Reflections on the clinical utility of the ICD-10 and DSM-IV classifications and their diagnostic criteria

Objective: The change to non-theoretical, criteria-based diagnostic classification in ICD-10 and DSM-III/IV has presented a major innovation in clinical psychiatry. The aim of the present paper is to provide a provisional evaluation of their utility in clinical practice, Method: The method involved a close scrutiny of ICD-10 and DSM-IV with a view to identifying difficulties and problems in their use. Results and Conclusions: The criteria-based classifications are no longer just coding conventions, but have become part of the conceptual framework of the discipline itself. The advantages, particularly as to the quality and reliability of clinical diagnoses, outweigh the disadvantages with temptations to mechanistic and reductionistic applications of criteria and incomplete nosological evaluation. Comprehensive clinical evaluation, however, should work at two separate levels: one, the initial, syndromatical diagnostic level, followed by the other, the nosological level, with evaluation of factors possibly influencing course and outcome of the psychiatric disorders. Only when both the syndromatical diagnosis and nosological factors are taken into consideration, is it possible to get a full understanding of the disorder necessary for optimal treatment. In this way, clinical psychiatry can be kept as it was intended: a healing discipline.