Published on 12, July, 2020
Many years ago my local AS support group had to make a decision between ICD-10 and DSM-IV as their primary reference manual. We chose ICD-10.
One reason for choosing ICD-10 is that it's already used by GPs, school nurses, and pediatric consultants (who are the first lines of contact in the medical profession) whereas DSM-IV tends to be confined to the bookshelves of folk who specialise in psychiatry and mental health rather than working in general medicine.
The second reason is that ICD-10 is FREE and available on the internet whereas DSM-IV costs ££££ as it's a commercial product sold by the American Psychiatric Association.
After DSM-5 was released I have had numerous parents ask me where they can get hold of it for free, because it's now the norm for ASD diagnosis in Britain. A copy of DSM-5 and DSM-IV are kept on the bookshelf of my local AS support group but I have to constantly remind parents that if they want a copy themselves then they must pay ££££ for it whereas ICD-10 and ICD-11 are available for FREE on the internet.
Why then is DSM now more popular in Britain than ICD is when you have to pay ££££ for it?
Leach said:What I do potentially see from the forums I get involved with is the UK has much more of a problem of actually finding a specialist capable of dealing with ASD for everyone in all areas, whereas US areas can ahve problems with "specialists" not really being specialists, or having a very generic view of ASD and therefore diagnose/don't diagnose without a real capability to do so.
A bit of inside information I have is that the NAS prefers DSM-5 over ICD-10 and ICD-11. This is because the NAS basically functions as a government service provider for children who fit the criteria for its schools and adults who require residential care services as there is public money available for these people, but the NAS doesn't like having to deal with people with Asperger Syndrome or other forms of ASD where there is next to no public money available.
Therefore a linear graded system of ASD diagnosis (as used by DSM-5) is more beneficial to the interests of the NAS than a differentiated system of ASD diagnosis (as used by ICD-10 and ICD-11) is. Anybody with a DSM-5 Level 1 Autism will be handled by the NAS as the lowest priority and only thrown the crumbs as priority will be given to providing services for people with a higher level diagnosis where there is usually more public money available for them.
Leach said:Many places (AFAIK) actually can use a combination of the two manuals - and if you went through most peoples diagnosis, they would meet criteria for both ICD-11 and DSM-5.
My local AS support group unanimously supports ICD as their primary reference manual, but consensus has not been reached on DSM apart from a (cynical?) belief that DSM exists as a cash cow for the American Psychological Association more than anything else, and is designed to meet the needs and requirements of the privatised American healthcare system - with possible connections to big pharma - more so than the needs and requirements of patients and the general public.
One faction finds it difficult to understand why the world needs two reference and diagnostic manuals for psychiatric and mental health conditions, rather than one single international manual.
A second faction holds the view that DSM is a national version of ICD for the American marketplace but also believes that national versions of ICD for Britain and other countries should also be produced, taking into account certain cultural factors, that are more descriptive than the terse ICD is in a similar manner to the format of DSM.
Arran said:However, situation regarding DSM vs ICD in online communities should not have any bearing on the situation regarding diagnosis in a clinical environment in Britain.
Agreed - problem being is it does socially. The more visible something is, the more people will relate to it. That and again I think the DSM criteria is actually very concise and simple, even if wordy for a clinical setting - as far as it can be for an Autism Diagnosis. So agreed it should have no bearing from a clinical point of view - however there is also no detriment necessarily to use them both collaboratively to make decisions on diagnosis IMO.
Many places (AFAIK) actually can use a combination of the two manuals - and if you went through most peoples diagnosis, they would meet criteria for both ICD-11 and DSM-5.
What I do potentially see from the forums I get involved with is the UK has much more of a problem of actually finding a specialist capable of dealing with ASD for everyone in all areas, whereas US areas can ahve problems with "specialists" not really being specialists, or having a very generic view of ASD and therefore diagnose/don't diagnose without a real capability to do so.
Having said that, I like both criteria, and I love the fact that ICD-11 is made freely available. But I also like how concise DSM is, and there is so much online on the ASD DSM criteria that it is easily accessible now.
I don't think it's a case of "giving up on British English" and embracing "American English" - it's just a case of cultivating affective development and understanding so that both can work in collaboration to better improve our services.
It's DSM-5 not DSM-V.
Leach said:Well yes, I never stated there aren't any non-US communites. But there is a large foundation of US based communities that all reference DSM5 as they developed it. Take reddit for example, the US Autism based forums are very large, the UK one is pretty miniscule. So everyone just gravitates to the one that references DSM.
You make a fair point about DSM overshadowing ICD in US based online communities, but this also raises the question whether British people should also give up with standard British English and embrace American English instead.
However, situation regarding DSM vs ICD in online communities should not have any bearing on the situation regarding diagnosis in a clinical environment in Britain.
I'm intrigued to know the differences between ASD in the US and Britain due to differences in culture, social expectations, and the education system.
DSM-V is considered the main standard manual that is used, so that's the most renowned and thus probs the most requested for that reason
Well yes, I never stated there aren't any non-US communites. But there is a large foundation of US based communities that all reference DSM5 as they developed it. Take reddit for example, the US Autism based forums are very large, the UK one is pretty miniscule. So everyone just gravitates to the one that references DSM.
That and my second point also stands.
Also I never stated at any point that other people SHOULD use DSM5, the thread simply asked why do people ask for it. I gave my experience as to why so many communities I come across online reference DSM5 - I made no reference as to whether one SHOULD use DSM5 or not, I just stated my view on the diagnostic criteria of DSM5.
What exactly was the driving force behind the widespread adoption of DSM-5 for the purpose of diagnosis of ASD in Britain? Was DSM-5 simply perceived as more modern than ICD-10? Was it an attempt to harmonise diagnosis in Britain with diagnosis in the US? Was there a significant dissatisfaction with ICD-10 (and possibly DSM-IV as well) by clinical psychologists?
Before the publication of DSM-5 the use of ICD-10 was much more popular than DSM-IV.
Leach said:Probably less so it's more popular in Britian, but more than the online community is more DSM focussed as many now adopt this one. The US is DSM based generally and there is a large mass of US based people on autism online communities, so if someone visits online forums, they are likely to encounter it a lot more.
There are online communities that are based in Britain and other countries apart from the US.
Your scenario is almost analgous that the rest of the world should use fahrenheit for temperature, rather than celsius, because it's what American online communities mostly use.
Probably less so it's more popular in Britian, but more than the online community is more DSM focussed as many now adopt this one. The US is DSM based generally and there is a large mass of US based people on autism online communities, so if someone visits online forums, they are likely to encounter it a lot more.
On top of that personally I think the DSM format is pretty clear, concise, and even if the book costs money, the individual criterias for diagnostics are fairly easily obtainable and easy to understand in black and white terms, and is also easily translatable to online communities.