Academic journal article International Journal of Clinical and Health Psychology

Problematic, Absent and Stigmatizing Diagnoses in Current Mental Disorders Classifications: Results from the WHO-WPA and WHO-IUPsyS Global Surveys*

Academic journal article International Journal of Clinical and Health Psychology

Problematic, Absent and Stigmatizing Diagnoses in Current Mental Disorders Classifications: Results from the WHO-WPA and WHO-IUPsyS Global Surveys*

Article excerpt

In the ongoing development of the 11th Revision of the International Classification of Diseases and Related Health Problems (ICD-11) by the World Heath Organization (WHO), a major focus is to improve the clinical utility and cross- cultural applicability of mental and behavioural disorder diagnostic categories. General descriptions of the develop- ment of the ICD-11 classification of mental and behavioural disorders, the importance of clinical utility as a part of this effort, and the specific relevance of the ICD-11 to psycholo- gists have previously been published (International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders, 2011; Reed, 2010). As described in these reports, psychologists and psychiatrists are key professional con- stituencies in WHO's development of the ICD-11, as they come into contact with persons in need of mental health services on a daily basis, and represent particularly critical groups in the diagnosis and management of mental disor- ders. In order to improve the clinical utility of the ICD, it is essential to assess these professionals' attitudes and opin- ions regarding diagnostic classification systems (Evans et al., 2013; Reed, Correia, Esparza, Saxena, & Maj, 2011).

Surveys of clinicians are among the most feasible and direct methods of obtaining relevant information from health professionals around the world. Several studies have used surveys to assess the attitudes and views of mental health professionals regarding diagnostic classification sys- tems for mental disorders, mainly among psychiatrists (Bell, Sowers, & Thompson, 2008; Mellsop, Banzato, & Shinfuku, 2008; Mellsop, Dutu, & Robinson, 2007; Suzuki et al., 2010; Zielasek et al., 2010). However, the findings of these stud- ies typically have limited generalizability due to limitations in sample size, methodology, and/or specificity of the geo- graphical regions assessed.

To overcome these limitations, WHO developed two global surveys in the context of the development of the ICD-11 classification of mental and behavioural disorders, the first designed for psychiatrists and conducted in collab- oration with the World Psychiatric Association (WPA) (Reed et al., 2011), and the second designed for psychologists and conducted in collaboration with the International Union of Psychological Science (Evans et al., 2013). These surveys examined psychiatrists' and psychologists' attitudes and experiences with diagnostic classification systems, focus- ing on conceptual and practical issues in mental disorder classification systems as encountered in psychiatrists' and psychologists' daily clinical practice.

A total of 4887 psychiatrists from 44 countries and 2155 psychologists from 23 countries participated. Reed and col- leagues (2011) found that psychiatrists indicated that the most important purposes of a classification are to facilitate communication among clinicians and to inform treatment and management. Psychiatrists preferred a simpler system with 100 or fewer categories, as well as flexible guidance on diagnostic definitions compared to a strict criteria-based approach. They expressed some problems with the cross- cultural applicability of existing classifications (especially psychiatrists from Latin American and Asian countries) and reported several categories with poor utility in clinical practice (such as vascular dementia, schizotypal disor- der, schizoaffective disorder, mixed anxiety and depressive disorder, adjustment disorder, dissociative disorders and somatoform disorders).

Evans and colleagues (2013) found that sixty percent of global psychologists routinely used a formal classification system (ICD-10 by 51% and DSM-IV by 44%). Psycholo- gists viewed informing treatment decisions and facilitating communication as the most important purposes of classi- fication; preferred flexible diagnostic guidelines to strict criteria; identified a number of problematic diagnoses (such as Asperger's syndrome, borderline personality disorder, dissociative disorders, somatoform disorders, and schizoaf- fective disorder); and reported problems with cross-cultural applicability and cultural bias (especially those from outside the USA and Europe). …

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