Reference no: EM133256561

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The DSM and ICD diagnostic classification systems are the most commonly used systems throughout the world. ICD was developed by the World Health Organization, an affiliative organization with the United Nations. The DSM was developed by psychiatrists in the United States and the two systems evolved alongside each other. Though the ICD-10 was published in the early 1990's, the United States did not adopt and integrate the diagnosis codes from the ICD-10 until 2015, and the current DSM-5 is actually harmonized with the ICD-11 (Sommers-Flanagan and Sommers-Flanagan, 2016). Though the two systems have developed alongside each other and efforts have been made for them to work in harmony, there is complexity when it comes to how each system conceptualizes mental disorders differently. This is mostly because the insurance industry in the United States has been resistant to changing its own system for approving coverage of mental health services in a way that is tailored to diagnostic criteria other than what appears in the DSM.

The complexity that arises from how these two systems have been integrated and "harmonized" makes it difficult to accurately diagnose clients. For example, the DSM and ICD both present slightly different criteria for diagnosing general anxiety disorder (GAD). The DSM has specific categories and listed criteria consisting of specific symptoms and lengths of time in which symptoms appear that are necessary to meet a diagnostic threshold, however the ICD's criteria for diagnosing GAD is vaguer than what is presented in the DSM (Sommers-Flanagan & Sommers-Flanagan, 2016). The confusion between the two systems has been partially resolved by integrating diagnostic codes for the same mental disorders from the ICD-11 into the DSM-5. However, the symptom lists themselves often leave a lot of room for subjective interpretation. For example, the first diagnostic criteria for GAD in the DSM-5 describes "excessive anxiety and worry...occurring more days than not for at least 6 months, about a number of events or activities" (APA, 2013). What is considered "excessive anxiety"? How reliable is the client's accounting of whether or not anxiety and worry has occurred for at least 6 months? On top of these questions are complicated matters related to which codes, ICD or DSM or both, to use for submitting client diagnoses for insurance purposes.

It is also critical for us as future counselors to understand that the conceptualization of mental disorders according to both the DSM and ICD systems are rooted in Western cultures. They are not universal conceptualizations of mental disorders and forcing a Westernized view of every client's presenting problems solely through the lens of the DSM or ICD, which are rooted in mostly a biomedical model of assessing and diagnosing, can actually be harmful to clients from non-Western or marginalized cultural backgrounds. Also, the research that was conducted to create the various diagnostic descriptions and criteria did not include samples that proportionally represented people from all cultural, ethnic, or racial backgrounds. The DSM-5 contends that Black people in the United States are at a lower risk for developing ADHD than the general population. However, the flaws in the research include not having a fair or proportional representation of Black clients in the samples the APA used to reach such a conclusion. A meta-analysis of 21 different studies on ADHD published in 2021 counters this assertion by pointing out that Black parents often don't report ADHD symptoms out of fear of creating additional bias or prejudice against their children. The analysis also points out that being in a lower SES, in which the Black population disproportionally resides, brings about certain risk factors related to ADHD that are generally protected against by being in a higher SES. Generally being in a lower SES restricts people from having the resources needed to seek mental health treatment (Knopf, 2021). This all points to the need to not simply check off certain symptom clusters listed in the DSM or ICD when assessing and diagnosing. The ADDRESSING model is useful in integrating the understanding of the client's background and influences into the intake interview, including assessment and diagnosis, as well as throughout the entire counseling process to ensure that diagnoses do not ultimately harm clients or drive them away from mental health services. Of course, counselors should be continuously educating themselves, through training, reading, and directly experiencing various cultures to make sure that their presenting problems, which could potentially lead a multiculturally incompetent clinician to misdiagnose, are conceptualized through the worldviews of the clients, not just through the lens of the DSM or ICD.