The structure of DSMIV

DSM-IV is not a general medical classification but comprises only mental disorders. The structure of DSM-IV resembles that of Chapter V of ICD-10, except that the disorders of childhood and adolescence are considered in the first chapters, followed by the chapter on organic mental disorders, which is entitled 'Delirium, dementia, amnesic and other cognitive disorders'. The title of the chapter was changed from the earlier 'Organic disorders' since research data suggest that many other mental disorders have some kind of somatic aetiology.

The difference between DSM-IV and ICD-10 in the time criterion for the diagnosis of schizophrenia has already been mentioned, as has the distinction between conversion and dissociative disorders made in DSM-IV but not in ICD-10. Furthermore, the two systems classify eating disorders differently. DSM-IV includes two distinct forms of anorexia (the restricting type and the binge eating type) and two distinct types of bulimia (the purging and the non-purging types), whereas ICD-10 only includes only anorexia, bulimia, and their (undefined) atypical forms.

Apart from these specific differences there are some structural distinctions. DSM-IV exists in one version only, so that no differences are made between diagnostic guidelines for clinical practice, for research criteria, and for use in primary health care. This may assist in the use of the DSM diagnostic criteria in research because they are primarily meant for scientific work. In some instances, however, such as in general practice, the application may be more difficult because there is no simpler version of the system. Social and occupational criteria have been avoided as far as possible in ICD-10 because of the difficulty of equating these criteria between various cultures, but they are used in DSM-IV which is a national classification. Another difference, which has been mentioned earlier, concerns the use of multiple axes.

Owing to difficulties with the registration and insurance systems, code numbers in the American edition of DSM-IV are still analogous to those of ICD-9—Clinical Modification (ICD-9-CM). However, the international edition and several translations (e.g. the German translation) have adopted ICD-10 code numbers. In about the year 2000 the United States will be ready to adopt the ICD-10 coding system and will introduce ICD-10 as a whole (i.e. for all medical disciplines). The American edition of DSM-IV will then use the same code numbers as ICD-10, Chapter V (F), but the textual differences will remain. DSM-IV provides much additional information, for example on prevalence, stress in the family or at work, and differential diagnoses. Thus it is not only a diagnostic manual but also a textbook, although without information about therapy.

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Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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