History and Development of ICD and DSM

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Evolution of the International Classification of Diseases (ICD)

In 1948, the World Health Organization (WHO) took charge of the classification system,
which expanded the ensuing time to include rendering for causes of morbidity and mortality.
The system was rechristened the International Classification of Disease system. Under the
aegis of the WHO, International Classification of Diseases (ICD) development continued
more predictably.

ICD 1 – 5
The first 5 performances of the ICD system were each entirely contained within a single
volume. That volume included an alphabetic indicator and an irregular list.
ICD – 6
By the sixth modification, the rendering system included morbidity and mortality
designations and needed 2 volumes. Most importantly, ICD-6 expanded to include a section
on psychiatric diseases. This sixth interpretation was now called the Manual of the
International Statistical Classification of Diseases, Injuries, and Causes of Death. The ICD-6
extended the compass of the classification to nonfatal diseases, and WHO has continued to be
responsible for periodic variations of the classification. With a need to produce community at
the transnational position in public health and in clinical exploration, more and more clinical
generalities have been introduced.
ICD - 7
The International Conference for the Seventh Alteration of the International Classification of
Diseases was held in Paris under the aegis of WHO in February 1955. In agreement with a
recommendation of the WHO Expert Committee on Health Statistics, this modification was
restricted to changes and amendments of wrongdoings and inconsistencies.
ICD - 8
The Eighth Revision Conference convened by WHO met in Geneva, from 6 to 12 July 1965.
This modification was more radical than the Seventh but left unchanged the fundamental
structure of the Classification and the general doctrine of classifying diseases, whenever
possible, according to their etiology rather than a particular externalization. During the ages
when the Seventh and Eighth modifications of the ICD were in force, the use of the ICD for
indexing clinic medical histories increased quickly. Some countries fixed public adjustments
which handed the added detail demanded for this operation of the ICD.
ICD - 9
The International Conference for the Ninth Modification of the International Classification
of Diseases, summoned by WHO, met in Geneva from 30 September to 6 October 1975. In
the exchanges leading up to the conference, it had initially been intended that there should be
little change other than contemporizing the classification. The final Conference retained the
fundamental structure of the ICD, although with important added detail at the position of the
four-number subcategories, and some voluntary five-number services. For the benefit of
users, no taking similar detail, care was taken to ensure that the orders at the three-number
position were applicable. For the users wishing to produce statistics and indexes acquainted
with medical care, the Ninth modification included a voluntary volition system of classifying
individual statements, including information about both an underpinning general complaint
and an externalization in a particular organ or point. Several other specialized inventions
were included in the Ninth Revision, aimed at adding its inflexibility for use in various
situations. The Conference also made recommendations on several affiliated specialized
subjects rendering rules for mortality were amended slightly and rules for the selection of a
single cause for the tabulation of morbidity were introduced; delineations and
recommendations for statistics in the field of perinatal mortality were amended and extended
and an instrument of causes of perinatal death was recommended; countries were encouraged
to do farther work on multiple- condition coding and analysis, but no formal styles were
recommended; and a new introductory tabulation list was produced.
ICD - 10
The earliest effort on ICD-10 ended in 1992. The ICD-10-CM was also introduced for its
periodic process of reconsideration in 1992. The current modification, the ICD-10, consists of
three volumes, and for accurate coding all three volumes are necessary. Volume I contains
the irregular list, as well as some descriptions and the WHO nomenclature ground rules.
Volume II is the manual with an expansive description of the classification and approaches
for application in mortality and morbidity, containing shortlists. Volume III is the
alphabetical indicator. It contains individual indicators for diseases, extraneous causes, and
medicines substances. The structure and the content of ICD-10 are substantially grounded on
scientific knowledge at the time of its creation, as well as on former editions, and earn
thorough modification. Overall, ICD-10 is available in 42 languages. ICD-10 is much more
granular than ICD-9, with an expansion from 17,000 codes to roughly 155,000. When ICD-9
and ICD-10 are compared, several differences in title are incontinently egregious. ICD-9-CM
codes are three to five characters in length, while ICD-10-CM codes are three to seven
characters in length. ICD-9-CM encompassed just more than 14,000 codes, but ICD-10-CM
will have over 69,000 codes to start. Implicit in this rendering redesign, ICD-10-CM will
have increased inflexibility for adding new codes when compared to ICD-9-CM. To
accommodate this increase, where ICD-9-CM rendering consists of a first character that
could be alphanumeric
(first character E or V or numeric), ICD-10-CM consists of a first character that can be
alphanumeric, characters 2 and 3 that are numeric, and characters 4 through 7 that can be
alphanumeric. By computation, ICD-10-CM can potentially accommodate close to 375,000
codes. With the capability to decode for multitudinous contingencies, ICD-10-CM can be
veritably specific and detailed. Where ICD-9-CM demanded the capability to distinguish
laterality, the ICD-10-CM language can distinguish between left- and right-sided judgments.
The 11th modification of ICD is long overdue, specifically presenting that ICD-10 is now
further than 25 times old.
ICD–11 and Comparison with ICD - 10
Following the multinational collaboration and reconsideration of all the codes,
categorizations, and classifications, On May 25, 2019, the 72nd World Health Assembly
unanimously suggested borrowing ICD-11. Over a decade, this newest version in the making
showed notable progress in science and drugs in the clinical context. The classification
system went through a major redesign. It is now structured as a database that includes up to
13 codes, with changes ranging from making it easier to use and more suitable to support data
collection on morbidity, to lowering cost. It also has a new name ICD-11 for Mortality and
Morbidity Statistics (ICD-11-MMS). Bringing ICD into the 21st century, updates include a
fully digital design easy integration with electronic health exercises and information systems;
much better capability that addresses multiple contents, similar to bringing in quality and safe
healthcare data; and a more user-friendly format. The structure of ICD-11 is defined in
linearization that incorporates properties and attributes with a focus on mortality, morbidity,
public health, the degree of direct care, and exploration. These advancements have made
ICD-11 far more detailed and comprehensive than its forerunners. This version contains over
55,000 codes and is capable of linking with other ICD groups, similar to the International
Classification of Functioning, Disability, and Health (ICF), and the International
Classification of Primary Care (ICPC). In addition to being suitable to produce digital
attestation on a coarse position, ICD-11, for the first occasion, “will enable binary coding of
traditional medicine determinations alongside mainstream medicine and now it also permits
the generation of a performing score grounded on the WHO Disability Assessment Schedule
(WHODAS),” under the WHO commission or Transition companion.

Tabular lists New methods

Fit for a particular: reporting morbidity, Pre-coordination and system codes
mortality, or other uses Post- coordination (optional extension codes)
Entities of the foundation become categories Sanctioning rules
That are jointly exhaustive and mutually Multiple parenting
inclusive of each other Linearization

New contents New and improved tools

In several instances, new chapters Browsing tools
Disorders of the Immune System Transition tools
Disorders of blood and blood-forming organs Mapping tool
Conditions related to sexual health Proposal tools
Sleep-wake disorders
Traditional medicines
Extension codes

The new codes look different than those in ICD-10 and have a simplified structure. There is
also a big difference in the number of pre-coordinated codes, with 14,622 codes in ICD-11 to
that of 71,932 codes in ICD-10-CM. Still, with post-coordination, the number of codes
possible is much larger. ICD-11 introduced two citable features which include., extensions
and clustering that enabled two kinds of post-coordination and the addition of specific detail
to coded realities. Both these features have the eventuality to enhance ICD-11 code data.
 Evolution of DSM

DSM- 1

The APA Committee on Nomenclature and Statistics developed a variant of the ICD–6 that
was published in 1952 as the first edition of DSM. DSM contained a glossary of descriptions
of the diagnostic categories and was the first official manual of mental disorders to focus on
clinical use. The use of the term “reaction” throughout DSM reflected the influence of Adolf
Meyer’s psychobiological view that mental disorders represented reactions of the personality
to psychological, social, and biological factors.
The DSM-1 contained 102 very broad diagnostic categories that were based on
psychodynamic (Freudian) principles. The diagnostic categories were divided into two major
groups of mental disorders that included:
 Conditions that were assumed to be caused by some type of brain dysfunction.
 Conditions that were assumed to be the result of the effects of environmental stress in a
person and resulted in an inability to adapt.

The second group was subdivided into

(1) psychoses: severe conditions, such as schizophrenia and manic-depressive disorder, and
(2) psychoneuroses, which included personality disorders, depression, and anxiety-related
conditions.
Despite the development of an organized classification system with diagnostic categories, the
manual had very little diagnostic utility and exhibited little influence on the diagnostic
process. This set the stage for the development of a second edition of the DSM.

DSM- 2

DSM–II was similar to DSM but eliminated the term “reaction.”

The DSM-II was published in 1968 but still had criticism over its validity and reliability.
Changes in the DSM-II included eleven major diagnostic categories, with 185 total diagnoses
for mental disorders. Additionally, increased attention was given to children and adolescents
in the DSM-II. For example, the diagnostic category of Behavior Disorders of Childhood-
Adolescence was presented for the first time.

In 1974, the seventh printing of the DSM-II no longer listed homosexuality as a disorder.
During the 1960s and 1970s, critics like Thomas Szasz challenged the DSM's fundamental
principle that psychiatric conditions were real illnesses. The lack of clear boundaries between
mental health, normal behavior, and illness, and the low reliability of the psychiatric
categories in the DSM-2 were criticized.
DSM- 3
The DSM-3 was released in 1980, with 265 diagnostic categories and the removal of many
psychiatric terms. It also included novel disorders, such as post-traumatic stress disorder and
attention deficit disorder. As with the DSM-II, many significant changes were made in the
third edition of the DSM. For example, previously many of the anxiety disorders were
lumped together as one diagnosis of Anxiety Neurosis. The DSM-III broke that broad
diagnosis down to include many different anxiety disorders such as generalized anxiety
disorder (GAD), panic disorder, agoraphobia, and social phobia. The term “neurosis” was
removed from the DSM-III altogether. Furthermore, social issues came into play with the
development of the DSM-III. Racism was considered a mental disorder to be added, but after
much deliberation and research was not included. Post-traumatic stress disorder was added to
the DSM at this time. Also, the DSM-II category of “sexual orientation disturbance” was
changed to ego-dystonic homosexuality.
The DSM-3 is considered the benchmark in the change of focus of the diagnostic system of
psychiatry, moving toward more biologically oriented views of mental illness and shunning
Freudian principles.
DSM-3 R

In 1987, the APA published a revised edition of the DSM-3 that renamed and reorganized
certain categories and made changes in the diagnostic criteria of others. The DSM-3-
R contained 292 diagnostic categories and removed several controversial diagnoses including
ego-dystonic homosexuality. Interestingly, this manual was significantly longer than other
manuals (567 pages). The concentration on diagnostic reliability began with the DSM-3, and
it continued in the DSM-3-R. Before these editions, it was not uncommon for two different
psychiatrists assessing the same individual to give different diagnoses. This was a major

criticism of earlier editions of the DSM.

 DSM- 4

The revision in 1994, the DSM-4 was published, listing 297 different disorders over 886
pages. The other major change was the addition of the descriptive diagnostic term clinical
significance. This criterion indicated that the symptoms displayed by the person must result
in “clinically significant distress or impairment in social, occupational, or other important
areas of functioning” for them to receive a specific diagnosis. Other minor changes and
diagnoses were deleted or removed.

DSM- 4 TR

In 2000, the DSM-4-TR was published. The diagnostic categories in this revision remained
essentially the same, and the text sections describing certain aspects of the diagnostic criteria
were updated and revised. In addition, the manual used a five-part axial diagnostic system
that incorporated several different dimensions of diagnoses, including:
 Axis I: the clinical syndromes
 Axis II: personality and developmental disorders (mental retardation)
 Axis III: general medical conditions
 Axis IV: psychosocial and environmental issues
 Axis V: global assessment of functioning (rated on a scale of 0-100)

DSM- 5

In 2013, the DSM-5 was released, which had several significant changes. For example:

 Several disorders were deleted (e.g., subsets of autism spectrum disorder, such as Asperger’s
syndrome, classic autism, Rett syndrome, etc., in favor of one overall diagnosis).
 The traditional five subtypes of schizophrenia were deleted.
 Schizophrenia was conceptualized as a singular disorder.
 Other disorders were given their own category (e.g., post-traumatic stress disorder) or
changed significantly (e.g., somatization disorder).
DSM- 5 TR

The DSM-5-TR development effort started in 2019 and involved more than 200 experts, the
majority of whom were involved in the development of DSM-5. These experts were given the
task of conducting literature reviews covering the past nine years and reviewing the text to
identify out-of-date material. Four cross-cutting review groups (Culture, Sex, and Gender,
Suicide, and Forensic) reviewed all the chapters, focusing on material involving their specific
expertise. The text was also reviewed by a Work Group on Ethno Racial Equity and Inclusion
to ensure appropriate attention to risk factors such as racism and discrimination and the use of
non-stigmatizing language. Although the scope of the text revision did not include conceptual
changes to the criteria sets, some necessary clarifications to certain diagnostic criteria were
reviewed and approved by the DSM Steering Committee, as well as the APA Assembly and
Board of Trustees. DSM-5-TR was published in March 2022.
Comparison of the ICD‐11 vs. the DSM‐5 meta-structure

ICD‐11 DSM‐5

Neurodevelopmental Disorders Neurodevelopmental Disorders

Schizophrenia and Other Primary Schizophrenia Spectrum and Other

Psychotic Disorders Psychotic Disorders
Catatonia
Bipolar and Related Disorders
Mood Disorders
Depressive Disorders
Anxiety and Fear‐Related
Anxiety Disorders
Disorders
Obsessive‐Compulsive and Related Obsessive‐Compulsive and Related
Disorders Disorders
Disorders Specifically Associated Trauma‐ and Stressor‐Related
with Stress Disorders
Dissociative Disorders Dissociative Disorders
Feeding and Eating Disorders Feeding and Eating Disorders
Elimination Disorders Elimination Disorders
Somatic Symptoms and Related
Disorders of Bodily Distress and Disorders (not in the same order as
Bodily Experience ICD‐11; placed before Feeding and
Eating Disorders)
Disorders Due to Substance Use Substance‐Related and Addictive
and Addictive Behaviours Disorders
Impulse Control Disorders
Disruptive, Impulse‐Control, and
Disruptive Behaviour and Conduct Disorders
Dissocial Disorders
Personality Disorders (not in the
Personality Disorders and Related
same order as ICD‐11; placed after
Traits
Neurocognitive Disorders)
Paraphilic Disorders (not in the same
Paraphilic Disorders order as ICD‐11; placed after
Personality Disorders)
Not a separate grouping but included
Factitious Disorders in Somatic Symptom and Related
Disorders
Neurocognitive Disorders Neurocognitive Disorders
Mental or Behavioural Disorders Not a separate grouping; perinatal
 ICD‐11 DSM‐5
Associated with Pregnancy, specifiers available for specific
Childbirth and the Puerperium disorders
Secondary Mental or Behavioural
Not a separate grouping but included
Syndromes Associated with
within the disorder groupings with
Disorders or Diseases Classified
which they share phenomenology
Elsewhere
Psychological and Behavioural Not a separate grouping but included
Factors Affecting Disorders or - in Somatic Symptom and Related
Diseases Classified Elsewhere Disorders
Sleep‐Wake Disorders (within mental
Sleep‐Wake Disorders (Chapter 7) disorders; placed after Elimination
Disorders)
Sexual Dysfunctions (placed in Sexual Dysfunctions (within mental
Chapter 17, Conditions Related to disorders; placed after Sleep‐Wake
Sexual Health) Disorders)
Gender Incongruence (placed in Gender Dysphoria (within mental
Chapter 17, Conditions related to disorders; placed after Sexual
Sexual Health) Dysfunctions)

Which is better and why?

I prefer DSM-5 over ICD-11 because of its specialized focus on mental health. It provides
more detailed diagnostic criteria for mental disorders, which helps in understanding various
conditions. Also provides in-depth guidance for mental health professionals about the
symptoms, courses, and features of mental disorders aiding them in making comprehensive
assessments, treatment planning, and tailoring interventions for patients. It focuses on
behavioral and psychological aspects, which allows for a more precise characterization of
mental health conditions. Additionally, the editions of the DSM are more regularly updated to
the recent research. On the other hand, ICD-11 serves a broader healthcare context including
a wide range of medical conditions. Thus, it depends on the utility and context in which they
are used.
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