Language: ASPPB offers a French form of the EPPP (the FEPPP) where a licensing authority legally requires one. ASPPB has not yet published the competency statements in French, so our questions and cards are in English until it does.

2.D.3

Diagnosing with current taxonomies

ASPPB's competency statement 2.D.3: Use current taxonomies to determine diagnoses

Diagnoses are made with the current editions of the major classifications: DSM-5-TR, published by the American Psychiatric Association in 2022, and the World Health Organization's ICD-11, used for health statistics reporting from January 2022. Using them well means applying the criteria as written, including duration, exclusion and specifier rules, and knowing the options for a presentation that does not fit a full category.

Key ideas

DSM-5-TR: The current DSM is the 2022 text revision, which added prolonged grief disorder. Its criteria combine symptom counts, duration, distress or impairment, and exclusions for substances, other medical conditions and other mental disorders.
ICD-11: ICD-11 was approved in 2019, with reporting based on it from January 2022. It adds a lifespan approach and cultural guidance for each disorder and builds dimensional approaches into personality disorders and primary psychotic disorders.
How the two systems differ: Comparing 103 conditions found in both, one analysis rated 31 as essentially identical and 20 as having major differences. ICD-11, for example, distinguishes complex PTSD from PTSD, a distinction DSM-5-TR does not make.
Other specified and unspecified: For presentations with significant distress or impairment that do not meet full criteria, DSM-5-TR offers 'other specified' (the clinician records the reason, such as limited-symptom attacks) or 'unspecified' (no reason recorded, for example when information is insufficient).
Duration rules: In DSM-5-TR, psychotic symptoms lasting from 1 day to under 1 month fit brief psychotic disorder, from 1 to under 6 months schizophreniform disorder, and 6 months or more, counting prodromal and residual phases, schizophrenia.

Worked example

Ana, 20, a college student, has had auditory hallucinations, disorganized speech and social withdrawal for ten weeks. A medical workup and drug screen are negative, she has had no manic or major depressive episode, and she has not recovered.

Exclusions first: no substance or medical cause has been found, and no major mood episode accompanies the psychosis, which points away from schizoaffective disorder and mood disorders with psychotic features.
Duration: ten weeks is more than one month and less than six, which fits schizophreniform disorder rather than brief psychotic disorder or schizophrenia.
Because she has not yet recovered and the episode could reach six months, DSM-5-TR asks for the qualifier 'provisional.'
If her symptoms continue and the full criteria are met at six months, the diagnosis is revised to schizophrenia.

Apply exclusions first, then the duration and specifier rules exactly as the current manual states them.

Check yourself

An emergency department psychologist sees a man with clear depressive symptoms and impairment but has too little information to tell which depressive disorder applies, and does not record a reason. Which DSM-5-TR choice fits?

Practise 2.D.3

Sources

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR; American Psychiatric Association, 2022), Use of the Manual (other specified and unspecified disorders); Brief Psychotic Disorder, Schizophreniform Disorder (provisional specifier) and Schizophrenia, duration criteria; Prolonged Grief Disorder
Prigerson, Boelen, Xu, Smith and Maciejewski (2021), Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale, World Psychiatry (PMID 33432758), World Psychiatry 20, 96-106 (prolonged grief disorder added to DSM-5-TR)
Reed, First, Kogan, Hyman, Gureje, Gaebel and colleagues (2019), Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders, World Psychiatry (PMID 30600616), World Psychiatry 18, 3-19 (approval in 2019; reporting from January 1, 2022; lifespan, culture, dimensional approaches)
First, Gaebel, Maj, Stein, Kogan, Saunders and colleagues (2021), An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5, World Psychiatry (PMID 33432742), World Psychiatry 20, 34-51 (103 shared entities; 31 essentially identical; 20 major differences)
Brewin, Cloitre, Hyland, Shevlin, Maercker, Bryant and colleagues (2017), A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD, Clinical Psychology Review (PMID 29029837), Clinical Psychology Review 58, 1-15 (PTSD and complex PTSD as sibling disorders in ICD-11)