The ICD will also be easy to get, adds Reed. In addition
to the usual printed version, which will be inexpensive and
available at even lower cost to low- and middle-income
countries, the ICD- 11 will be available for free on the Internet.
A broader perspective
While most U.S. psychologists use the DSM to make diagnoses,
those working in neuropsychology, rehabilitation and other health
settings not strictly devoted to mental health services are already
familiar with the ICD, says APA President Suzanne Bennett
Johnson, PhD, a research professor in the medical humanities and
social sciences department at Florida State University.
As a psychologist in a health center, Johnson is one of them.
“The reality is that we are, and need to act as, a member of
the worldwide community,” she says. “We should be part of that
worldwide effort to address human health and not just be doing
our own thing here in the U.S., using a different code than other
The ICD also helps to integrate psychology into the larger
health-care delivery system, says Johnson. While the DSM
encourages mind/body dualism, she says, the ICD allows
children and older adults. Take mild neurocognitive disorder,
for example. “Older people, especially those in nursing homes,
are already victims of over-zealous prescribing of psychiatric
drugs,” says Elkins. “We believe mild cognitive disorder is a net
that is going to catch hundreds of thousands of baby boomers
who are now on their way to retirement and experiencing
expected, normal declines in cognitive function.”
psychologists to recognize mind/body connections. When
Johnson sees a child with diabetes, for example, she’s able to use
a Type- 1 diabetes code rather than a code for a mental health
disorder. “The ICD opens up a whole world where we can
provide services to all kinds of patients, including those with
mental disorders,” she says.
The ICD is also a boon to researchers, adds Johnson. “If you
want to make any comparisons between countries in terms of
mental health burden or anything else, you need a common
diagnostic system,” she says.
Johnson can foresee a day when U.S. psychologists will no longer
need the DSM. And that transition is about to begin, she says.
Most insurers already use ICD codes, she points out. That’s
because the Health Insurance Accountability and Portability
Act of 1996 requires the use of ICD codes as a diagnostic
standard. When a clinician submits a DSM diagnostic code, a
professional coder or the insurer then translates it into an ICD
code. Sometimes psychologists use software that “crosswalks”
the codes so they can do the translation themselves.
thousands of individuals who responded to calls for comment.
“This level of both internal and external review and field trial
exposure has never before been undertaken by any previous
DSM or ICD [International Classification of Diseases] revision
proposals,” the task force noted.
The response didn’t satisfy Elkins and his group, who note
that the British Psychological Society, American Counseling
Association and even DSM–IV Chair Allen Frances, MD,
have also raised concerns. In another open letter (see www.
response-to-letter-from-dsm-5-task.html), the Div. 32
group calls for an independent review of the controversial
proposals by experts unaffiliated with the American Psychiatric
In December, the American Psychological Association
Board of Directors called upon the DSM Task Force to ensure
that the revision process is based on the best available science,
improves treatment outcomes and considers the potential
impact of new classifications on vulnerable populations.
Psychology professor Frank Farley, PhD, of Temple University,
an APA past president, would like to go even further. He’d like
to scrap what he calls “a failed manifesto of mental illness”
and start over.
Citing the proliferation in the number of disorders with each
edition of the DSM, Farley says, “The DSM has really become a
diagnostic growth industry.”