DSM and references to ICD

Question

I am still studying and where I extensively use the DSM whilst writing essays etc. for my coursework, a question has arisen with regard to referencing the International Statistical Classification of Diseases and Related Health Problems (ICD) whilst researching, and whilst answering a question within Cognitive Sciences. Providing the answer raised this question when referencing the ICD codes used in the DSM.

Those familiar with 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will know that with information on each mental health disgnostic criteria, there are ICD codes at the top, which are ICD-9 codes followed by the now compulsory ICD-10 codes in brackets. Whilst in my essays etc., just like in the DSM-5, I reference both ICD-9 and ICD-10 codes, however all HIPAA-covered entities had to transition from using ICD-9 codes to using ICD-10 codes back in late 2015.

The problem arises for me when looking in the ICD for the codes referenced in the DSM. I'll give some examples here.

In order for me to answer the question, I referenced DSM diagnostic criteria for Somatic Symptom Disorder, Illness Anxiety Disorder and Body Dysmorphic Disorder (BDD).

• For Somatic Symptom Disorder, in the DSM it references ICD-10 code F45.1 which in the ICD, that code is for Undifferentiated Somatoform Disorder, however as I highlighted in my answer, F45 which is the header of that section of codes refers to Somatoform Disorders.
• When looking at Illness Anxiety Disorder, the DSM references ICD-10 code F45.21 which doesn't exist.
• When looking at BDD, the DSM references ICD-10 code F45.22 and when you look in the ICD, again there is no such code, however there is F45.2 which refers to Hypochondriacal Disorder which in turn references BDD as a Hypochondriacal Disorder.

On page 23 of DSM-5 - under Coding and Reporting Procedures, which is within the Use of the Manual section - it indicates that the ICD codes are typically used by institutions and agencies for data collection and billing purposes and they were established by WHO, the U.S. Centers for Medicare and Medicaid Services (CMS), and the Centers for Disease Control and Prevention's National Center for Health Statistics to ensure consistent international recording of prevalence and mortality rates for identified health conditions.

Am I missing something when looking at the ICD publication to look the diagnoses up under the ICD-10 codes or am I looking at things in the wrong way?

Answer 1

There is this 2009 article on the APA website (The APA are the writers of the DSM)

It states that

There is widespread sentiment that it is not helpful to the field to have two separate classification systems for mental disorders. [However], Many important distinctions between the two systems remain.

The article also mentioned that Geoffrey Reed (WHO psychologist) said:

The American Psychiatric Association can really be credited with a revolution in psychiatric nosology with the publication of DSM-III by introducing a descriptive nosological system based on co-occurring clusters of symptoms,
...

The ICD is produced by a global health agency with a constitutional public health mission, while the DSM is produced by a single national professional association.

WHO's primary focus for the mental and behavioral disorders classification is to help countries to reduce the disease burden of mental disorders. ICD's development is global, multidisciplinary and multilingual; the primary constituency of the DSM is U.S. psychiatrists.

The ICD is approved by the World Health Assembly, composed of the health ministers of all 193 WHO member countries; the DSM is approved by the assembly of the American Psychiatric Association, a group much like APA's Council of Representatives.

The ICD is distributed as broadly as possible at a very low cost, with substantial discounts to low-income countries, and available free on the Internet; the DSM generates a very substantial portion of the American Psychiatric Association's revenue, not only from sales of the book itself, but also from related products and copyright permissions for books and scientific articles.

The article also says

There was very little international participation in the DSM-III, but at the time it may have been impossible to make such a big shift at the international level, he explained. As a result, DSM-III and ICD-8 (the version in effect at the time) were quite different from one another but as the descriptive phenomenological approach to diagnose mental disorders became dominant, the DSM and ICD have become very similar, partly because of collaborative agreements between the two organizations.

The article asked if the DSM will be superseded by the ICD?

It said

There is little justification for maintaining the DSM as a separate diagnostic system from the ICD in the long run, particularly given the U.S. government's substantial engagement with WHO in the area of classification systems. But, said Reed, "there would still be a role for the DSM, because it contains a lot of additional information that will never be part of the ICD. In the future, it may be viewed as an important textbook of psychiatric diagnosis rather than as the diagnostic 'Bible.'"

As there is more information in the DSM that will never be part of the ICD, plus, due to the fact that the DSM is the goto book for psychiatry, it is the DSM's criteria which needs to be followed when making psychiatric diagnoses. The ICD codes in the DSM should just be used for the purposes they have been designed for, which as mentioned in the DSM on page 23, they are for data collection and billing purposes and for health statistics to ensure consistent international recording of prevalence and mortality rates for identified health conditions.