Mental and behavioral disorders are one of the major public mental health problems (Gutiérrez et al., n. d.). They are common in different societies and cultures; they cause high levels of disability and suffering to those who suffer from them, and considerable distress at the level of friends and family. While, according to Gutiérrez et al. (n.d.), most societies show compassion and a certain level of support for people with physical disabilities, attitudes towards people with mental illnesses too often involve stigma and rejection.
Discretion in relation to mental and behavioral disorders defines the size of the problem (Gutierrez et al., n. d.). In correspondence with Gutiérrez et al. (n.d.), one must be honest enough to be able to deal with mental illness, have the necessary information to recognize it and the openness to involve family members and the community in treatments.
The concern of the WHO and psychiatric societies in terms of improving the diagnosis and classification of mental disorders has led to the conceptual basis of current classifications to evolve considerably compared to previous ones (Gutiérrez et al., n. d.). When the first classifications of mental illnesses were developed, they were only used to manage and obtain data for statistical purposes. However, according to Gutierrez at al. (n.d.), the current classifications are intended to contribute to clinical, epidemiological and service utilization research according to uniform criteria, as well as to provide recommendations in clinical practice regarding the semiological elements to be taken into account in the diagnosis.
Benefits
One of the arguments why it is essential to classify mental disorders is that most sciences require a classification, for example, the periodic table of chemical elements, or the classification made by biology that divides living beings into kingdoms, phylums, classes, among others (Butcher, Mineka & Hooley, 2007). But perhaps the most important reason, according to Butcher, Mineka & Hooley (2007), is that the classification system enables people to use a nomenclature or naming system to promote the structure of the information so that it can be used correctly.
In the specific case of psychology, the classification of mental disorders can be used in an integrated way to compare health information internationally and nationally, which helps to develop various reliable statistical systems for people locally, nationally and internationally (Gomez, 2015). In other words, according to Reed, Anaya & Evans (2012), the classification of mental disorders serves as a health information tool to be able to assess and monitor mortality, morbidity, global burden of disease and other important health-related parameters.
In the same vein, the organization of information in a classification system contributes to its research (Butcher, Mineka & Hooley, 2007). In other words, research can only progress when you know what to learn. In correspondence with Butcher, Mineka & Hooley (2007), it should not be forgotten that the classification system, in addition, provides relevant information about the treatment.
Another consequence of having a classification system, although somewhat trivial, can be mentioned (Butcher, Mineka & Hooley, 2007). As some authors have pointed out, the classification of mental disorders also has a social and political significance. Indeed, it identifies a number of issues that mental health professionals must confront. According to Butcher, Mineka & Hooley (2007), from a purely pragmatic perspective, the classification of mental disorders defines the types of illnesses to be covered by social security.
Disadvantages
Of course, the classification system has some disadvantages (Butcher, Mineka & Hooley, 2007). In essence, classification means a loss of information. For example, if a person says the neighbor's pet is a mammal, then they are sending some information, however, if they say the neighbor has a huge white Persian cat named Fluffy, more information is obtained. Similarly, reading the patient's medical history may yield more information than simply "schizophrenia." Therefore, in correspondence with Butcher, Mineka & Hooley (2007), classification allows information to be simplified and organized, but, inevitably causes many details to be lost.
Although the situation is changing, some stigmas related to psychiatric diagnosis may also be discovered (Butcher, Mineka & Hooley, 2007). There is no doubt that people who say they have diabetes and other illnesses may be even more reluctant to admit that they have a mental illness. To some extent, according to Butcher, Mineka & Hooley (2007), this is due to concerns that psychological problems will lead people to bad social or professional consequences.
Another disadvantage is stereotyping (Butcher, Mineka & Hooley, 2007). According to Butcher, Mineka & Hooley (2007), considering that almost everyone has heard that some behaviors are related to certain mental illnesses, it is automatically and erroneously concluded that this behavior is characteristic of anyone with a diagnosis of mental illness.
Finally, there is a problem with labels (Butcher, Mineka & Hooley, 2007). Once a set of symptoms is named and identified in the diagnosis, it is difficult to remove the "diagnostic label," even if the person has fully recovered (Butcher, Mineka & Hooley, 2007). In short, the detrimental effects of labeling generates expectations about a person's behavior that can be self-confirming (Alvarez, 2007). Therefore, in correspondence with Butcher, Mineka & Hooley (2007), it is very important to remember that the diagnostic classification system is not about classifying people, but about classifying the diseases that one suffers from.
In other words, it is essential not to ignore the fact that there will always be people behind an illness (Butcher, Mineka & Hooley, 2007). Therefore, the role of language is very important. In the past, mental health experts often described their patients as "schizophrenia" or "manic depression". Today, in correspondence with Butcher, Mineka & Hooley (2007), it is clearly recognized that the use of expressions such as "a person with schizophrenia" or "a person suffering from depression" is more accurate and more respected.
Relationship Between the ICD and the DSM
According to Gutiérrez et al. (n. d.), the Diagnostic and Statistical Manual of Mental Disorders (DSM) in its first version, as well as the International Classification of Diseases (ICD), arose from the need to establish a consensus classification of mental disorders due to the lack of consistency both in the content to be covered and in the method of conformation by psychiatrists and psychologists.
Some of the causes that influenced the establishment of the DSM include the need to collect statistical data on mental disorders and the need for an acceptable nomenclature for patients with severe psychiatric and neurological conditions (Gutierrez et al., n.d.). In its sixth edition, the ICD contains for the first time a section on mental disorders (Gutierrez et al., n.d.). According to Reed, Anaya & Evans (2012), this was how the first edition of the DSM (American Psychiatric Association, 1952) was created, as an adapted version of the ICD - 6 (World Health Organization, 1949) for use by American psychiatrists.
Similarly, the DSM - II (American Psychiatric Association, 1968) was published as an adaptation of ICD - 8 (World Health Organization, 1967). In fact, the American Psychiatric Association was heavily involved in the development of ICD - 8, but the other guidelines included in the DSM - II are specifically designed to be more useful in the application of psychiatry in the United States. At that time, according to Reed, Anaya & Evans (2012), the classification was a background professional support rather than a defining element of psychiatric identity.
This may be too big a conceptual shift to undertake on an international scale, mainly because the psychoanalytic model was still dominant in Europe, and the model that participated in the development of the DSM - III has gone through a very controversial process (Reed, Anaya & Evans, 2012). The DSM - III has little or no international involvement and no direct involvement of the WHO. According to Reed, Anaya & Evans (2012), the DSM - III has had great professional influence and achieved commercial success, so the DSM - III and its subsequent products have gained enormous international influence.
Since then, the developers involved in DSM - IV and ICD - 10 have maintained intense cooperation, which has led to an increase in the dominance of the psychopathological classification model established by DSM - III (Reed, Anaya & Evans, 2012). Therefore, DSM - IV and ICD - 10 are quite similar. However, according to Reed, Anaya & Evans (2012), the similarity between the two categories was never intended, since, they have different objectives and were developed in completely different organizational settings.
The ICD is a classification developed by the United Nations International Agency, which is a free public resource that can be used as a public health tool (Reed, Anaya & Evans, 2012). However, the DSM is a system produced by a single-discipline professional association from a single country in which the association has strong commercial interests. On the other hand, according to Reed, Anaya & Evans (2012), the development of ICD is done in a global and interdisciplinary process, and is done in different languages and taking into account global multiculturalism, while DSM is produced from the perspective of the United States and English as a representative.
In the same vein, ICD is designed to be used by WHO member states and frontline medical services, while DSM is primarily aimed at the field of psychiatry (Reed, Anaya & Evans, 2012). According to Reed, Anaya & Evans (2012), in the debate on the coexistence of these two classifications of mental disorders, the World Health Organization believes that it is necessary to make substantial changes in the categories of mental disorders and their definitions through a transparent, international, multidisciplinary and multilingual process, including the direct participation of all relevant parties, and to try to avoid conflicts of interest.
References
Álvarez, A. (2007). Valoración crítica de las actuales clasificaciones de los trastornos mentales.. Psiquiatria.com. Recuperado 8 September 2021, a partir de https://psiquiatria.com/article.php?ar=todas&wurl=valoracion-critica-de-las-actuales-clasificaciones-de-los-trastornos-mentales
Butcher, J., Mineka, S., & Hooley, J. (2007). Psicología clínica (12a. ed.). Distrito Federal: Pearson Educación.
Gómez, A. (2015). Minsalud.gov.co. Recuperado 13 December 2020, a partir de https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/IA/SSA/cie10-cie11.pdf
Gutiérrez, M., Peña, L., Santiuste, M., García, D., Ochotorena, M., San Eustaquio, F., & Cánovas, M. Comparación de los sistemas de clasificación de los trastornos mentales: CIE-10 y DSM-IV. Atlasvpm.org. Recuperado 8 September 2021, a partir de https://www.atlasvpm.org/wp-content/uploads/2019/06/Comparación-de-los-sistemas-de-clasificación-de-los-trastornos-mentales-CIE-10-y-DSM-IV.pdf
Reed, G., Anaya, C., & Evans, S. (2012). ¿Qué es la CIE y por qué es importante en la psicología?. Dialnet. Recuperado 9 December 2020, a partir de https://dialnet.unirioja.es/servlet/articulo?codigo=4009821
Comments