabulated into 10 groups.
- Mental disorders due to known physiological conditions (Vascular Dementia..)
- Mental and behavioral disorders due to psychoactive substance use (Alcohol Dependence..)
- Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders
- Mood [affective] disorders (Bipolar Disorder..)
- Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders
- Behavioral syndromes linked to physiological disturbances and physical factors (Anorexia Nervosa..)
- Disorders of adult personality and behavior (Antisocial Personality Disorder..)
- Intellectual disabilities (Mental Retardation..)
- Pervasive and specific developmental disorders (Autistic disorder, Asperger’s Syndrome..)
- Behavioral and emotional disorders with onset usually occurring in childhood and adolescence (ADHD..)
- Unspecified mental disorder
On the other hand, the American Psychiatric Association’s DSM 5 lists them as:
- Neurodevelopmental disorders (ADHD, Schizophrenia…)
- Schizophrenia spectrum and other psychotic disorders
- Bipolar and related disorders
- Depressive disorders
- Anxiety disorders (Generalized Anxiety Disorder..)
- Obsessive-compulsive and related disorders (Body Dysmorphic disorder..)
- Trauma- and stressor-related disorders (Post traumatic stress disorder..)
- Dissociative disorders (Dissociative Identity Disorder..)
- Somatic symptom disorders (Hypochondriasis..)
- Feeding and eating disorders (Bulimia nervosa…)
- Elimination disorders (Enuresis (bed wetting…))
- Sleep-wake disorders (Restless Legs syndrome..)
- Sexual dysfunctions (Female Orgasmic disorder..)
- Gender dysphoria (..in children, adolescents and adults)
- Disruptive, impulse control and conduct disorders (Kleptomania..)
- Substance use and addictive disorders (Cannabis Use Disorder..)
- Neurocognitive disorders (Delirium…)
- Personality disorders (Borderline Personality Disorder..)
- Paraphilic disorders (Sexual sadism disorder..)
- Other disorders
Yeah I know, it’s quite a long list. One can easily get carried away with self-diagnosis, and start picking disorders off the menu that relate to behaviors that may not be so extreme. I shall discuss the issues of diagnostics in the next post.
A few Differences
- The ICD is published by a international health agency (WHO) with a constitutional public health mission, while the DSM is published by a single national professional association (APA).
- The global, multilingual and multi-disciplinary ICD’s Mental and behavioral disorders classification serves to provide data and support to countries to reduce the disease burden of mental disorders. Whereas the primary electorates of the DSM are American psychiatrists.
- The ICD is approved by the World Health Assembly, composed of the health ministers of all 193 UN member countries; the DSM is approved by the assembly of the American Psychiatric Association.
Most American psychiatrists train using the DSM but because these diagnoses must be conveyed in terms of ICD codes, they must have some familiarity with ICD. An international survey of psychiatrists in 66 countries comparing use of the ICD-10 and DSM III in 2002 found that professionals preferred the ICD for clinical diagnosis and the was DSM more valued for research.
Other guides are The Chinese Society of Psychiatry’s Chinese Classification of Mental Disorders (CCMD-3) published in 2001, which is similar to the ICD and DSM but includes 40 culturally related disorders such as Koro (Genital retraction syndrome).
The Latin American Guide for Psychiatric Diagnosis (GLDP) published in 2002 and The Research Domain Criteria (RDoC), a project being developed by the US National Institute of Mental Health as a substitute for the DSM.
Essentially, these manuals are guides for doctors, psychiatrists and other mental health professionals during the diagnostic process. They help to deduce what the patient is battling with, communicate the illness with the patient and determine appropriate research participants.
Yet, a myriad of critics debate over their methods, structure and credibility.
We have certainly come a long way in Psychiatry over the last few decades. Homosexuality was only just removed from the DSM in 1973, and this decision faced objection from a number of psychiatrists.
Thus, we still have a long way to go on this pursuit to understand and to develop efficient therapies and ‘cures’ for these disorders. With much more research and empirical data it is possible to mitigate some of the controversies that surround diagnostics.