Reorganisation of DSMV can make it more clinically relevant.
Allan Frances is concerned that the first draft of DSMV may
inadvertently add to the variety of influences that 'fan the
flames of false positive diagnoses'1. But the proposals for
DSMV share a number of new approaches for which there is
already support from British psychiatrists and deserve to be
considered. The Royal College of Psychiatrists has recently
submitted proposals to the independent consultation for
ICD11 which is being developed in harmony with DSM. These
make the case for a diagnostic system with broad categories
and clinically relevant specifiers2. A much improved,
integrated and useful classification would result which can
embrace entry groups: psychosis unspecified and common
mental disorders, narrowing to categories such as
neuropsychiatric, affective and non-affective psychoses,
emotional, substance misuse and developmental disorders.
Specifiers for individual categories would be those which
are clinically relevant, e.g. childbirth-related, co-
existing drug misuse, or personality type3. Continuity
between childhood disorders, such as conduct disorder and
ADHD, and their adult counterparts would also be
incorporated. Classification systems need to be inclusive
but only to the extent that they are comprehensible and
useful for clinicians, researchers, managers, service users
and carers. The scientific evidence for benefit over risk
must first be developed and rigorously tested before
broadening the scope of classification to include less
severe forms of presentation but doing so could also
potentially allow for earlier intervention and even
prevention of mental disorder.
(1) Frances A. The first draft of DSM-V. BMJ
(Clinical Research Ed ) 2010; 340:1168.
(2) Royal College of Psychiatrists. Submission
to World Health Organisation on ICD11. London: Royal College
of Psychiatrists; 2010.
(3) Kingdon D, Afghan S, Arnold R, Faruqui R,
Friedman T, Jones I et al. A diagnostic system using broad
categories with clinically relevant specifiers: lessons for
ICD 11. International Journal of Social Psychiatry 2010; in
press.
Dinesh Bhugra, Safi Afghan, Rafey Faruqui, Trevor Friedman, Ian Jones, Peter B. Jones, Dasha Nicholls, F. Anthony O’Neill, Asif Ramzan, Hugh Series, Ekkehart Staufenberg, Terry Brugha.
University of Southampton, Royal South Hants Hospital, Southampton SO14 OYG
Rapid Response:
Reorganisation of DSMV can make it more clinically relevant.
Allan Frances is concerned that the first draft of DSMV may
inadvertently add to the variety of influences that 'fan the
flames of false positive diagnoses'1. But the proposals for
DSMV share a number of new approaches for which there is
already support from British psychiatrists and deserve to be
considered. The Royal College of Psychiatrists has recently
submitted proposals to the independent consultation for
ICD11 which is being developed in harmony with DSM. These
make the case for a diagnostic system with broad categories
and clinically relevant specifiers2. A much improved,
integrated and useful classification would result which can
embrace entry groups: psychosis unspecified and common
mental disorders, narrowing to categories such as
neuropsychiatric, affective and non-affective psychoses,
emotional, substance misuse and developmental disorders.
Specifiers for individual categories would be those which
are clinically relevant, e.g. childbirth-related, co-
existing drug misuse, or personality type3. Continuity
between childhood disorders, such as conduct disorder and
ADHD, and their adult counterparts would also be
incorporated. Classification systems need to be inclusive
but only to the extent that they are comprehensible and
useful for clinicians, researchers, managers, service users
and carers. The scientific evidence for benefit over risk
must first be developed and rigorously tested before
broadening the scope of classification to include less
severe forms of presentation but doing so could also
potentially allow for earlier intervention and even
prevention of mental disorder.
(1) Frances A. The first draft of DSM-V. BMJ
(Clinical Research Ed ) 2010; 340:1168.
(2) Royal College of Psychiatrists. Submission
to World Health Organisation on ICD11. London: Royal College
of Psychiatrists; 2010.
(3) Kingdon D, Afghan S, Arnold R, Faruqui R,
Friedman T, Jones I et al. A diagnostic system using broad
categories with clinically relevant specifiers: lessons for
ICD 11. International Journal of Social Psychiatry 2010; in
press.
Corresponding author:
David Kingdon dgk@soton.ac.uk
Competing interests:
None declared
Competing interests: No competing interests