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Re: DSM versus ICD

Posted by simcha on December 3, 2004, at 16:24:25

In reply to Re: DSM versus ICD, posted by ed_uk on December 3, 2004, at 14:59:21

I prefer the ICD. Now I'll make my case...

This applies to the USA:

The DSM classifications get used by insurance companies, governmental agencies, other mental health professionals to pigeon-hole clients in nice neat boxes. Once these clients are pigeon-holed, depending on the condition, they may or may not help the client to the extent that they actually need.

For example, if you get a diagnosis of Bipolar Disorder and you want to get private medical insurance because you've been layed-off of a job and you have run out of COBRA, you will not get the insurance or you will be charged at least $2000 per month, which basically amounts to not getting insurance... Also it is on your insurance record for 10-years. So, no insurance company, unless you get another job, will cover your Bipolar Disorder.

Personality Disorders are another difficult part of the DSM. A person labelled with a Personality Disorder will not get insurance. Most clinicians will deny treatment for Personality Disorders because they are seen as "untreatable."

By the way, look in the DSM-IVTR for the diagnosis of Bipolar. It only requires one manic episode for receiving the diagnosis of Bipolar. It does not call for a pattern or cycle of depressive episodes, euthymic, episodes, and manic episodes. Also, the specifiers for Bipolar I are time-based. They are based on the most recent event like a manic or depressive episode. Ask psychologists and psychiatrists if there is any utility to this part of the coding for the diagnosis. None of them will be able to tell you the value of knowing the state at which the person was diagnosed as Bipolar I at the time he or she was diagnosed as such.

So, with the ICD, you have no labels. You only have symptomology. In treatment, in practicality, clinicians are treating symptomology with medication and therapy. You can even use depth-orentied psychotherapy with the goal of treating symptoms.

So, the ICD codes have more use to the clinician because it is more specific. We can see the host of symptoms that the client is presenting. Bipolar I gives me only a general map as to what is possible that my client might be experiencing. The ICD sypmtom codes tell me exactly what the client has to deal with at the moment. You can also track the ICD codes during the course of treatment to predict prognosis better than simply having a DSM dx.

Also, moreover, US medical insurance companies will fight using ICD codes for diagnosing mental symptomology. This is because by US law, they must TREAT ALL ACTUAL SYMPTOMS. Therefore this makes exlusions impossible. Eventually this might force the insurance monster in this country to release its strangle-hold on medical care. It might actually lead to universal health care of some form in this country and bring us up to the rest of the first world in standard of care.

The DSM system fails we clinicians all the time. It blocks us from treating some poeple who need treatment because some DSM codes are covered and some are not. Thus the client cannot come up with the funds to pay for treatment. This is completely unjust and most first world countries find this to be yet another reason to look down on the USA.

So, I'm all for the ICD codes. And I hope the neuropsychologists win so that I might be able to give better treatment to my future clients as a Marriage and Family Therapist.

Simcha


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poster:simcha thread:422741
URL: http://www.dr-bob.org/babble/20041201/msgs/424060.html