ICD and DSM: neuroplasticity and staging are still missing

Area of Science:

• Psychiatry
• Medical Diagnostics
• Mental Health Classification Systems

Background:

• The International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM) are primary diagnostic systems.
• Both systems have undergone multiple revisions, with DSM-5 published in 2013 and ICD-11 anticipated by 2018.

Purpose of the Study:

• To analyze the convergence and divergence between the ICD and DSM diagnostic systems.
• To evaluate the incorporation of emerging scientific findings into these classification systems.

Main Methods:

• Comparative analysis of the diagnostic criteria and classification approaches of ICD and DSM.
• Review of the revision processes and stated aims of both systems.

Main Results:

• The forthcoming ICD revision shows a trend toward harmonization with the DSM, particularly in disorder reclassification.
• Significant differences persist between ICD and DSM due to distinct purposes, development, and target audiences.
• Neither system adequately incorporates novel concepts like clinical staging, neuroprogression, or endophenotypes.

Conclusions:

• Despite efforts toward harmonization, substantial disparities remain between ICD and DSM.
• Current diagnostic systems are slow to integrate advancements from neuroscience and genomics.
• Future psychiatric classification requires incorporating concepts like neuroprogression and endophenotypes for a more comprehensive approach.