The document provides an overview of psychiatric classification systems. It discusses the definition and advantages of classification, as well as key terms and historical approaches including etiological, descriptive, categorical, and dimensional. It then describes the development of major classification systems including the DSM and ICD. The DSM is the diagnostic manual published by the American Psychiatric Association while the ICD is published by the World Health Organization. The document outlines the various editions of the DSM from DSM-I to the current DSM-5. It also discusses other classification systems and tools used in psychiatry such as the Chinese Classification of Mental Disorders and the Research Domain Criteria.

1. CLASSIFICATION IN
PSYCHIATRY
DR.R.G.ENOCH
MD Psychiatry I Year
GMKMCH, Salem

2. • Definition
• Advantages of Classification
• Key terms
• Approaches to Classification
• Historical Development
• DSM
• ICD
• ICD 11
• Other Classification Systems
• Classification of sleep disorders

3. Definition
• Classification also known as psychiatric
nosology or psychiatric taxonomy, a process
by which complex phenomena are reduced by
rearranging into categories based on shared
characteristics.

4. ADVANTAGES OF CLASSIFICATION
• Organization of disorders into diagnostic classes
• To allow mental health practitioners and researchers to
communicate more effectively with each other
• To arrive at a diagnosis that has important predictive power
• To distinguish between one diagnosis from another
• Structure for teaching phenomenology and differential
diagnosis
• Psychoeducation of patients and their families
• Health care epidemiologists to determine the incidence and
prevalence of disorders

5. KEY TERMS
• Syndrome – It is a cluster of symptoms that can result from
different disease processes.
• Disorder - It is a derangement or abnormality of function
• Disease – it is a definite pathological process having a
characteristic set of signs and symptoms
• Diagnosis - is simply the opinion, by someone with expertise
in the matter, that a given disorder is present (or absent) in a
patient, or the procedure to decide whether or not a certain
disease or disorder is present (or absent).
i. categorical - it is either present or absent
ii. dimensional - a certain point in a continuum.

6. KEY TERMS
• Diagnostic Classification - is the listing of diagnoses
grouped by relatedness (for example, infectious,
autoimmune diseases, cancer, or injuries in medicine, or
anxiety, affective or psychotic disorders in psychiatry).
• Diagnostic Criteria - are the rules that need to be
followed for making a diagnosis.
• Reliability - Once made, a diagnosis is reliable if the
same conclusion about can be reached by two
independent observers (inter-rater reliability) or the
same diagnosis is achieved when examined more than
once within a reasonable time period (test–retest
reliability).
• Validity - Finally, a diagnosis is valid, if it picks out a
“real” entity, based on etiology and pathophysiology.

7. Mental Disorder
As defined in the DSM-5 Manual,
• 1. “A mental disorder is a syndrome characterized by clinically
significant disturbance in an individual’s cognition, emotion
regulation, or behavior
• 2. that reflects a dysfunction in the psychological, biological or
developmental processes underlying mental functioning.
• 3. Mental disorders are usually associated with significant
distress or disability in social, occupational, or other important
activities.
• 4. An expectable or culturally approved response to a common
stressor or loss, such as the death of a loved one, is not a mental
disorder.
• 5. Socially deviant behavior (e.g., political, religious, or sexual)
and conflicts that are primarily between the individual and
society are not mental disorders unless the deviance or conflict
results from a dysfunction in the individual, as described
above.”

8. APPROACHES TO CLASSIFICATION
1. Etiological
2. Descriptive
3. Categorical
4. Dimensional

9. ETIOLOGICAL APPROACH
• It tends to find “reason” for the set of symptoms. The reasons
could be biological, psychological, or social.
• However, the etiological approach is difficult to use for psychiatric
disorders since the etiology is usually multifactorial.
• Interplay of genetic and environmental factors is implicated in
development of most disorders. Role of each factor can be hardly
quantified with certain degree of precision. Also, it may be unclear
whether a factor causes the disorder or merely unmasks it in
susceptible individuals.
• 16th century Swiss physician Paracelsus developed a classification
system. He divided psychotic presentations into three types of
disorders based on presumed etiology
 VESANIA: Disorders caused by poisons - Substance-induced
disorders
 INSANITY: Diseases caused by heredity - Schizophrenia and bipolar
disorder
 LUNACY: Periodical condition. Influenced by the phases of Moon.
Has no analogous condition today

10. DESCRIPTIVE APPROACH
• Descriptive approach to classification defines
disorders based on clinical descriptions of
presenting symptoms.
• It has proved to be of greater utility. This
approach advanced by the work of the
nineteenth century psychiatrist Emil Kraepelin
(Kraepelin, 1992).
• Forms the basis for the current DSM and ICD
classification system.

11. CATEGORICAL APPROACH
• It involves the assessment of whether an
individual has a disorder on the basis of
symptoms and characteristics that is described
as typical of the disorder. This approach is the
classification strategies used in DSM and ICD.
• The DSM names the disorders and describes
them in specific terms.
• The ICD identifies symptoms that indicate the
presence of a disorder.

12. •Thoughts, feelings and behaviour can be organised into
categories representing disorders
•All or nothing principle. This approach considers illness
as being either present or absent.
•there are no “in between” diagnoses. (so the individual
either has a diagnosable metal disorder or does not have
a diagnosable disorder.)
•This system used to classify and diagnose metal
disorders is both valid and reliable( this classification
system actually organises metal disorders into discrete
and distinct disorders and that the classification system
produces the same diagnosis each time it is used In the
same situation)
CATEGORICAL APPROACH

13. CATEGORICAL APPROACH
Strengths for using this approach include:
• Helps communication
• Allows diagnosis
Weaknesses for using this approach include:
• Lots of overlap between symptoms which can
make diagnosis tricky
• Stigma and labelling

14. DIMENSIONAL APPROACH
• Symptoms of disorder exist on a dimension which is a continuum
from normal to severely ill
• Dimensionality can be envisaged in terms of number of symptoms
(e.g., five out of eight symptoms to diagnose major depressive
disorder) and severity of each symptom group (mild, moderate and
severe).
• This approach classifies the mental disorders that quantifies a
person’s symptoms with numerical values on one or more scales
or continuums, rather than assigning them to a mental disorder
category.
• Diagnosis then becomes not a process of deciding the presence or
absence of a symptom or disorder but rather the degree to which a
particular characteristic is present.
• The dimensional approach suggests that symptoms may be present
in normal as well as in ill.

15. ADVANTAGES OF DIMENSIONAL APPROACH
1. Comorbid disorders can be easily represented.
 Individual who presents with depression, anxiety, and social
avoidance using the DSM-5 categorical system, criteria
might be met for three diagnoses.
 A dimensional approach may simply indicate that the
person has elevated values on the depression, anxiety and
social avoidance dimensions
2. Dimensional approach avoids setting of a particular
thresholds for distinguishing between pathology and
normality. Categorically individual has major depressive
disorder only if the threshold of five depressive symptoms
is met or exceeded. Dimensional approach might say that
the person is high on the depression dimension
3. More detailed information on each symptom

16. • 4. It takes into account a wider range of factors.
(More than categorical approaches)
• 5. A profile is created instead of labelling.
• 6. Dimensions can be helpful in indicating the
severity of the disorder. The range of appropriate
treatments is related to the severity of the
disorder.
• 7. Facilitate research into the underlying etiology
and pathophysiology of mental disorders.
• 8. Research studies using dimensional scales have
greater power to detect differences in groups

17. DISADVANTAGES OF DIMENSIONAL APPROACH
• 1.Clinicians are accustomed to thinking in terms of
diagnostic categories
• 2.Existing knowledge base about the presentation, etiology,
epidemiology, course, prognosis, and treatment is based on
these categories.
• 3.Decisions about the management of individual patients
are easier to make if the patient is thought of as having a
particular disorder
• 4.The value of dimensions in terms of communicating
information from one clinician to another is likely to be
quite limited. one clinician communicates with another by
saying something like, ‘this is a bad case of depression and
so far intractable to treatment,’ not by saying, ‘on
dimensional scales x, y, and z the patient has such and such
scores

18. • The previous editions of DSM strictly used a
categorical approach.
• In the present DSM 5 and ICD -10 there is an
integration of the dimensional approach along
with the categorical approach.

19. HISTORICAL DEVELOPMENT
• 460 – 377 BC In Ancient Greece, Hippocrates and his
followers are generally credited with the first classification
system . 6 Conditions -mania, melancholia, epilepsy, hysteria,
phrenitis and Scythian disease (transvestism). They held that
they were due to different kinds of imbalance in four humors.
• 1624–1689 – Thomas Sydenham – the "English
Hippocrates", emphasized careful clinical observation and
diagnosis and developed the concept of a syndrome.
Rejected single dysfunction was the root cause. Each disease
has an uniform presentation in different individuals.
• 18th century - Boissier de Sauvages developed an extremely
extensive psychiatric classification. It was only a part of his
classification of 2400 medical diseases. Nosologia methodica

20. • 19th century - The diagnosis of "moral insanity" coined
by James Prichard also became popular; meaning
disordered emotions or behavior.
• 1808 The term "psychiatry" ("Psychiatrie") was coined
by German physician Johann Christian Reil , from the
Greek psychē: "soul or mind" and iatros: "healer or
doctor"
• 1840 Recording of mental illness in the United States
census that included, besides physical illnesses, a
category for idiocy/insanity and normals
• 1844 Association of Medical Superintendents of
American Institutions for the Insane formed

21. • 1856 – 1926 German psychiatrist Emil Kraepelin advanced
a new system.
• In all he proposed 15 categories
• The three main categories are
o Dementia precox
o Mood disorder
o Paranoia
• 1886 – 1950 Adolf Meyer – introduction of Krapelin’s
classification in US. He eventually gave his own
classification based on the notion of reaction types –
disorders are reaction of the individual to environment
stressors.

22. • 1880 Census, “mania, melancholia, monomania,
paresis, dementia, dipsomania, and epilepsy”
• 1917 together with the National Commission on
Mental Hygiene, the precursor of the APA developed a
“Statistical Manual for the Use of Institutions for the
Insane,”
• 1921 American Psychiatric Association.
• 1930 The term “stress” emerged
from endocrinology work
• 1945 William C. Menninger advanced a classification
scheme for the US army, called Medical 203. This system
was adopted by the Veterans Administration in
the United States and strongly influenced the DSM

23. • 1946 Mental disorders were first included in the sixth
revision of the International Classification of Diseases (ICD-6)
• 1952 Introduction of its first edition of DSM
• 1967 Present State Examination by John Wing
• 1950s to the early 1970s.The Feighner Criteria developed
at Washington University in St. Louis, Missouri
• The criteria are named after a famous psychiatric paper
published in 1972 of which John Feighner was the first listed
author.
• The development of the criteria had been led by a trio of
psychiatrists Eli Robins, Samuel Guze and George Winokur.
• Fourteen conditions were defined, including primary affective
disorders (such as depression), schizophrenia, anxiety
neurosis, antisocial personality disorder and homosexuality

24. • 1970 Research Diagnostic Criteria (RDC) led by Robert
Spitzer at Columbia University
• Some of the criteria were based on the earlier Feighner
Criteria, although many new disorders were included
• DSM-III was based on many of the RDC descriptions.[3]

25. Present State Examination
• John Wing produced a simple descriptive categorisation of the four
leading symptoms of chronic schizophrenia, i.e. flatness of affect,
poverty of speech, incoherence of speech,and delusions
• Sections dealing with neurotic symptoms were added in the second
and third versions.
• Reliability studies were done in the the fourth and the fifth editions.
• In all its versions, the P.S.E. has been a systematically arranged
interview schedule, containing all the symptoms which are relevant
to a present mental state examination.
• Present State Examination later became the SCAN in 1990 in 10th Ed
• The SCAN system (Schedules for Clinical Assessment in
Neuropsychiatry) is a set of instruments and manuals aimed at
classifying the psychopathology and behavior associated with the
major psychiatric disorders . This approach emphasises gathering
clinical data along with social and environmental influences.

26. Schedule for Affective Disorders and
Schizophrenia (SADS)
• It is a collection of psychiatric diagnostic criteria and symptom
rating scales originally published in 1978.
• It is organized as a semi-structured diagnostic interview. The
structured aspect is that the screening questions are about
the same set of disorders regardless of the presenting
problem.
• The diagnoses covered by the interview
include schizophrenia, schizoaffective disorder, major
depressive disorder, bipolar disorder, anxiety disorders and a
limited number of other fairly common diagnoses.
• The SADS was developed by the same group of rearchers as
the Research Diagnostic Criteria (RDC).

27. Systems of classifications in
Psychiatry.
• ICD by WHO
• DSM by APA
• Chinese Classification of Mental Disorders
[CCMD]
• Latin American Guide for Psychiatric Diagnosis
• The Research Domain Criteria [RDoC] by NIMH

28. DSM

29. • DSM-I (1952)
• 132 Pages
• 106 Diagnosis
• Mental disorders as “reactions” to psychological, social and
biological factors.
• Definitions were simple, brief paragraphs with prototypical
descriptions.
• It was influenced by the Medical 203
• DSM-II (1968)
• 134 pages
• 182 diagnosis
• Rationale – to conform to the system used in ICD
• Almost similar to DSM I
• “Reaction” terminology dropped, Users encouraged to record
multiple psychiatric diagnoses (in order of importance) and
associated physical conditions.
• Meyer and Meninger developed both the editions.

30. DSM-III (1980)
• 494 Pages
• 265 Diagnosis
• Rationale – to conform to the newest ICD
• Reflected a shift from a theoretical paradigm to a medical model.
Coincided with ICD-9. Goal was to introduce reliability.
• Influenced by research – oriented psychiatrists who felt
psychodynamic orientation to be unscientific.
DSM-III-R (1987)
• 567 Pages
• 292 Diagnosis
• Rationale – to increase the reliability and validity
• Categories were renamed and reorganized, and significant changes
in criteria were made.
• Controversial diagnoses, such as pre-menstrual dysphoric disorder,
masochistic personality disorder, and Ego-dystonic homosexuality"
was removed
• Influence – Robert Spitzer

31. • DSM-IV (1994)
• 886 Pages
• 365 Diagnosis
• Rationale – to conform with ICD 10
• Inclusion of a clinical significance criterion. New disorders
introduced (e.g., Acute Stress Disorder, PTSD, Bipolar II
Disorder, Asperger’s Disorder), others deleted (e.g., Cluttering,
Passive-Aggressive Personality Disorder).
• Allen Francis was the Chairman.
• DSM-IV-TR (2000)
• 936 Pages
• 365 Diagnosis – none added
• The text sections giving extra information on each diagnosis
were updated, as were some of the diagnostic codes to
maintain consistency with the ICD.
• Influence – John Wakefield
• The DSM-IV-TR was organized into a five-part axial system.

32. • Axis I: All psychological diagnostic categories
• Axis II: Personality disorders and mental
retardation
• Axis III: General medical condition; acute
medical conditions and physical disorders
• Axis IV: Psychosocial and environmental
factors contributing to the disorder
• Axis V: Global Assessment of Functioning or
Child Global Assessment of Functioning [cGAF]

33. DSM 5
• The DSM-5 task force was officially convened in August
2007. Chair – David Kupfer
• The first step was to name several workgroups with
responsibility for specific diagnostic areas, each led by
a member of the task force.
• For the ensuing 5-year period (2008 to 2013) the task
force and workgroups met frequently both in person
and via teleconference, reviewing the evidence base
related to current diagnoses as well as that for
potential new ones.
• DSM-5 would become a second “paradigm shift” for
psychiatric diagnosis (DSM-III has been viewed as the
first), by incorporating a dimensional approach.

34. The Process of Approving/Disapproving
Changes or New Diagnoses in DSM-5.
• Several levels of clearance and approval of the new
proposals.
• The first premise was that any changes to DSM-IV or
proposals for new diagnoses had to be evidence-based.
• Committee recommendations went to an
“independent” body called the “Scientific Advisory
Committee
• CPHC, “Clinical Public Health Committee” reviewed
proposals keeping in mind potential practical or public-
health implications of proposed changes.
• The SAC and CPHC recommendations then went to the
full task force for final debate.
• These final recommendations were then forwarded to
the APA Board of Trustees for their review.

35. DSM 5
• 947 pages
• Approved by the Board of Trustees of the APA on
December 1, 2012
• Released on 18th May2013. The DSM-5 is the first
major edition of the manual in twenty years.
• 22 Chapters
• DSM-IV - 17 Chapters
• It is notable that The DSM-5 is identified with
Hindu rather than Roman numerals.
• Incremental updates will be identified with
decimals (DSM-5.1,DSM-5.2, etc.). A new edition
will be signified by whole number changes (DSM-
5,DSM-6, etc.)

36. INSIDE DSM- 5
Divided into three sections.
• Section I - DSM 5 basics
• Section II - Diagnostic criterion and codes
• Section III - Emerging measures and models
and an Appendix.

37. INSIDE DSM- 5
 Section I
•Introduction
•Historical back ground
•Development of DSM-5
•Harmonization with ICD system.
•Dimensional approach
Section II - Diagnostic criterion and codes

38. INSIDE DSM- 5
 Section III - Emerging Measures and Models
• •Assessment measures
• •Cultural formulation
• •Alternative DSM-5 model for personality disorders
• •“Criteria Sets for Conditions for Further Study”
 Appendix
• •Highlights of changes from DSM-IV to DSM-5
• •Glossary of technical terms
• •Glossary of cultural concepts of distress
• •Alpha & numeric listings of diagnoses and codes
• •List of advisors and contributors

39. Key Changes in DSM-5
 DELETION OF THE MULTIAXIAL SYSTEM.
• The five-axis frame of DSM-III and IV was eliminated in DSM-5. This
makes DSM-5 closer to the structure of the ICD-10 diagnostic
system.
 STRUCTURE AND GROUPING OF DISORDERS.
• The removal of PTSD and acute stress disorders from the anxiety
disorders category in DSM-IV and their placement in a new chapter
called Trauma and Stress Related Disorders (TSRD).
• Obsessive-compulsive disorder was also moved out of the anxiety
disorders chapter and also placed in a new chapter called
Obsessive-Compulsive and Related Disorders. This group also
includes “body dysmorphic disorder,”“trichotillomania” (hair pulling
disorder), a new diagnosis “hoarding disorder,” as well as “skin-
picking” disorder.

40. New Disorders IN DSM 5
1. Social Communication Disorder
2. Disruptive Mood Dysregulation Disorder
3. Premenstrual Dysphoric Disorder
4. Hoarding Disorder
5. Excoriation (Skin‐Picking) Disorder
6. Disinhibited Social Engagement
7. Binge Eating Disorder
8. Central Sleep Apnea
9. Sleep-Related Hypoventilation
10. Rapid Eye Movement Sleep Behavior Disorder
11. Restless Legs Syndrome
12. Caffeine Withdrawal
13. Cannabis Withdrawal
14. Major Neurocognitive Disorder with Lewy Body Disease
15. Mild Neurocognitive Disorder

41. Eliminated Disorders in DSM 5
• Sexual Aversion Disorder
• Polysubstance‐Related Disorder

42. NEURODEVELOPMENTAL DISORDERS.
• Mental Retardation was renamed Intellectual
Disability (Intellectual Developmental Disorder).
• Autism Spectrum Disorder replaces Autism, Asperger
Syndrome and Pervasive Developmental Disorder
NOS in DSM-IV.
NEUROCOGNITIVE DISORDERS.
• These disorders were previously referred in DSM-IV
as “dementia, delirium, amnestic, and other
cognitive disorders.” In DSM-5, they are headed by
“delirium.”

43. SCHIZOPHRENIA SPECTRUM
• This included removal of special consideration for “bizarre”
delusions and “special” hallucinations under Criterion A
(characteristic symptoms).
• Rewording of negative symptoms in efforts to provide more
clarity (“affective flattening” was changed to “restricted
affect”; “alogia or avolition” were changed to
“avolition/asociality”).
• The second change is the addition of a requirement in
Criterion A that the individual must have at least one of these
three symptoms: delusions, hallucinations, and disorganized
speech.
• The DSM-IV subtypes of schizophrenia (i.e., paranoid,
disorganized, catatonic,undifferentiated, and residual types)
are eliminated due to their limited diagnostic stability, low
reliability, and poor validity.

44. BIPOLAR DISORDER
• Inclusion of “increased energy/activity” as a criterion a
symptom of mania/hypomania. Also addition of “mixed
features” specifiers for mania, hypomania, and depression
• The complete list of “specifiers” for bipolar and related
disorders include
 “anxious distress,”
 “manic or hypomanic episode with mixed features,”
 “depressive episode with mixed features,”
 “with rapid cycling,”
 “with melancholic features,”
 “with atypical features,”
 “with psychotic features,”
 “with catatonia,”
 “with seasonal pattern.”

45. • DEPRESSIVE DISORDERS.
• Included here are “Disruptive Mood Dysregulation Disorder,”
a new disorder intended to decrease the “excess” of
diagnoses of bipolar disorder observed in children and
adolescents.
• “Major Depressive Disorder,” remains virtually identical to the
DSM-IV category
• No more bereavement exclusion for diagnosing MDD.
Bereavement is now recognized as a severe psychosocial
stressor that can precipitate a major depressive episode in a
vulnerable individual
• List of “specifiers,”
 “with anxious distress
 “with mixed features,”
 “with melancholic features” and
 “with atypical features.”

46. • PTSD
• Qualifying traumatic events are now explicit as to whether
they were experienced directly, witnessed or experienced
indirectly.
• Four symptom clusters instead of three namely
 -Re-experiencing
 -Arousal
 -Avoidance
 -Persistent negative alterations in cognition and mood.
• Acute Stress Disorder
• Requires being explicit as to whether qualifying traumatic
events were experienced directly, witnessed, or experienced
indirectly. Criterion A2 regarding subjective reaction has been
eliminated

47. • ANXIETY DISORDERS
• OCD and PTSD have been omitted and made into separate
categories.
• Separation anxiety and selective mutism are included in anxiety
disorders.
• Anxiety disorders no longer need age >18 for diagnosis.
• 6-month duration used to be limited to individuals under age 18,
but is now extended to all ages
• Panic disorder and Agoraphobia are unlinked. The co-occurrence
of these two disorders is now coded with two diagnoses. This
change was made because there is a substantial number of
individuals with agoraphobia who do not experience panic
symptoms.
• Social anxiety disorder - Formerly called Social Phobia, but now
called Social Anxiety Disorder.
• Generalized specifier has been deleted and replaced with a
“performance only” specifier.

48. Separation anxiety disorder
• Formerly in the section “Disorders Usually First diagnosed in
Infancy, Childhood, or Adolescence.” Now, classified as an
anxiety disorder. Includes symptoms in adulthood as well as
childhood.
SUBSTANCE USE DISORDERS.
• Substance abuse and substance dependence were
consolidated into a single disorder called “substance use
disorder.”
• A continuum or dimension was created that includes “mild,”
“moderate,” or “severe” substance use.
• One of the DSM-IV abuse criteria was removed (“legal
consequences such as multiple arrests”), and a new criterion,
“craving,” was added.

49. SOMATIC SYMPTOM AND RELATED DISORDERS.
• This new category replaced the somatoform disorders category from DSM-
IV.
• The symptoms to be “medically unexplained” was removed from DSM-5.
• Somatization Disorder, Pain Disorder, and Undifferentiated Somatoform
Disorder were all merged into a new diagnosis called “Somatic Symptom
Disorder.” Hypochondriasis became “Illness Anxiety Disorder.”
• “Conversion Disorder” was significantly revised and the term “Functional
Neurological Symptom Disorder” was added to the title
OBSESSIVE COMPULSIVE AND RELATED DISORDERS
• New chapter.
• New disorders include hoarding disorder, excoriation(skin picking)disorder,
Substance/Medication induced obsessive –compulsive and related
disorders and obsessive-compulsive disorders due to another medical
condition, Trichotillomania (hair-pulling disorder), Body Dysmorphic
disorder
• Specifiers for Obsessive-Compulsive and Related Disorders - “with poor
insight” specifier has been refined to allow a distinction between those
with good or fair insight, poor insight, and “absent insight/delusional”

50. SLEEP–WAKE DISORDERS.
• This group includes a large number of
categories and subcategories, starting with
Insomnia Disorder, Hypersomnolence
Disorder, Narcolepsy (various subtypes)

51. Alternative DSM-5 model for personality disorders
• The current approach to personality disorders appears in
Section II of DSM-5, and an alternative model developed for
DSM-5 is presented here in Section III.
• For example, the typical patient meeting criteria for a specific
personality disorder frequently also meets criteria for other
personality disorders.
• In the alternative model, the essential criteria to define any
personality disorder are:
• a) moderate or greater impairment in personality functioning
and b) the presence of pathological personality traits.
• In addition, a new diagnosis called Personality Disorder-Trait
Specific was established, replacing Personality Disorder Not
Otherwise Specified in DSM-IV.

52. Conditions for Further Study
• Attenuated Psychosis Syndrome
• Depressive Episodes With Short-Duration Hypomania
• Persistent Complex Bereavement Disorder
• Caffeine Use Disorder
• Internet Gaming Disorder
• Neurobehavioral Disorder Associated With Prenatal Alcohol
Exposure
• Suicidal Behavior Disorder
• Nonsuicidal Self-Injury

53. I C D

54. ICD
• Represents International Statistical
Classification of Diseases and Related Health
Problems.
• Can be defined as a system of categories to
which morbid entities are assigned according
to established criteria.
• Used to translate diagnoses of diseases from
words into an alphanumeric code.

55. Purpose and uses
 Identification of health trends and statistics globally.
 It is the international standard for defining and reporting
diseases and health conditions.
 ICD allows the counting of deaths as well as diseases, injuries,
symptoms, reasons for encounter, factors that influence
health status, and external causes of disease.
 Easy storage, retrieval and analysis of health information for
evidence-based decision making;
 Sharing and comparing health information between hospitals,
regions, settings and countries; and
 Data comparisons in the same location across different time
periods.
 It is the diagnostic classification standard for all clinical and
research purposes.

56. EVOLUTION OF ICD
• 1855 William Farr first medical statistician of the
General Register Office of England and Wales
submitted his Report on nomenclature and statistical
classification of diseases
• 1893 “Bertillon Classification of Causes of Death,”
introduced by the French physician Jacques Bertillon
• 1900 an international conference revised what was
then called the “International Classification of Causes
of Death,” and agreed to hold revisions of the system
every 10 years.
• 1948 the recently created WHO, an agency of the
United Nations, assumed responsibility for the ICD.

57. • 1949 The sixth revision, published in, involved significant changes.
 Included morbidity in addition to mortality,
 title was changed to International Statistical Classification of
Diseases, Injuries, and Causes of Death.
 It included a section on mental disorders.
• 1965 Eighth Revision
• 1975 Nineth Revision
• well-known convention of using a dagger (†) marking the
underlying disease and an asterisk (*) to mark its manifestations
was issued in this revision.
• However, the most important single event for classification in
psychiatry was the inclusion of a glossary and brief descriptions of
the categories included in the fifth chapter (mental disorders), a
procedure that was not part of the other chapters
• 1989 Tenth Revision
• 1990 ICD-10 was endorsed by the Forty-third World Health
Assembly and came to use in WHO Member States as from 1994.
• 2000 India adopted this classification

58. DSM ICD
National classification of the United States Official World classification
Focus on psychiatrists and psychologists
Designed to be used by and useful for the
different health professionals
Developed to fulfill the particular information
needs of the US health system
Created with the idea of being useful for
different health systems around the world
Property of the APA Free of charge and open access
Operational criteria
Clinical descriptions
US, Anglophone perspective
Multilingual and multicultural
Advantages for research
Advantages for clinical use
Different formats, one version Multiple versions and formats for multiple users

59. ICD 10
• Much larger than ICD-9
• ICD-10 has 21 chapters against 17 Chapters in
ICD-9
• Numeric codes ( 001-999 ) were used in ICD-9
where as an alphanumeric coding, (A00-Z99)
has been adopted in ICD-10.
• It enlarged the number of categories available
for the classification.

60. Volumes of ICD-10
• Volume 1: Main classifications
• Volume 2: Instruction/ Guidance to users
• Volume 3: Alphabetical Index

63. Basic coding guidelines
• The basic ICD is a single coded list of three character categories,
each of which can be further divided into up to 10 four-character
subcategories.
• Tenth Revision uses an alphanumeric code with a letter in the
first position and a number in the second, third and fourth
positions.
• Some three-character categories have been left vacant for future
expansion / Revision
• Codes U00–U49 are to be used by WHO for the provisional
assignment of new diseases of uncertain etiology.
• Codes U50–U99 may be used in research
• The fourth character follows a decimal point.
• Possible code numbers therefore range from A00.0 to Z99.9.
• Fill fourth position with X , when sub-division is not there, so
that the codes are of a standard length for data-processing.

64. Multi Axial System
• Axis I, clinical syndromes (psychiatric disorders
including personality disorders and somatic
diseases);
• Axis II, disabilities;
• Axis III, environmental/circumstantial and
personal life-style/life management factors.

65. List of Blocks of Chapter V: Mental
and Behavioral Disorders from ICD-10
• F00 - F09 Organic including Symptomatic Mental Disorders
• F10 - F19 Mental and Behavioral Disorders due to Psychoactive
Substance Use
• F20 - F29 Schizophrenia, Schizotypal and Delusional Disorders
• F30 - F39 Mood (Affective) Disorders
• F40 - F49 Neurotic, Stress-Related and Somatoform Disorders
• F50 - F59 Behavioral Syndromes Associated with Physiological
Disturbances and Physical Factors
• F60 - F69 Disorders of Adult Personality and Behavior
• F70 - F79 Mental Retardation
• F80 - F89 Disorders of Psychological Development
• F90 - F98 Behaviroal and Emotional Disorders with Onset usually
occurring in childhood and Adolescence
• F99 Unspecified Mental Disorders

66. (F00–F09) Organic, including
symptomatic, mental disorders
• (F00) Dementia in Alzheimer's disease
• (F01) Vascular dementia
(F02)Dementia in other diseases classified elsewhere
• (F03) Unspecified dementia
• (F04) Organic amnesic syndrome, not induced by alcohol and other
psychoactive substances
• (F05) Delirium, not induced by alcohol and other psychoactive
substances
• (F06) Other mental disorders due to brain damage and dysfunction
and to physical disease
• (F07) Personality and behavioural disorders due to brain disease,
damage and dysfunction
• (F09) Unspecified organic or symptomatic mental disorder

67. F10--F19 Mental and behavioural disorders due
to psychoactive substance use
• F10.-Mental and behavioural disorders due to use of alcohol
• F11.-Mental and behavioural disorders due to use of opioids
• F12.-Mental and behavioural disorders due to use of cannabinoids
• F13.-Mental and behavioural disorders due to use of sedatives or
hypnotics
• F14.-Mental and behavioural disorders due to use of cocaine
• F15.-Mental and behavioural disorders due to use of other stimulants,
including caffeine
• F16.-Mental and behavioural disorders due to use of hallucinoeens
• F17.-Mental and behavioural disorders due to use of tobacco
• F18.-Mental and behavioural disorders due to use of volatile solvents
• F19.-Mental and behavioural disorders due to multiple drug use and use
of other psychoactive substances

68. • Four- and five-character categories may be used to
specify the clinical conditions, as follows:
• F1x.0 Acute intoxication
• F1x.1 Harmful use
• F1x.2 Dependence syndrome
• F1x.3 Withdrawal state
• F1x.4 Withdrawal state with delirium
• F1x.5 Psychotic disorder
• F1x.6 Amnesic syndrome
• F1x.7 Residual and late-onset psychotic disorder
• F1x.8 Other mental and behavioural disorders

69. F20-F29
Schizophrenia, schizotypal and delusional disorders
• F20 Schizophrenia
• F20.0 Paranoid schizophrenia
• F20.1 Hebephrenic schizophrenia
• F20.2 Catatonic schizophrenia
• F20.3 Undifferentiated schizophrenia
• F20.4 Post-schizophrenic depression
• F20.5 Residual schizophrenia
• F20.6 Simple schizophrenia
• F20.8 Other schizophrenia
• F20.9 Schizophrenia, unspecified
• F21 Schizotypal disorder
• F22 Persistent delusional disorders
• F23 Acute and transient psychotic disorders
• F24 Induced delusional disorder
• F25 Schizoaffective disorders
• F28 Other nonorganic psychotic disorders
• F29 Unspecified nonorganic psychosis

70. F30-F39 Mood [affective] disorders
• F30 Manic episode
• F31 Bipolar affective disorder
• F32 Depressive episode
• F33 Recurrent depressive disorder
• F34 Persistent mood [affective] disorders
• F38 Other mood [affective] disorders
• F39 Unspecified mood [affective] disorder

71. F40-F48 Neurotic, stress-related and
somatoform disorders
• F40 Phobic anxiety disorders
• F41 Other anxiety disorders
• F42 Obsessive - compulsive disorder
• F43 Reaction to severe stress, and adjustment
disorders
• F44 Dissociative [conversion] disorders
• F45 Somatoform disorders
• F48 Other neurotic disorders
•

72. F50-F59 Behavioural syndromes associated with
physiological disturbances and physical factors
• F50 Eating disorders
• F51 Nonorganic sleep disorders
• F52 Sexual dysfunction, not caused by organic disorder or
disease
• F53Mental and behavioural disorders associated with the
puerperium, not elsewhere classified
• F54Psychological and behavioural factors associated with
disorders or diseases classified elsewhere
• F55 Abuse of non-dependence-producing substances
• F59Unspecified behavioural syndromes associated with
physiological disturbances and physical factors

73. F60-F69 Disorders of adult personality and behaviour
• F60 Specific personality disorders
• F60.0 Paranoid personality disorder
• F60.1 Schizoid personality disorder
• F60.2 Dissocial personality disorder
• F60.3 Emotionally unstable personality disorder
• .30 Impulsive type
• .31 Borderline type
• F60.4 Histrionic personality disorder
• F60.5 Anankastic personality disorder
• F60.6 Anxious [avoidant] personality disorder
• F60.7 Dependent personality disorder
• F60.8 Other specific personality disorders
• F60.9 Personality disorder, unspecified
• F61 Mixed and other personality disorders
• F62 Enduring personality changes, not attributable to brain damage
• and disease
• F63 Habit and impulse disorders
• F64 Gender identity disorders
• F65 Disorders of sexual preference

74. F70-F79 Mental retardation
• F70 Mild mental retardation
• F71 Moderate mental retardation
• F72 Severe mental retardation
• F73 Profound mental retardation
• F78 Other mental retardation
• F79 Unspecified

75. F80-F89 Disorders of psychological development
• F80 Specific developmental disorders of speech and
language
• F81 Specific developmental disorders of scholastic skills
• F82 Specific developmental disorder of motor function
• F83 Mixed specific developmental disorders
• F84 Pervasive developmental disorders
• F88 Other disorders of psychological development
• F89 Unspecified disorder of psychological development

76. • F90-F98 Behavioural and emotional disorders with
onset usually occurring in childhood and adolescence
• F90 Hyperkinetic disorders
• F91 Conduct disorders
• F92 Mixed disorders of conduct and emotions
• F93 Emotional disorders with onset specific to childhood
• F94 Disorders of social functioning with onset specific to
childhood and adolescence
• F95 Tic disorders
• F98 Other behavioural and emotional disorders with onset
usually occurring in childhood and adolescence
• F99 Unspecified mental disorder

77. Mental Disorders in ICD-11
• Included in Chapter 7
• Major reasons for reviewing ICD-10 include
a) to improve the consistency and uniformity of
the diagnostic information provided by the
clinical descriptions and
b) to adapt to new demands from users and
conditions of use.
c) The environmental components and the context
in which classification is used have undergone
profound changes with the passage of time.

78. • The Definition of Mental Disorder Will Not Change in ICD-11
• Major changes in the definition of mental disorder are not
expected in ICD-11 and therefore, the ICD-10 definition will be
maintained:
• “A clinically recognizable set of symptoms or behaviors
associated in most cases with distress and with interference
with personal functions.”
• While the emphasis will be on categories, ICD-11 may also
consider dimensions at least in a few situations, where simple
measurements may be feasible.
• “Specifiers” and “Qualifiers” in ICD-11. ICD will not use coded
“specifiers” because of the limits of the coding system.
Therefore, if some features of a disorder are deemed
important to be highlighted, noncoded “qualifiers” will be
added

79. List of Blocks of Chapter 7 Mental and Behavioral
Disorders of ICD-11
• Neurodevelopmental disorders
• Schizophrenia and other primary psychotic disorders
• Mood disorders
• Anxiety and fear-related disorders
• Obsessive-compulsive and related disorders
• Disorders specifically associated with stress
• Dissociative disorders
• Bodily distress disorder
• Feeding and eating disorders
• Elimination disorders
• Disorders due to substance use
• Impulse control disorders
• Disruptive behavior and dissocial disorders
• Personality disorders
• Paraphilic disorders
• Factitious disorders
• Neurocognitive disorders
• Mental and behavioral disorders associated with disorders or diseases classified
elsewhere

80. Standard Format for ICD-11 Clinical Descriptions and
Diagnostic Guidelines
• Category Name
• Brief Definition: containing a summary statement (100–125 words) of the common essential
features of the disorder
• Inclusion Terms
• Exclusion Terms
• Essential (Required) Features: relatively explicit guidance regarding features needed to
confidently make the diagnosis
• Boundary with Normality (Threshold): specifying those aspects of the disorder that are
indicative of its pathological character
• Boundary with Other Disorders (Differential Diagnosis): this section provides guidance to
the clinician about how to make this differentiation
• Coded Qualifiers/Subtypes
• Course Features: information on temporal patterns like age of onset, persistence, duration,
likely progression overtime, etc.
• Associated Clinical Presentations: information about features that are important and help to
recognize variations in presentation but also highlights areas where clinical intervention
might be important
• Culture-Related Feature: brief information regarding cultural considerations for diagnosis
• Developmental Presentations
• Gender-Related Features

81. The World Health Organization World Mental Health
Composite International Diagnostic Interview
(WHO WMH-CIDI)
• The WHO WMH-CIDI is a comprehensive, fully-
structured interview designed to be used by trained
lay interviewers for the assessment of mental
disorders according to the definitions and criteria of
ICD-10 and DSM-IV.
• It is intended for use in epidemiological and cross-
cultural studies as well as for clinical and research
purposes.

82. The Chinese Classification of Mental Disorders
• Published by the Chinese Society of Psychiatry (CSP) Is a clinical guide
used in China for the diagnosis of mental disorders.
• It is currently on a third version, the CCMD-3, written in Chinese and
English.
• It is similar in structure and categorisation to the ICD and DSM
• Diagnoses that are more specific to Chinese or Asian culture include:
1. Koro or Genital retraction syndrome: excessive fear of
the genitals (and also breasts in women) shrinking or drawing back
into the body.
2. Zou huo ru mo or qigong deviation perception of uncontrolled flow
of energy in the body.
3. Mental disorders due to superstition or witchcraft.
4. Travelling psychosis
• The CCMD-3 lists several "disorders of sexual preference"
including ego-dystonic homosexuality.

83. The Research Domain Criteria (RDoC)
• Developed by Bruce Cuthbert and Thomas Insel
of the US National Institute of Mental Health in
1970.
• It is a research framework for new ways of
studying mental disorders
• "RDoC is an attempt to create a new kind of
taxonomy for mental disorders by bringing the
research approaches in genetics, neuroscience,
and behavioral science to the problem of mental
illness."
• RDoC is conceived as a dimensional system

84. SLEEP DISORDER CLASSIFICATIONS
• Three different nosologies provide classification systems for
sleep disorders: (1) DSM, (2) the International Classification of
Sleep Disorders (ICSD), and (3) ICD
• ICSD-3 is more comprehensive
• ICSD-3 includes 60 specific diagnoses within the seven major
categories, as well as an appendix
1. Insomnia
2. Sleep-related breathing disorders
3. Isolated symptoms and normal variants
4. Central disorders of hypersomnolence
5. Circadian rhythm sleep-wake disorders
6. Parasomnias
7. Sleep-related movement disorders
8. Other sleep disorders

85. CONCLUSION
 DSM and ICD are essential clinical tools; the former has
emphasized diagnostic validity, and the latter has emphasized
clinical utility.
 Clinical utility is however reliant on diagnostic validity, and
there is considerable overlap between the two.
 RDoC provides a useful focus on the individual-level causal
mechanisms that are relevant to vulnerability to mental
disorder.
 In their day-to-day clinical work for the near future, clinicians
are likely to continue to use DSM and ICD. However, our hope
is that advances in work on endophenotypes and
exophenotypes will ultimately lead to improved classification
systems, and in turn to better individualized care as well as
improved global mental health.

86. References
• Kaplan and Sadocks Comprehensive textbook
of Psychiatry – 10th edition
• Kaplan and Sadocks Synopsis of Psychiatry –
11th edition
• Postgraduate Textbook of Psychiatry - Ahuja