Exploring the feasibility of a meta-structure for DSM-V and ICD-11: could it improve utility and validity?
BACKGROUND
The organization of mental disorders into 16 DSM-IV and 10 ICD-10 chapters is complex and based on clinical presentation. We explored the feasibility of a more parsimonious meta-structure based on both risk factors and clinical factors.


METHODS
Most DSM-IV disorders were allocated to one of five clusters as a starting premise. Teams of experts then reviewed the literature to determine within-cluster similarities on 11 predetermined validating criteria. Disorders were included and excluded as determined by the available data. These data are intended to inform the grouping of disorders in the DSM-V and ICD-11 processes.


RESULTS
The final clusters were neurocognitive (identified principally by neural substrate abnormalities), neurodevelopmental (identified principally by early and continuing cognitive deficits), psychosis (identified principally by clinical features and biomarkers for information processing deficits), emotional (identified principally by the temperamental antecedent of negative emotionality), and externalizing (identified principally by the temperamental antecedent of disinhibition).


CONCLUSIONS
Large groups of disorders were found to share risk factors and also clinical picture. There could be advantages for clinical practice, public administration and research from the adoption of such an organizing principle.
School of Psychiatry, University of New South Wales, Sydney, Australia. gavina@unsw.edu.au
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D039721:Diagnostic and Statistical Manual of Mental Disorders; D035081:Editorial Policies; D005240:Feasibility Studies; D006801:Humans; D038801:International Classification of Diseases; D001523:Mental Disorders / Q000145:classification* / Q000175:diagnosis*; D011643:Publishing; D015203:Reproducibility of Results; D014481:United States