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Classification systems in psychiatry: diagnosis and global mental health in the era of DSM-5 and ICD-11

Stein, Dan J.a; Lund, Cricka; Nesse, Randolph M.b

doi: 10.1097/YCO.0b013e3283642dfd

Purpose of review The development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and- of the 11th edition of the International Classification of Disease (ICD-11) have led to renewed attention to the conceptual controversies surrounding the nosology of mental disorder. This article reviews recent work in this area, and suggests potential ways forward for psychiatric nosology, focusing in particular on the need for improved classification approaches for public and global mental health.

Recent findings DSM-5 and ICD-11 have taken somewhat different approaches, but both appropriately emphasize the importance of clinical utility and diagnosic validity in psychiatric nosology. The Research Domain Criteria framework provides a useful focus on the individual-level causal mechanisms that are relevant to vulnerability to mental disorder. An analogous approach to societal-level causal mechanisms would be useful from a public and global mental health perspective.

Summary In their day-to-day work, clinicians will continue to use the fuzzy constructs operationally defined and narratively depicted in DSM-5 and ICD-11. Advances in our understanding of the individual-level and society-level causal mechanisms that contribute to vulnerability to mental disorder may ultimately lead to improved classification systems, and in turn to better individualized care as well as improved global mental health.

aDepartment of Psychiatry, University of Cape Town, South Africa

bDepartment of Psychiatry, University of Michigan, USA

Correspondence to Dan J. Stein, UCT Department of Psychiatry, Groote Schuur Hospital J2, Observatory 7925, Cape Town, South Africa. Tel: +27 21 406 6566; e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins