ICD 10 / DSM 5 : a critical

analysis
Presenters:
SR:
Chair:
SHORT HISTORY
 ICD
• International Statistical Classification of Diseases
and Related Health Problems
• International Classification of Diseases
• International List of Causes of Death – 1893
• WHO – 1948 – ICD 6- section on mental disorders
• 1955 – ICD 7 / 1965 – ICD 8/ 1975 – ICD 9
• May 1990 – 43rd World Health Assembly – ICD 10
• Revision – ICD 11 – by 2018
-www.who.int
 DSM
• Diagnostic and statistical manual of mental
disorders
• American Psychiatric Association
• 1952 – variant of ICD 6 – DSM
• ICD –Basic health statistics
• DSM – diagnostic – clinician oriented
• DSM II – 1968
• DSM I , II – psychodynamic theory- similar to ICD
• 1974 - DSM II – 7th print
 DSM III
• 1980
• Uniformity , Validity of psychiatric diagnoses
• Standardization of diagnoses
• Psychodynamic view – abandoned
• Descriptive view used
• Multi axial
• DSM III R- 1987
• DSM IV – 1994 – Clinical significance criterion
• DSM IV TR – 2000- 5 axis system
• DSM 5 – 2013 – first major revision in 20 years
• Extensively revised diagnostic criteria
 ICD vs DSM
ICD DSM
Published by a global health agency Published by a professional association in
(WHO) a single nation (APA)

Primary focus is global, multilingual, Primary focus is US psychiatrists

multidisciplinary
Oriented to public health, basic health Oriented to clinical diagnosis
statistics
Approved by World Health Assembly Approved by American Psychiatric
Association
Supplied globally, low cost Higher cost, not freely available
Consists of psychiatric and non psychiatric Psychiatric illnesses
illnesses
Axis –I,II,III Axis I-V
AXIS ICD 10 DSM IV
1 Clinical syndromes Principal
(psychiatric disorders disorder(psychiatric) that
including personality needs immediate attention
disorders,somatic diseases)
II Disabilities Personality disorder,
mental retardation,
learning disability
III Environmental/ Medical /neurological
circumstantial, personal life illness
style/ life management
factors
IV Psychosocial factors
V Level of function
SCHIZOPHRENIA
Either 1 symptom from a set of characteristic symptoms
ICD 10
• Thought echo/ Thought insertion/ Thought broadcasting/
Thought withdrawal
• Delusions of control/ influence/ passivity/delusional
perception
• Auditory Hallucinations – running commentary / discussing/
from some part of the body
• Persistent delusions- completely impossible. Culturally
inappropriate
DSM IV
• bizarre delusions
• auditory hallucinations
Or Atleast 2 from a second list
ICD 10
hallucinations accompanied by delusions or
overvalued ideas/ incoherence or irrelevant
speech/catatonic behavior/Negative symptoms/
change in overall quality of personal behavior
DSM IV
hallucinations of any type/disorganized
speech/catatonic or grossly disorganized
behavior/negative symptoms/delusions of any
type
• Both systems require these symptoms to be
present for most of the time for at least 1
month
• DSM-IV requires that the total duration of the
illness be at least 6 months
• First onset of psychotic symptoms lasting for
at least 1 month but less than 6 months.
• In ICD-10- Schizophrenia
• In DSM-IV -Schizophreniform Disorder.
MOOD DISORDERS
 Hypomania
Common to ICD10 & DSM IV
• elevated or irritable mood lasting at least 4 days
• increased activity or physical restlessness, increased
talkativeness, distractibility, decreased need for sleep,
and irresponsible or reckless behavior
Extra items
• ICD 10 -increased sexual energy and increased
sociability or over-familiarity
• DSM-IV-inflated self-esteem or grandiosity and flight of
ideas / mentions social and sexual activity as examples
of increased goal-directed activity
 Mania without psychotic symptoms
• The ICD-10 and DSM-IV definitions both
require abnormally elevated or irritable mood
lasting at least one week (or less if
hospitalization is required )
• ICD-10 set of accompanying symptoms
includes all seven of the items in the DSM-IV
definition but also contains two additional
items: marked sexual energy or indiscretions
and loss of normal social inhibitions
 Mania with psychotic symptoms
• ICD-10 excludes those delusions or
hallucinations that are “completely impossible
or culturally inappropriate and hallucinations
that are in the third person or are giving a
running commentary.”
• in DSM-IV such delusions or hallucinations are
consistent with a diagnosis of Manic Episode
With Psychotic Features
 BPAD
• In ICD-10, a diagnosis of Bipolar Affective
Disorder requires that there be recurrent mood
episodes
• In ICD-10 a single manic or mixed episode is
diagnosed as Mania or Mixed Affective Episode.
• DSM-IV a single manic or mixed episode is
sufficient for a diagnosis of Bipolar I Disorder
• DSM IV- if at least one manic or mixed episode -
Bipolar I Disorder, only hypomanic episodes and
major depressive episodes -Bipolar II Disorder
• ICD – no such distinction
 Depressive episode
Common to ICD 10 & DSM IV
depressed mood,loss of interest, decreased energy
or increased fatiguability, recurrent thoughts of
death or suicidal behavior, inability to
concentrate or indecisiveness, psychomotor
agitation or retardation, sleep disturbance,
change in appetite or weight
ICD-10 -loss of confidence or self esteem ,
inappropriate or excessive guilt
DSM IV - inappropriate or excessive guilt with
feelings of worthlessness
• ICD-10 groups the items into two sets-one containing
the three items depressed mood, loss of interest, and
decreased energy and the other set containing the
remaining seven items
• DSM-IV presents the nine items in one set but
indicates that either depressed mood or loss of interest
is required for a diagnosis of Major Depressive Episode
• The ICD-10 criteria do not mention any exclusion based
on bereavement whereas DSM-IV excludes a diagnosis
if the depressive disturbance is better accounted for by
bereavement
Psychotic symptoms in depression
• ICD 10- excludes those delusions or
hallucinations that are “completely impossible
or culturally inappropriate and hallucinations
that are in the third person or are giving a
running commentary.”
• DSM-IV such delusions or hallucinations are
consistent with a diagnosis of Major
Depressive Episode With Psychotic Features
Somatic Syndrome (With Melancholic
Features specifier in DSM-IV)
• Common to ICD and DSM- loss of interest or pleasure,
lack of reactivity, early morning awakening, depression
worse in morning, psychomotor retardation or
agitation, appetite loss, and weight loss.
• ICD-10 – loss of libido
• DSM-IV - single category for Major Depressive Disorder
with two subtypes-single episode and recurrent
• ICD-10-has two separate categories; F32 for a
depressive episode, F33 for recurrent depressive
disorder.
ANXIETY DISORDERS
 Agoraphobia
• DSM-IV, agoraphobia is defined as being
secondary to panic attacks or panic-like
symptoms
• Agoraphobia without Panic is a separate category
in DSM-IV
• ICD 10- agoraphobia -specific situations that are
feared or avoided /ICD-10 also requires that there
be at least two symptoms of anxiety (drawn from
the same list of fourteen symptom used in the
definition of a panic)
 Social & Specific phobia
• Social phobia -ICD-10 defines the phobia as
fear OR avoidance of social situations,
whereas DSM-IV requires fear AND either
avoidance or endurance with extreme anxiety
• Same – specific phobia
• DSM IV – stresses on the dysfunction caused
by the phobia / present atleast 6 months if
age <18
 Generalized Anxiety Disorder
• DSM-IV requires that there be “excessive anxiety
and worry…more days than not” for at least 6
months and that the person “finds it difficult to
control the worry.”
• ICD-10- “a period of at least 6 months with
prominent tension, worry and feelings of
apprehension about everyday events and
problems” without requiring that the anxiety be
excessive and without specifying how often the
anxiety must occur during the 6 month period
 Obsessive Compulsive Disorder
• DSM-IV defines obsessions and compulsions differently
and distinguishes between obsessions and compulsions
based on whether the thought, idea, or image causes
anxiety or distress or prevents or reduces it
• ICD-10 differentiates between obsessions and
compulsions entirely based on whether they are
thoughts, ideas, images, impulses (obsessions) or acts
(compulsions)
• ICD-10 sets a minimum duration of at least 2 weeks
,whereas DSM-IV does not specify any minimum
duration
Thank you !!!!