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Exploring the feasibility of a meta-structure for DSM-V and ICD-11: could it improve utility and validity?

Paper 1 of 7 of the thematic section: ‘A proposal for a meta-structure for DSM-V and ICD-11’

Published online by Cambridge University Press:  01 October 2009

G. Andrews ,
D. P. Goldberg ,
R. F. Krueger ,
W. T. Carpenter Jr. ,
S. E. Hyman ,
P. Sachdev  and
D. S. Pine
G. Andrews*
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia
D. P. Goldberg
Affiliation:
Institute of Psychiatry, King's College, London, UK
R. F. Krueger
Affiliation:
Departments of Psychology and Psychiatry, Washington University in St Louis, USA
W. T. Carpenter Jr.
Affiliation:
University of Maryland School of Medicine, the Maryland Psychiatric Research Center, and the VISN 5 Mental Illness Research, Education and Clinical Center, Baltimore, MD, USA
S. E. Hyman
Affiliation:
Harvard University, Cambridge, MA, USA
P. Sachdev
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia
D. S. Pine
Affiliation:
National Institute of Mental Health, Bethesda, MD, USA
*
*Address for correspondence: Professor G. Andrews, 299 Forbes Street, Darlinghurst, NSW, Australia2010. (Email: gavina@unsw.edu.au)
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Abstract

Background

The organization of mental disorders into 16 DSM-IV and 10 ICD-10 chapters is complex and based on clinical presentation. We explored the feasibility of a more parsimonious meta-structure based on both risk factors and clinical factors.

Method

Most DSM-IV disorders were allocated to one of five clusters as a starting premise. Teams of experts then reviewed the literature to determine within-cluster similarities on 11 predetermined validating criteria. Disorders were included and excluded as determined by the available data. These data are intended to inform the grouping of disorders in the DSM-V and ICD-11 processes.

Results

The final clusters were neurocognitive (identified principally by neural substrate abnormalities), neurodevelopmental (identified principally by early and continuing cognitive deficits), psychosis (identified principally by clinical features and biomarkers for information processing deficits), emotional (identified principally by the temperamental antecedent of negative emotionality), and externalizing (identified principally by the temperamental antecedent of disinhibition).

Conclusions

Large groups of disorders were found to share risk factors and also clinical picture. There could be advantages for clinical practice, public administration and research from the adoption of such an organizing principle.

Keywords

ClassificationDSM-VICD-11mental disordersmeta structure
Type
Thematic section: A proposal for a meta-structure for DSM-V and ICD-11
Information
Psychological Medicine , Volume 39 , Issue 12 , December 2009 , pp. 1993 - 2000
Copyright
Copyright © Cambridge University Press 2009

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