How Are Diseases Classified? Read the DSM-5 and ICD-11
Medical science takes a backseat to no other field when it comes to the density of its “inside baseball” jargon.
Exhibit A for this argument is the fact that two of the most respected medical manuals in the world (DSM-5 and ICD-11), both of which the general public know little to nothing about, are thicker than Gutenberg’s Bible and come with acronyms for titles.
For those of us without a degree in medicine, the titles and sheer size of the manuals are almost immediately off-putting.
While it might take years and years of college to comprehend the handbooks from front to back, understanding the basics about their history and function is a useful exercise and, as it turns out, a fairly simple endeavor.
ICD-11 Basics and History
The International Classification of Diseases (ICD-11) is compiled and published by the World Health Organization (WHO). Now in its 11th edition, published in June 2018, the ICD has a long history. Its full name is the International Statistical Classification of Diseases and Related Health Problems.
The origins of the ICD-11 span as far back as 1860 when Florence Nightingale proposed, at a gathering in London, that hospitals should begin the development of a collection of medical data that doctors and nurses could access for diagnosis and treatment purposes.
“ICD is the foundation for the identification of heath trends and statistics globally, and the international standard for reporting diseases and health conditions,” according to the WHO. “[The manual] defines the universe diseases, disorders, injuries and other related health conditions…”
Today, the ICD-11 is used around the world for mortality statistics, providing diagnostic codes for healthcare reimbursement and assistance, and classifying all health disorders and diseases.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is compiled by the American Psychiatric Association (APA). It was first published in 1952 and is now in its fifth edition, which came out in May 2013.
The DSM-5 is often referred to as the “Bible of Psychiatry.”
In the United States, the DSM-5 is the most widely used handbook by healthcare professionals. It “contains descriptions, symptoms and other criteria for diagnosing mental health disorders,” according to the APA’s website.
It also sets the standard for terms and language that physicians and researchers can use to clearly communicate their diagnoses and findings.
“The American Psychiatric Association can really be credited with a revolution in psychiatric [classification] with the publication of the DSM-III by introducing a descriptive [classification] system based on co-occurring clusters of symptoms,” Dr. Geoffrey Reed, a WHO psychologist, said in an interview with the American Psychological Association.
Co-occurring disorders, often referred to as a dual-diagnosis, arise when a patient is battling two separate disorders, such as depression and substance use disorder.
Competing Diagnoses and Classifications
The history of the two world-renowned manuals isn’t without some controversy. Because there was very little international participation in the DSM, neither handbook resembled the other, until relatively recently.
Much of the issue during these years, at least in part, was the difficulty of researchers located around the world to collaborate.
As the U.S. government’s commitment to the World Health Organization grew in the ’90s, however, the DSM and ICD are much more similar.
Still, some observers like Dr. Reed see little use for two diagnostic structures. Since the ICD is put out by a global health agency, it is multilingual and distributed at a much cheaper cost than the DSM, which accounts for a substantial portion of the APA’s revenue.
It seems unlikely that physicians, researchers and insurance companies will refer to a global diagnostic standard in the near future. Even if that Herculean project is ever undertaken, Dr. Reed believes the DSM will always have value.
“[T]here would still be a role for the DSM,” Reed said, “because it contains a lot of additional information that will never be part of the ICD. In the future, [the DSM] may be viewed as an important textbook of psychiatric diagnosis rather than as the diagnostic ‘Bible.'”
The DSM focuses only on the classification and diagnosis of mental health and psychiatric disorders almost exclusively in the United States.
The ICD, on the other hand, provides a wider perspective and role in the use of its codes for hospitals, Medicare and Medicaid claims, insurance reimbursement, and a whole host of other healthcare related issues.
Both provide invaluable information widely used by doctors, hospitals, and clinicians in the United States and around the world for diagnosing and classifying diseases and disorders for improving the lives of everyone.
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