New directions in classification of mental disorders: an Arab perspective

That is wrong with DSM IV and ICD-10? They are complex with too many chapters and numbers of disorders which increase sharply with each new edition, comorbidity, excessive use made of “Not Otherwise Classified” (NOC), within category heterogeneity and no place for subthreshold disorders. Has the right nosologic system been conceptualized? Are the right diagnostic categories and criteria being used? Has the diagnostic threshold been at the right level? Have the course and characteristics of disorders been correctly typified? Are existing diagnostic criteria being employed in an unbiased and culturally appropriate way? The goals of Psychiatric Classification are to bring “order to chaos”, to make research easier, to enable everyone to communicate clearly, to help clinicians determine prognosis and treatment and to satisfy sociocultural demands placed on psychiatry. Currently five main groups of psychiatric disorders exist: Neuro-cognitive disorders - disorders of cerebral tissue; Developmental Disorders - failures of normal development; Psychoses, loss of contact with reality; Externalizing Disorders, low constraint, disinhibition; and, Emotional Disorders – high neuroticism (“negative affect”). Those who are involved in DSM V and ICD-11 are deliberating dimensions or spectra or clusters, e.g. cognitive, psychotic, mood or affective, obsessive, externalizing (substance abuse, personality disorders), internalizing (high neuroticism, e.g. anxiety, depression, panic, phobia), bodily disorders (eating, sleep and sexual). The addition to the categorical system of continuous, “dimensional” measures into the various diagnostic domains might help resolve some of the critical taxonomic issues currently facing the field of mental health, especially the subthreshold disorders. Diagnosis in diverse cultures has some caveats namely: disparities that may be the result of misdiagnosis or nondiagnosis due to unfamiliarity with the culturally determined pathoplastic components of any clinical entity, differences in measures employed to assess psychiatric disorders that can generate response biases, discrimination, racism, social position, and even expectations about services and treatment that may cloud the diagnostic process . Linguistic limitations on the patient s and the clinician s side produce a formidable (and obvious) communication obstacle. Diagnosis in psychiatry is meant to reflect individual coping styles on the one hand, and customary treatment options on the other. Both factors are culturally charged and both are also parcels of the disparities field.