Increasing Clinical Utility by Aligning the DSM and ICD With Clinicians' Conceptualizations

• Published in: Professional psychology, research and practice Vol. 41; no. 6; pp. 474 - 481
• Main Authors: Flanagan, Elizabeth H, Blashfield, Roger K
• Format: Journal Article
• Language: English
• Published: Washington American Psychological Association 01-12-2010
• Subjects: Classification; Clinical Practice; Clinicians; Concept Formation; Concepts; Conceptualization; Diagnostic and Statistical Manual; Emotional responses; Emotions; Health Personnel Attitudes; Human; International Classification of Diseases; Medical diagnosis; Medical treatment; Mental Disorders; Mental Health Personnel; Mental illness; Psychiatric disorders; Stigmatization; Taxonomy; United States > US; clinicians; ICD; classification; clinical utility; DSM
• ISSN: 0735-7028; 1939-1323
• DOI: 10.1037/a0021603

Clinicians are trained to conceptualize and diagnose mental disorders according to their depiction in the
Diagnostic and Statistical Manual of Mental Disorders
(
DSM
) and International Classification of Diseases (ICD). But to what extent do the
DSM
and ICD truly represent the way that clinicians think about mental disorders? We outline the history of studies examining how clinicians think about mental disorders and discuss our current research on clinicians' natural taxonomies of mental disorders, which compares clinicians' conceptualization of mental disorders with their depiction in the
DSM
and the ICD. We make practical suggestions for how to make the
DSM
and ICD more like the way clinicians think about mental disorders to improve its clinical utility. We argue that the
DSM
and ICD would be more useful to clinicians if it had fewer categories, fewer diagnostic levels, removed the Axis I-II distinction used in the
DSM
, and included practical considerations such as treatment access (and the role of insurance companies in the United States or the local economy in developing countries), stigma, and clinicians' emotional reactions. Another way the
DSM
and ICD could be more useful to clinicians is if they more accurately represented the way that mental illness is experienced by the person who has the mental illness. Continued research of clinicians' conceptualization of mental disorders is necessary to make the
DSM
and ICD as useful to clinicians as possible.