Psychiatric classification: DSM-5-TR and ICD-11

Meet the exam question

The viva opens cold: "Is psychiatric diagnosis valid?" Half the candidates freeze; the other half lecture about biomarkers. Neither scores.^[2]

The mark-winning first sentence is a single split: "Validity and utility are different properties, sir." Kendell and Jablensky said it plainly in 2003 — a diagnosis can be useful for choosing an antidepressant without being a validated natural disease entity. Say that line, and the examiner stops probing and starts listening.^[2]

This topic is the nosology that sits behind every syndrome page in psychiatry. There is no patient in front of you on a ward round — there is an examiner asking whether you can wield a label without worshipping it.^[2][20]

References20ShowHide

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2. [2]Kendell R, Jablensky A Distinguishing between the validity and utility of psychiatric diagnoses Am J Psychiatry, 2003.PMID 12505793
3. [3]Clarke DE, Narrow WE, Regier DA, et al. DSM-5 field trials in the United States and Canada, Part I: study design, sampling strategy, implementation, and analytic approaches Am J Psychiatry, 2013.PMID 23111546
4. [4]Regier DA, Narrow WE, Clarke DE, et al. DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses Am J Psychiatry, 2013.PMID 23111466
5. [5]Narrow WE, Clarke DE, Kuramoto SJ, et al. DSM-5 field trials in the United States and Canada, Part III: development and reliability testing of a cross-cutting symptom assessment for DSM-5 Am J Psychiatry, 2013.PMID 23111499
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9. [9]Clark LA, Cuthbert B, Lewis-Fernández R, et al. Three Approaches to Understanding and Classifying Mental Disorder: ICD-11, DSM-5, and the National Institute of Mental Health's Research Domain Criteria (RDoC) Psychol Sci Public Interest, 2017.PMID 29211974
10. [10]Kotov R, Krueger RF, Watson D, et al. The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies J Abnorm Psychol, 2017.PMID 28333488
11. [11]Kotov R, Krueger RF, Watson D A paradigm shift in psychiatric classification: the Hierarchical Taxonomy Of Psychopathology (HiTOP) World Psychiatry, 2018.PMID 29352543
12. [12]Kotov R, Cicero DC, Conway CC, et al. The Hierarchical Taxonomy of Psychopathology (HiTOP) in psychiatric practice and research Psychol Med, 2022.PMID 35650658
13. [13]Insel TR The NIMH Research Domain Criteria (RDoC) Project: precision medicine for psychiatry Am J Psychiatry, 2014.PMID 24687194
14. [14]Cuthbert BN, Insel TR Toward the future of psychiatric diagnosis: the seven pillars of RDoC BMC Med, 2013.PMID 23672542
15. [15]Tyrer P, Mulder R, Kim YR, et al. The Development of the ICD-11 Classification of Personality Disorders: An Amalgam of Science, Pragmatism, and Politics Annu Rev Clin Psychol, 2019.PMID 30601688
16. [16]Bach B, First MB Application of the ICD-11 classification of personality disorders BMC Psychiatry, 2018.PMID 30373564
17. [17]Gaebel W, Kerst A, Stricker J Classification and Diagnosis of Schizophrenia or Other Primary Psychotic Disorders: Changes from ICD-10 to ICD-11 and Implementation in Clinical Practice Psychiatr Danub, 2020.PMID 33370728
18. [18]Gaebel W, Stricker J, Riesbeck M, et al. Accuracy of diagnostic classification and clinical utility assessment of ICD-11 compared to ICD-10 in 10 mental disorders: findings from a web-based field study Eur Arch Psychiatry Clin Neurosci, 2020.PMID 31654119
19. [19]Stein DJ, Palk AC, Kendler KS What is a mental disorder? An exemplar-focused approach Psychol Med, 2021.PMID 33843505
20. [20]Macneil CA, Hasty MK, Conus P, et al. Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice BMC Med, 2012.PMID 23016556