welcome to my scientifically informed insider look at mental health topics if you find this video to be interesting or helpful please like it and subscribe to my channel oh this is dr. Grande today's question asks if I can review the differences between the ICD and the DSM so the ICD is the International classification of diseases and the DSM is the Diagnostic and Statistical Manual so I'll talk about what these manuals are used for and then take a look at each one and then go over some of the similarities and differences so both of these manuals contain definitions of mental disorders so they are used for diagnostic purposes classification of mental disorders helps with treatment that allows us to better explore causes prevention the course of disorders and this includes as well how a disorder may progress if it's untreated sometimes this is called natural history so the natural history of a disorder having these manuals lets mental health practitioners like mental health counselors speak a common language so a client could move from one counselor to another and then when the new counselor looked at the chart and saw the diagnosis it would make sense to the new counselor it also allows faster communication for example if a counselor says that one of their clients has bipolar one disorder just by saying that a lot is communicated you know that the client would have met the full criteria for mania and they likely also have depressive episodes and you would know what type of comorbidity to be on a lookout for so comorbidity is when mental disorders tend to occur together so bipolar disorder for instance has high comorbidity with substance use disorder now the difficulty with mental disorders is that there aren't a lot of biological or pathophysiological markers that tell us a disorder is there when we look at the world of medicine we really see something different than what we see with mental health so medical disorders are usually diagnosed using some sort of biological indicator and various types of labs are available like x-rays ultrasounds MRIs and a lot of other tests the interpretations of lab work while not always straightforward do follow certain guidelines then we also have this other issue of the gap between characteristics of a biological disorder with a clear diagnosis and other conditions that do not carry that diagnosis this is called the zone of rarity and it's basically a zone that separates disorders from one another in the world of mental health there is no zone of rarity if you look at an instrument that measures for instance depression and let's say a score of 80 on that instrument indicates that somebody does have depression if we saw a score of 79 it would be safe to say in a lot of situations that that person would still likely have depression so the cutoff scores are really more or less arbitrary clinical judgment is required to figure out if somebody really has depression or any other mental disorder so with all this in mind let's take a look at the ICD verses the DSM so the ICD again is the International classification of diseases the first international classification edition was the International list of causes of death and this was published in 1893 in 1900 we see it officially called the ICD it wasn't until 1948 that morbidity was added so until then it only had mortality so morbidity is illness and mortality is death so we saw that morbidity came along again in 1948 with the sixth edition so ICD six the tenth revision of the ICD came out in 1990 ICD 10 and this is still widely used at this particular moment although icd-11 has been available since 2018 the ICD is available to the public and it can be viewed online at no cost it can also be downloaded in a PDF unlike the DSM which I'll talk about in a moment the ICD covers all disorders so the vast majority of its content is actually related to medicine and not mental health the mental health section is in a section referred to as mental behavioral and neurodevelopmental disorders so from here on out when I say ICD I'm really talking about this one section related to mental health the ICD is used by mental health counselors and other mental health professionals all over the world but is generally not used in the United States the ICD looks fairly similar to the DSM but there are some diagnoses that we see in the ICD that do not appear in the DSM for example I see the eleven has complex PTSD which takes some symptoms of PTSD and adds other symptoms like emotional dysregulation shame guilt and interpersonal conflict we see that icd-11 has gaming disorder a pattern of persistent or recurrent gaming behavior it has compulsive sexual behavior disorder which is listed as an impulse control disorder as opposed to an addictive disorder and it also has prolonged grief disorder one of the largest differences between the diagnoses in the ICD and the DSM is in the area of personality disorders and the ICD there is only one diagnosis simply called personality disorder which can be rated in terms of severity and in terms of six trait domain areas some of which correspond what we see categorically listed in a Diagnostic and Statistical Manual for example in the ICD we see the sociality and personality disorder it's kind of like a combination of antisocial and narcissistic personality disorder in the DSM we also see what the ICD refers to as borderline pattern which is a lot like borderline personality so in the DSM but then we see some personality disorders that don't really seem to have a correlate in the DSM like negative affectivity in person a sorter that's a personality disorder that has emotional lability negative attitudes low self-esteem low self-confidence and distrustful nough so again we don't really see something in the DSM that closely aligns with that disorder in terms of using the ICD to diagnose the symptoms are listed out and many are very similar to what we see in the DSM but there aren't really the same types of requirements right like for example the DSM we might see a diagnosis like borderline personality or where five of the nine characteristics have to be met for diagnosis but in the ICD really more heavily depends on clinical discretion so you could say that it uses guidelines and not criteria which really leaves a lot open to interpretation one counselor could diagnose a person in one way and another counsellor could treat the same client and diagnose them another so what we really see here is low reliability specifically low interrater reliability now moving over to the DSM again this is the Diagnostic and Statistical Manual the first DSM was published in 1952 that was DSM 1 DSM 2 was released in 1968 the first DSM that became really popular was DSM 3 in 1980 we saw 4 come out 94 and version 5 was released in 2013 the DSM is extremely popular in the United States we don't see it used too much in other countries it's published by the American Psychiatric Association but it's used by a number of different types of practitioners so not only psychiatrists but also counselors like me psychologists social workers marriage and family therapists and advanced practice nurses the advantage that DSM is that it operationalized definitions of disorders so it has a number of criteria that a client either meets or they don't meet if someone meets the number of criteria specified for diagnosis they get the diagnosis this is referred to as meeting the full criteria for a disorder which is a little confusing because it sounds like all the criteria have to be met but only the number that are specified have to be met so it's not always the case that all of the criteria have to be met for a diagnosis so the DSM has much better reliability than the ICD the inter-rater reliability is much higher and of course it doesn't allow in theory as much clinician freedom in terms of diagnosing so it appear that we have this trade-off right so with the DSM we have good operationalized definitions that are really clear to follow with the ICD we have a lot more freedom in diagnosing now the DSM has some disorders that are not included in the ICD like disruptive mood dysregulation disorder only appears in the DSM and it offers a much better description of each disorder including research findings around that disorder and the associated characteristics so a question I get a lot is which one is better right so I imagine if someone used the ICD when they were learning how to be a counselor they would probably like the ICD better and the same could be said of the DSM there is a tremendous amount of overlap between the two but if I had to choose one I would probably say I do like the DSM better simply because it gives more information about the disorders and it defines the disorders more clearly again we see specific criteria somebody meets or they don't meet as for the argument around clinical discretion somebody can use the DSM and still exercise clinical discretion the DSM is just a manual it doesn't demand anything of anybody it doesn't demand that a certain diagnosis be given if the criteria are met again it's essentially just a book it's a book that clinicians use to guide treatment a counselor decides how to diagnose a client not a book right so if somebody doesn't meet the full criteria for a disorder but the counselor is concerned of the client has it the counselor can always record something descriptive they can express the symptoms that were observed and explain their concern and say what diagnosis they suspect may be there or they can label the diagnosis with the term rule-out so if somebody meets the criteria for cyclothymic disorder for example but a clinician is concerned they may have bipolar two disorder the clinician can say the diagnosis is cyclothymic disorder rule out bipolar two disorder right so there's always that option to apply clinical discretion now we also see a lot more research on the DSM so the disorders in the DSM are studied and these findings are published in scientific literature that doesn't automatically make it a better manual but it does mean there's just more information about mental disorders from the DSM so if a clinician is interested in learning more about it's sorter because they have a client with that disorder there's just a lot they can read on that and that really is quite convenient a lot of times in clinical practice you have a presentation you have a certain set of disorders and you really need to learn more you really want to see what the details are what the research findings say in terms of some of the nuances of the disorder and just get more information about that in general and again with the DSM that's just a little bit easier because of the research base now in most settings in the United States if a clinician wants to use the ICD instead of the SM they can do that some practices only use the DSM so there are again certain places where that's not possible but generally counselors are free to choose and most do choose the DSM probably largely because they are introduced to the SM in school and because everyone else is already using it in clinical settings right so probably many counselors don't really seriously consider using the ICD and said that the SM and I think in most instances it just is easier to use the DSM when again everyone else around you is already using it if the DSM were outlawed tomorrow for whatever reason I don't know why that would happen but if that happened and the ICD became what was used all over the United States not a lot would change the ICD is a good manual again largely the same in terms of the disorders that we see in the DSM in the future if possible it would be convenient if the two manuals could be merged together into one manual but somehow I don't think that's gonna happen anytime soon so I know whenever I talk about topics like this the ICD verses the DSM there will be people who agree with me and those who disagree with me and those who have other examples from their own experiences please put those thoughts and opinions in the comments section they always generate early interesting dialogue as always I hope you found this description of the ICD and the DSM to be interesting thanks for watching