Notes by Shweta Lal

PSYACOR 11T- Unit 1: Understanding Psychopathology

DSM V AND ICD 11

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) and ICD-11
(International Classification of Diseases, Eleventh Revision) are two widely recognized
classification systems used in the field of mental health and healthcare, respectively. Here is an
extensive definition of each:

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition):

The DSM-5 is a comprehensive and widely accepted classification system for mental health
disorders. It is published by the American Psychiatric Association (APA) and is primarily used by
mental health professionals in the United States. The DSM-5 provides a standardized
framework for diagnosing and classifying mental disorders based on clinical criteria. Key
features of the DSM-5 include:

1. Diagnostic Criteria: The manual outlines specific criteria for each mental disorder, including
symptoms, duration, and impairment criteria. This allows clinicians to make consistent and
reliable diagnoses.

2. Multiaxial System: In previous editions of the DSM, a multiaxial system was used to
consider various aspects of a person's mental health, such as clinical symptoms, psychosocial
stressors, and overall functioning. However, this system was removed in the DSM-5.

3. Categorical Approach: The DSM-5 primarily relies on a categorical approach, meaning that
it defines discrete mental disorders as separate entities. Each disorder is associated with a
specific set of symptoms and criteria.

4. Dimensional Assessment: In addition to categorical diagnoses, the DSM-5 also introduces

a dimensional approach, where clinicians can assess the severity of certain symptoms or
features on a continuum. This provides a more nuanced understanding of an individual's
condition.

5. Updates and Revisions: The DSM-5 represents the most recent update to the manual,
replacing the DSM-IV-TR (Fourth Edition, Text Revision). It reflects changes in the
understanding of mental disorders based on ongoing research and clinical expertise.

ICD-11 (International Classification of Diseases, Eleventh Revision):

The ICD-11 is a global standard for the classification of diseases and health conditions. It is
published by the World Health Organization (WHO) and is used by healthcare professionals and
organizations worldwide for various purposes, including billing, epidemiology, and healthcare
management. Key features of the ICD-11 include:

1. Comprehensive Scope: The ICD-11 covers a wide range of health conditions, not limited to
mental disorders. It includes diseases, injuries, infectious diseases, and other health-related
issues.

2. Global Applicability: Unlike the DSM-5, which is primarily used in the United States, the
ICD-11 is a globally recognized system. It is used by healthcare systems in many countries and
serves as the international standard for reporting health statistics.
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PSYACOR 11T- Unit 1: Understanding Psychopathology
3. Multiaxial System: The ICD-11 continues to use a multiaxial system, which allows for a more
comprehensive assessment of a person's health. It includes multiple axes for recording different
aspects of a patient's condition.

4. Coding System: The ICD-11 uses alphanumeric codes to classify diseases and health
conditions systematically. These codes are essential for billing, insurance claims, and statistical
analysis.

5. Regular Updates: The ICD is periodically updated to reflect advances in medical knowledge
and changes in the understanding of diseases. The ICD-11 is the latest revision as of my
knowledge cutoff date in September 2021.

Precisely, the DSM-5 is a specialized classification system for mental disorders, primarily used
in the United States, while the ICD-11 is a comprehensive global classification system for a wide
range of health conditions. Both play critical roles in the diagnosis, treatment, and management
of mental and physical health disorders, respectively.

Criteria and Classification of DSM V & ICD 11

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides
a comprehensive framework for identifying and categorizing various mental health conditions.
Let's delve into the criteria and classification system of the DSM-5 with examples:

1. Multiaxial Assessment:
- In earlier editions of the DSM, a multiaxial system was used to assess various aspects of an
individual's mental health. However, the DSM-5 has moved away from this system and instead
focuses on a single-axis diagnosis. This means that clinicians consider all relevant information
when making a diagnosis without separating it into distinct axes.

2. Diagnostic Criteria:
- Each mental health disorder in the DSM-5 is accompanied by a set of diagnostic criteria.
These criteria outline the specific symptoms and behaviors required for a diagnosis. For
example, let's take Major Depressive Disorder (MDD):
- Depressed mood most of the day, nearly every day.
- Diminished interest or pleasure in activities.
- Significant weight loss or gain.
- Insomnia or hypersomnia.
- Fatigue or loss of energy.
- Feelings of worthlessness or excessive guilt.
- Difficulty concentrating or making decisions.
- Recurrent thoughts of death or suicide.

3. Specifiers:
- Specifiers are additional descriptors that provide more detail about a specific diagnosis. For
MDD, specifiers might include "with melancholic features" or "with psychotic features,"
depending on the nature of the symptoms.
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PSYACOR 11T- Unit 1: Understanding Psychopathology
4. Differential Diagnosis:
- Clinicians must consider other conditions that may present with similar symptoms before
making a final diagnosis. For example, distinguishing between MDD and Bipolar Disorder
requires careful evaluation of the patient's mood patterns over time.

5. Dimensional Assessments:
- In addition to categorical diagnoses, the DSM-5 also introduces dimensional assessments.
These assess various factors, such as the severity of symptoms, to provide a more
comprehensive understanding of the individual's condition. For example, the level of severity in
Generalized Anxiety Disorder may range from mild to severe, depending on the impact of
symptoms on daily life.

6. Cultural Formulation:
- The DSM-5 emphasizes the importance of considering cultural factors in diagnosis. It
encourages clinicians to take into account an individual's cultural background, beliefs, and
practices when evaluating mental health conditions. For example, cultural factors may influence
the presentation of somatic symptoms in certain disorders.

7. Disorders Classified into Categories:

- The DSM-5 categorizes mental disorders into various groups, including mood disorders (e.g.,
depression and bipolar disorder), anxiety disorders (e.g., generalized anxiety disorder and panic
disorder), and psychotic disorders (e.g., schizophrenia).

Here's a summary of its classification:

1. Neurodevelopmental Disorders: These include disorders that typically manifest early in

development, such as autism spectrum disorder and attention-deficit/hyperactivity disorder
(ADHD).

2. Schizophrenia Spectrum and Other Psychotic Disorders: This category covers conditions like
schizophrenia, schizoaffective disorder, and delusional disorder.

3. Bipolar and Related Disorders: It includes bipolar I disorder, bipolar II disorder, and
cyclothymic disorder, characterized by mood swings.

4. Depressive Disorders: Major depressive disorder and persistent depressive disorder

(dysthymia) fall into this category.

5. Anxiety Disorders: This encompasses disorders like generalized anxiety disorder, panic
disorder, and social anxiety disorder.

6. Obsessive-Compulsive and Related Disorders: Conditions involving obsessions and

compulsions, such as obsessive-compulsive disorder (OCD) and body dysmorphic disorder.

7. Trauma- and Stressor-Related Disorders: Post-traumatic stress disorder (PTSD) and acute
stress disorder are examples of this group.

8. Dissociative Disorders: Conditions where there is a disruption in consciousness, identity, or

memory, including dissociative identity disorder.
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PSYACOR 11T- Unit 1: Understanding Psychopathology
9. Somatic Symptoms and Related Disorders: This includes somatic symptom disorder, illness
anxiety disorder, and conversion disorder.

10. Feeding and Eating Disorders: Anorexia nervosa, bulimia nervosa, and binge-eating
disorder are covered here.

11. Elimination Disorders: This category includes enuresis (bed-wetting) and encopresis
(involuntary bowel movements).

12. Sleep-Wake Disorders: Conditions like insomnia, sleep apnea, and narcolepsy are classified
here.

13. Sexual Dysfunctions: Disorders related to sexual function, including erectile disorder and
female orgasmic disorder.

14. Gender Dysphoria: This involves distress associated with incongruence between one's
experienced and assigned gender.

15. Disruptive, Impulse-Control, and Conduct Disorders: Oppositional defiant disorder, conduct
disorder, and intermittent explosive disorder fall under this category.

16. Substance-Related and Addictive Disorders: Substance use disorders, such as alcohol use
disorder and opioid use disorder, are included.

17. Neurocognitive Disorders: Alzheimer's disease, mild cognitive impairment, and other
conditions affecting cognitive function are in this group.

18. Personality Disorders: These include borderline, antisocial, and narcissistic personality
disorders.

19. Paraphilic Disorders: Conditions related to unusual sexual interests or behaviors are
categorized here.

20. Other Mental Disorders: Conditions not covered in the previous categories are placed in this
category, such as disruptive mood dysregulation disorder.

21. Medication-Induced Movement Disorders and Other Adverse Effects of Medication: This
covers movement disorders and side effects related to medication use.

22. Other Conditions That May Be a Focus of Clinical Attention: Various conditions that may not
fit into the above categories, like relational problems or phase of life issues.

**Please note that this is a simplified summary of the DSM-5 classification, and the manual
provides detailed criteria and descriptions for each disorder. It's essential to consult a qualified
mental health professional for accurate diagnosis and treatment.
Notes by Shweta Lal
PSYACOR 11T- Unit 1: Understanding Psychopathology

ICD-11, which stands for the International Classification of Diseases, 11th Revision, is a
comprehensive system developed by the World Health Organization (WHO) for classifying
diseases, conditions, and various health-related issues. It serves as a global standard for health
statistics, medical billing, and clinical documentation. ICD-11 is a vast and complex classification
system, so I'll provide an overview of its criteria and classification, along with some examples:

Criteria for ICD-11 Classification:

1. **Clinical Description:** ICD-11 includes detailed clinical descriptions of diseases and health
conditions. These descriptions are essential for accurate diagnosis and treatment. For example,
the clinical description of "Type 2 Diabetes Mellitus" includes information about symptoms, risk
factors, and diagnostic criteria.

2. **Etiology:** ICD-11 considers the cause or etiology of diseases when classifying them. For
instance, "Lung Cancer" is classified under ICD-11 with codes for different types of lung cancer,
such as adenocarcinoma or squamous cell carcinoma.

3. **Anatomy and Site:** The anatomical location or site of the condition is crucial for
classification. For example, "Fracture of the Femur" is classified based on the specific part of the
femur bone affected, such as the neck or shaft.

4. **Severity and Complications:** ICD-11 allows for the classification of conditions based on
their severity and any associated complications. For instance, "Myocardial Infarction" (heart
attack) can be classified with codes indicating the extent of damage and the presence of
complications like arrhythmias.

5. **Function and Disability:** Conditions that affect a person's functional abilities and disabilities
are also considered. "Stroke" can be classified in terms of its impact on motor function, speech,
or cognitive abilities.

**Classification in ICD-11:**

ICD-11 uses alphanumeric codes to classify diseases and conditions. It is organized into
chapters, with each chapter representing a broad category of health issues. Here are some
examples of classifications in ICD-11:

1. **Chapter 2: Neoplasms (C00-D48):** This chapter covers various types of cancers. For
example, "Breast Carcinoma" is classified as C50.

2. **Chapter 6: Diseases of the Nervous System (G00-G99):** Conditions like "Alzheimer's

Disease" are classified under this chapter, with "Alzheimer's Disease" being assigned the code
G30.

3. **Chapter 11: Diseases of the Digestive System (K00-K95):** "Gastric Ulcer" falls under this
chapter and is assigned the code K25.

4. **Chapter 20: External Causes of Morbidity (V01-Y98):** This chapter includes classifications
for various external factors, such as "Motorcycle Accident" under the code V20.
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PSYACOR 11T- Unit 1: Understanding Psychopathology
5. **Chapter 21: Factors Influencing Health Status and Contact with Health Services
(Z00-Z99):** This chapter encompasses factors like "Smoking" under code Z72, indicating its
influence on health status.

ICD-11 is continuously updated and refined to reflect advances in medical knowledge and
changes in the understanding of diseases. It plays a vital role in healthcare worldwide,
facilitating accurate diagnosis, treatment, and health data collection for epidemiological studies
and healthcare management.