DSM-5-TR and ICD-11
The two main diagnostic systems in mental health: the DSM (American, used heavily in research and US practice) and the ICD (global, used for health statistics and in most countries' services). Both define conditions by lists of symptoms and duration.
What drives it
They give clinicians, insurers and researchers a shared language so that 'major depression' means roughly the same thing everywhere; useful for identification as a checklist of what clinicians look for, but not a map of how minds actually divide.
How it shows
Work
Shows up in sick notes, occupational health reports and accommodations: a diagnosis is often needed to access support. People may introduce themselves with labels ('I'm ADHD', 'he's a narcissist') borrowed loosely from these systems.
Relationships
Labels from the manuals travel into everyday conflict ('You're bipolar', 'She's borderline'), often as accusations; they frequently reduce curiosity rather than increase understanding.
Self
You notice yourself sorting people into diagnostic boxes, or finding relief or a threat in a label for yourself. The useful question is what the label explains and what it hides.
What tells it apart
HiTOP (dimensional model of psychopathology): DSM and ICD sort people into yes-or-no categories; HiTOP measures dimensions on a continuum and groups symptoms by how they actually co-occur in data.
Personality disorder (general concept and dimensional model): ICD-11 already dropped most named personality disorder types in favour of a severity rating plus trait domains, while DSM-5-TR still lists the ten categories; this is the clearest live example of the shift towards dimensions.
Comorbidity: High comorbidity is partly a product of the categorical systems: overlapping criteria and arbitrary cut-offs produce multiple diagnoses in one person.
A test
When a diagnosis comes up, ask what specific behaviours it rests on and who made it; trust it more when it comes from a full professional assessment over time rather than from a questionnaire or a colleague.
Questions to carry
- When a diagnosis comes up, which specific behaviours does it rest on, and who made it, over what time?
- Which label have I given myself or someone else without a full assessment, and what does it let me stop asking?
How strong the research is
moderate. Criteria-based diagnoses improved reliability, but many categories have questionable validity, high comorbidity and arbitrary thresholds.
Where it comes from
DSM-I by the American Psychiatric Association, 1952; DSM-III led by Robert Spitzer, 1980; DSM-5, 2013; DSM-5-TR, 2022; ICD-11 by the World Health Organization, adopted 2019, in effect 2022
Sources
- American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (2013)