Academic journal article International Journal of Psychology Research

Implications for Patients regarding Ptsd Diagnostic Criteria Differences When Using the Dsm and Icd Classification Systems

Academic journal article International Journal of Psychology Research

Implications for Patients regarding Ptsd Diagnostic Criteria Differences When Using the Dsm and Icd Classification Systems

Article excerpt


Beginning October 15, 2015 mental health providers who bill for Medicare, Medicaid and many other health insurance providers moved to a new era regarding the DSM-5 and the ICD-10. In the past, the codes in the ICD-9 and the DSM-IV-TR were generally congruent, with minimal discrepancies existing between the two (Lilienfeld & Treadway, 2016). However, with the introduction of the DSM-5 and the ICD-10, more inconsistencies between diagnostic criteria exist and have become more prominent (Keely, et al., 2016). The diagnostic criteria for Posttraumatic Stress Disorder (PTSD), in particular, possess some incongruities that in the present article we argue are particularly noteworthy. The differences are more than academic; they impact both practitioners and patients. Practitioners will sometimes be faced with the dilemma of choosing which system to use when diagnosing PTSD, especially in cases where one system would yield a potential diagnosis and another system would not. Arguably, of even greater concern, is the patient. The discrepancies in these two systems could cause significant confusion for a client who desires to know and understand his/her disorder and what the best course of treatment is. In the present article, we examine the history of the two classification systems, as well as how each system outlines the diagnostic criteria for PTSD. We subsequently note potential implications of such differences and, in behalf of patients, advocate for needed for resolution in criteria distinctions.

An Overview Regarding Psychiatric Disorder Classification Systems

Modern disease classification was formalized in the mid-1800s with the first proposals for systematically classifying diseases, or causes of death (First, Reed, Hyman, & Saxena, 2015). Near the turn of the 20th century, Jacques Bertillon of France introduced his Bertillon Classification of Causes of Death, essentially launching a new movement across several countries regarding nosology. In 1898, the American Public Health Association recommended that the United States adopt this system as well (Leclair, Leclair, & Brigham, 2009). Every decade, the system was reviewed, but it was not significantly modified until 1948 (World Health Organization, 2015). That year, what we now know as the World Health Organization was tasked with revising the system and, from their conference, the 6th edition of the International Causes of Death was expanded into two volumes. In addition, the work included new domains and was given a new name: The International Statistical Classification of Diseases, Injuries, and Causes of Death. This was the birth of what we now know as the modern International Classification of Diseases (ICD). It was published in 1949 and the volumes, for the first time, included a section pertaining to mental disorders (Topaz, Shafran-Topaz, & Bowles, 2013).

The ICD has since undergone 10 revisions and currently is referred to as the ICD-10. It is still published by the World Health Organization and the work is the most widely used system for diagnosing disease, although its use in the United States is not as prominent as it is in other countries ("International Classification of Diseases," 2016). The most recent revision was published in 2015, and its next scheduled revision is set for 2017. The ICD-10 includes a section on behavioral and mental disorders, which is where the criteria for PTSD is located. In the United States, the version of the ICD used is the ICD-10-CM, which is a "clinical modification" of the standard ICD text. WHO authorizes various countries to adapt the ICD to their specific region and idiographic health needs (Tandon & Dawn-Christi, 2016).

The history of the Diagnostic Statistical Manual for Mental Disorders (DSM) is similar to the ICD's, in that a need existed in order to collect statistical information regarding mental health (Kendler, 2013). In 1921, when the American Medico-Psychological Association became the American Psychiatric Association (APA), the organization also developed a system of psychiatric classification. …

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