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dx revision watch  monitoring the development of DSM-5, ICD-11, ICD-10-CM

Site domain and name change

This site originally operated at the sub domain dsm5watch.wordpress.com under the site name DSM-5 and ICD-11 Watch. On December 22, 2011, I was served two cease and desist letters on behalf of American Psychiatric Publishing, A Division of American Psychiatric Association threatening potential legal action under US Trademark Law. This site now operates under the site name Dx Revision Watch at the domain dxrevisionwatch.com.

This site is owned and maintained by UK advocate, Suzy Chapman.   Contact Suzy Chapman

Follow on Twitter at @dxrevisionwatch

Why another site?

The concept for this site developed out of research and awareness raising undertaken throughout 2009 on a sister site around the forthcoming revisions of two important international disease classification systems:

Diagnostic and Statistical Manual of Mental Disorders (DSM)  American Psychiatric Association

International Statistical Classification of Diseases and Related Health Problems (ICD)  World Health Organization

The American Psychiatric Association, frequently abbreviated to “APA”, should not be confused with the American Psychological Association – both professional organizations use the acronym “APA”. Unless otherwise specified, “APA” on this site refers to the American Psychiatric Association.

How does this site work?

This site has been monitoring the revision processes towards DSM-5 and ICD-11, generally, since the beginning of 2010 and endeavours to provide timely updates and content of interest to consumer groups and professionals who are stakeholders in these classification systems.

Key information and resources on Tab pages and Tab child pages. Updates, reports, documents, commentaries, media coverage and other material is posted on the Main page, which displays the 6 most recent postings. Earlier posts can be pulled up from the “Older posts” button (at the foot of the Home page), via the monthly archives widget, via “Categories” or from the Post index tab.

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Two new international classification systems by 2015 

Update: In January 2014, WHO/ICD-11 Revision Steering Group revised the ICD-11 schedule, shifting the date by which ICD-11 is planned to be presented for World Health Assembly approval from 2015 to 2017. See Extension to timeline official: ICD-11 rescheduled for 2017.

The next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders will be known as DSM-5. The revision of the current edition, DSM-IV, began in 1999. DSM-5 is now scheduled for publication in May 2013 – a year later than originally planned.

The revision of the current version of the WHO’s International Statistical Classification of Diseases, ICD-10, and the development of the structure of ICD-11 began in 2007. WHO anticipates that ICD-11 will be completed by 2015/16 2017, though targets for the population of content for the Beta draft have slipped.

Assuming no further shifts in publication dates, DSM-5 will publish two years in advance of ICD-11.

Update: DSM-5 published in May 2013.

Diagnostic and Statistical Manual of Mental Disorders (DSM)

Commonly referred to as the “Psychiatrist’s Bible”, the DSM is used by mental health and medical professionals for diagnosing and coding mental disorders. It is also used by medical insurance companies for reimbursement, in medical practices, clinics and hospitals, by social services agencies, government, policy makers, courts, forensics, prisons, drug regulation agencies, pharmaceutical companies and researchers.

Diagnostic criteria defined within DSM determine what is considered a mental health disorder and what is not, what medical treatments individuals receive and which treatments health insurers will authorise funding for. The inclusion or not of a disorder within DSM has revenue implications for pharmaceutical companies seeking licences for new drugs or to expand markets and applications for existing products.

DSM is the primary mental health diagnostic system in the US and is used to a varying extent in other countries. In the UK and some European countries, Chapter V, the Mental and Behavioural Disorders chapter of ICD-10, is also used for diagnosing mental health disorders.

The next edition of DSM will shape international research and influence literature in the fields of psychiatry and psychosomatics for many years to come.

The revision of DSM-IV is being undertaken by a 27 member Task Force, 13 Work Groups and 6 Study Groups.

The names of the members of the 13 Work Groups were released in May 2008, via an APA Press Release, following criticism over lack of transparency. Work Groups also draw on external advisors whose names are not being identified.

It’s been a controversial process. Some of the most vocal critics have been those who had served on the Task Force committees for previous revisions.

Criticism has been voiced by professionals in the field, consumer groups and the media around lack of transparency, potential conflicts of interest from DSM-5 Task Force and Work Group members’ financial links with pharmaceutical companies and a lack of professional diversity and patient representation in the make up of the Work Groups.

There is considerable controversy around the implications for the proposed introduction of new disorder categories and for the lowering of diagnostic thresholds for existing disorders, which may artificially inflate disorder prevalence.

For an overview see  Controversial issues for the future DSM-V: Sarah Kamens MA, paper regarding the future revision of the DSM-5, published in the January 2010 Newsletter of the Society for Humanistic Psychology

International Statistical Classification of Diseases (ICD)

The International Statistical Classification of Diseases (ICD) is the international standard diagnostic classification of diseases for use in epidemiology, health management and clinical practice.

ICD is used to classify diseases and other health problems recorded on many types of health and other records, including death certificates and insurance. These records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States and are used to monitor health related spending and to inform policy makers.

The chapter of ICD-10 which is used for mental health classification is Chapter V: Mental and behavioural disorders. This chapter will be known as “Chapter 5″ in ICD-11.

ICD-10 is being revised through a Steering Group and a number of Topic Advisory Groups (TAGs), under Managing Editors (TAGMEs), with responsibility for recruiting external peer reviewers and experts for reviewing proposals and advising on content. The names of the members of the TAGs are published on the WHO website but not the member of the sub working groups; the names of external advisers peer reviewing proposals and content are not being disclosed.

The WHO is promoting the development of ICD-11 and ICD-11-PHC, the Primary Care version of ICD-11, as an open and transparent process but reports on ICD-11 Revision objectives, proposals, focus group opinion and field trials are not always readily accessible for stakeholder scrutiny when published in subscription journals.

The Beta drafting process is being carried out via an electronic collaborative authoring platform – the iCAT that is not accessible to the public.

A second, publicly viewable version of the drafting platform known as the Beta Browser was launched in May 2012. Professional stakeholders and others who register an interest can interact with the platform, obtain greater access to content and may submit comments or suggestions.

Key documentation, style guides, models for the population of content and information on the structure of ICD-11 and meetings materials were being posted on a dedicated, public domain ICD Revision website. That site has not been updated since 2011.

When are the first drafts of DSM-5 and ICD-11 expected?

The APA published its first draft proposals for DSM-5 diagnostic categories and criteria on a dedicated website, on February 10, 2010.

The first public review ran from February 10 to April, 20, 2010.

The second public review ran from May 4 to July 15, 2011.

The final draft for public review ran from May 2 to June 15, 2012.

APA webpages for DSM-5 development: DSM-5 Development

Acording to DSM-5 Task Force Chair, David Kupfer, MD, the specific diagnostic categories that received the most feedback during the second public review and feedback exercise were sexual and gender identity disorders, followed closely by somatic symptom disorders and anxiety disorders.

ICD-11 Alpha Drafting platform was released on May 2011.

ICD-11 Beta Drafting platform has been publicly viewable since May 2012.

Continued on Page 2: “Harmonization” of DSM-5 and ICD-10; Timelines; Clinical Modifications of ICD
image credit | belgianchocolate | creative commons

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