(PSYCHIATRIC TIMES) - I have elsewhere summarized the problems caused by the excessive and misdirected ambitions of the DSM-V effort.1 My purpose here is to suggest a different, more useful and attainable ambition for DSM-V—namely trying to integrate DSM-V and ICD-11 into one system. If successfully achieved, this would be by far the biggest accomplishment possible in this round of revision.
DSM-IV and ICD-10 are very similar, but annoyingly different—and neither is clearly superior to the other. In fact, no system of descriptive psychiatric classification can ever be very much better than any other, just as no language can claim superiority over any other language. What we need now is to eliminate the totally unnecessary confusion of having 2 different classificatory languages.
This seemingly obvious goal has been surprisingly difficult to realize. After becoming chair of the DSM-IV Task Force, I was enthusiastic about the possibility of integrating our work with that of the World Health Organization to develop ICD-10. We had many joint meetings bringing together the DSM-IV Workgroup members with those who were working on ICD-10. Everyone involved had good intentions, but the effort to bring the 2 systems together fell far short. Although DSM-IV and ICD-10 are much more similar than were DSM-III and ICD-9, there were still a multitude of meaningless differences.
The obstacles to full integration were molehills that turned out to be mountains. By the time we started work on DSM-IV, ICD-10 was already in a fairly advanced form. The DSM-IV Task Force was faced with divided loyalties. We had a mandate to be conservative and adhere closely to DSM-III-TR to stabilize the diagnostic system. This conflicted with the goal of drawing closer to an ICD-10 draft that was close to DSM-III-TR, but also different in many small ways. Since the ICD-10 group had also grown understandably attached to their own new wordings, it was usually impossible to reach consensus on one unified criteria set.
The result was predictable. Although we were able to reconcile many of the more obviously unnecessary differences in criteria wording between DSM-IV and ICD-10, overall the 2 systems remained different in mostly trivial and arbitrary ways. It has been estimated that only 1 diagnosis (ie, transient tic disorder) has identical wording in both systems. A majority (roughly 80%) of the disorders have minor wording differences; roughly 20% have divergent definitions that reflect slightly different conceptions. All in all, however, none of these differences is really consequential. We would be better off having had only 1system, either DSM-IV or ICD-10, than we are having both.
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