Evaluation: DSM and ICD and Diagnosis

DSM-IV/DSM-IV-TR
1. The DSM stands for the Diagnostic and Statistical Manual of mental disorders and only focuses on diagnosis of mental health disorders.
2. The DSM is only in English and is limited to certain countries - inaccessible to the whole world.
3. Its diagnoses are based one symptoms as well as existing medical issues and environmental stressors.
4. The DSM is revised regularly and is currently on its fifth edition.
5. The mental health disorders are put on 5 axes, which include psychiatric diagnoses, personality problems, general medical conditions, environmental stress and 'global functioning'.
ICD-10
1. The ICD stands for the International Classification of Disorders. It focuses on all health conditions, including mental health.
2. The ICD is multi-lingual and aims to improve healthcare and diagnosis all over the world.
3. The ICD is in its 10 edition and is reviewed regularly.
4. Its diagnoses are based on symptoms only.
5. Section F of the ICD is specific for mental health disorders and within this section, each disorder is grouped in a family. For example, depression is part of the the mood disorders (represented by the family digit 3). More digits can be added to this to represent the specific disorder, the sub-type of the disorder, and very specific categorisations.
Reliability
1. Reliability refers to whether diagnosis is consistent regardless of clinician.
  1. One issue with reliability of diagnosis is the subjectivity of criteria. This is because one clinician may believe a behaviour meets a certain criteria whereas another may not.
2. Inter-rater reliability is when two or more clinicians use the same diagnostic tool and come to the same diagnosis for the same individual.
  1. Rosenhan found that the DSM-II had high inter-rater reliability as 7/8 pseudo patients in the study (with the same symptoms) were all diagnosed with schizophrenia by different clinicians using the DSM-II.
    1. Goldstein found that the DSM-III also had high inter-rater reliability, and Brown found the DSM-IV had high inter-rater reliability.
3. Test-retest reliability is when the same diagnosis is reached with the same diagnostic tool but after a period of time to see if the diagnosis is consistent.
  1. Pontinovsky found the ICD had good test re-test reliability.
    1. Sanchez-Villegas found the DSM-IV-TR also has high test re-test reliability.
Validity
1. Validity refers to if the diagnosis is correct, reflects the actual disorder and can lead to a suitable treatment that works.
2. Validity can be affected by many factors, such as comorbidity (when symptoms overlap and can be applied to multiple disorders) which leads to a higher chance of misdiagnosis, implicit bias of the clinician (when a clinician's prejudices against people may influence their diagnosis), patient factors like accent which could lead to a misinterpretation of information, and revisions of systems which can improve the validity of diagnostic systems.
3. Construct validity refers to how far the constructs that are being measured represents that disorder.
  1. Brown et al found that the DSM-IV had low construct validity.
    1. However, Stinchfield found that the DSM-IV had high construct validity.
4. Concurrent validity is when two tests done at the same time come up with the same diagnosis, which would suggest the tests measure what they seem to measure.
  1. Hoffman and Lee found that DSM criteria had high concurrent validity with other diagnostic tools such as interviews and questionnaires.

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Evaluation: DSM and ICD and Diagnosis

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