Psychologists' Perspectives on the Diagnostic Classification of Mental Disorders: Results from the WHO-IUPsyS Global Survey

Abstract

BACKGROUND/PURPOSE: Revisions are underway for the two major diagnostic classification systems (DCSs) of mental disorders, the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). For the World Health Organization (WHO), improving clinical utility is a major priority for the ICD-11. International clinician surveys are informative in this regard, but such research has not been conducted among psychologists. This study investigates psychologists' views on DCSs in mental health care and how these views differ across countries, regions, and ICD-10 versus DSM-IV users. METHODS: WHO and the International Union of Psychological Science conducted an international online survey examining views of DCSs as part of the ICD revision process. Participants were 2,155 psychologists from 23 national psychological associations around the globe. Items addressed practical and conceptual issues related to DCSs and their clinical use. RESULTS: Majorities of participating psychologists were licensed, seeing patients, made diagnoses, and used a DCS regularly, the slight majority using the ICD-10 most often. The vast majority viewed the primary purpose of DCSs to be informing treatment decisions and facilitating clinical communication. Flexible diagnostic guidelines were preferred to strict criteria. Most respondents agreed that dimensional classification, severity, and functional impairment should be incorporated into a DCS, but with little agreement as to how or why. Significant percentages reported problems with their DCS including cross-cultural applicability, Western bias, stigmatizing terms, and a need for a national DCS. Clinicians favorably evaluated the ease of use and goodness of fit of most diagnoses, but identified some as problematic. There were more differences among regions and countries than between ICD-10 and DSM-IV users. CONCLUSIONS: Overall, psychologists' views reflect favorably upon the current ICD-10 and DSM-IV systems and categories, while also identifying areas for improvement. Findings underscore the priority of clinical utility in a DCS, the diverse purposes it must serve, and professional and cultural differences among its international users. Differences associated with countries/regions, DCSs, and psychologists and psychiatrists may be partially explained by country-level differences in health systems, cultural factors, and psychology. Implications for ICD-11 revisions, field trials, dissemination, and training efforts are discussed.