The development of modern classifications

In the 1960s and 1970s diagnosis and classification were criticized by antipsychiatry and psychoanalysis. Many psychotherapists argued that diagnosis and classification distracted from the understanding of the individual personal problems and that they missed an acceptable goodness of fit of the diagnostic categories. On the other hand, many psychiatrists, especially those working in the field of psychopharmacological research, believed that a consistent system of diagnosis and classification was necessary.(2 26) In the United States, in reaction to the dominating psychoanalytic psychiatry, so-called 'neokraepelinianism' (27) emerged, harking back to the diagnoses and nosology of Kraepelin. The Feighner criteria (28) and later the Research Diagnostic Criteria(29) were developed for scientific purposes, and were specialized precursors of later classifications, of which DSM-III(30) should be regarded as the first large system.

The long developmental history of psychiatric classification, beginning with the diagnostic schemes of rather a few famous psychiatrists and culminating today in a consensus by many national and international experts,(31) characterizes the road to the current version of the International Classification of Diseases (ICD-10) and the American national system of psychiatric classification, the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)(32> (these classifications are reproduced at the end of this chapter). This implies that only one or two relevant classifications will survive. Nevertheless, it is hoped that certain diagnostic and classificatory tendencies or geographically determined differences in certain disorders will continue.

The first international classification of diseases in 1855 was concerned with a nomenclature of causes of death. (33) After many revisions this list was adopted by the World Health Organization (WHO) in 1948 and the so-called Sixth Revision of the International Statistical Classification of Diseases, Injuries and Causes of Death (ICD-6) was produced.(34) It was only after the eighth revision that the ICD(35) was accepted by psychiatrists in many countries. In this edition a glossary was published for the first time. This short description of the disorders, largely based on British views, was produced by a working group chaired by Sir Aubrey Lewis. About 10 years later the ninth revision(36) was introduced with only minor changes.

The lack of multiaxiality, the difficulties in classifying depressions and other affective disorders, the problems of diagnosing sexual disorders, and especially the insufficient description of the disorders, which in turn caused low reliability, led American psychiatrists to construct a completely new system of classification, which differed radically from that of the WHO system, in the Third Revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).(30)

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