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DSM5 explained.

March 26, 2012

Brilliant! Well done!

From the psychiatric times…

Just to give you the flavour of the article………….

DSM-5 In the Homestretch—1. Integrating the Coding Systems

By James Phillips, MD | 07 March 2012

With DSM-5 scheduled for publication a little more than a year from now, we may safely assume that, barring unannounced surprises from, say, the APA Scientific Review Committee, what we will see on the DSM-5 Web site is what we will get. With that in mind it’s time to review what we will indeed get. But before moving to significant changes in the major disorder categories, we should remind ourselves where DSM-5 fits into the larger picture of coding mental illnesses.

There are, in case you have forgotten, two classificatory systems of mental disorders—the International Classification of Diseases (ICD), produced by the World Health Organization (WHO), and the Diagnostic and Statistical Manual (DSM), produced by the American Psychiatric Association. How are they related? It is a question that has confused me, and I assume, some of my psychiatric colleagues as well as others—other mental health professionals, and still others. For an answer to this question I asked Michael First, MD, Editor of DSM-IV-TR, Consultant on the WHO ICD-11 revision, and someone who knows much more about these matters than most of us. Here is his response to what I put as a question that could lend itself to a quick answer.

Dr First: I wish I could give you a quick answer, but as with any question about the coding, I need to give the background first.

This is how it works. The only official coding system in the United States is the ICD, produced by the WHO. The US has a treaty obligation to report health statistics using the ICD system. The US is still using a “clinical modification” of the WHO’s ICD-9 system (released in 1978) called ICD-9-CM. The diagnostic codes that appear in the DSM-IV are all legal ICD-9-CM codes. Clinicians fulfill their obligations to use the ICD-9-CM coding system by using the DSM-IV. When DSM-IV created its few new disorders, which were obviously not in the ICD-9-CM, the APA could either assign an existing ICD-9-CM code (which might be already used for another DSM-IV disorder, in which case multiple disorders would share the same code), or else request that the US Government to add a new code to the ICD-9-CM system (such a provision exists in the ICD-9-CM system to accommodate newly discovered or new subtypes of diseases), which is a year-long process.

When assigning an existing code, we would pick the code that was closest to the phenomenology of the new disorder. For example, ICD-9-CM had a code for “depressive neurosis,” which was then assigned to the DSM-III disorder “dysthymia,” because that ICD-9-CM concept came closest to the DSM-III concept. More often, for a category that was not really reflected in the ICD-9-CM at all, we would assign an “other” code, which are available throughout the ICD-9-CM precisely to accommodate the addition of new disorders. So for Bipolar II Disorder, which we added to DSM-IV, we picked the code 296.89, which corresponded to “Other Bipolar Disorder” in ICD-9-CM.

To be continued…..

Clear as mud then?


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