Petition Seeks to Dump DSM and Adopt ICD

By James Bradshaw, Senior Editor
September 12, 2012



Petition Seeks to Dump DSM and Adopt ICDThe National Alliance of Professional Psychology Providers (NAPPP) has launched a petition drive encouraging psychologists to abandon psychiatry’s Diagnostic and Statistical Manual (DSM) and adopt instead the International Classification of Diseases (ICD) as the standard for classifying mental disorders.

John Caccavale, Ph.D., NAPPP’s executive director, said the controversy over proposed revisions for the DSM-5 that is to be released next year should convince many psychologists that the time has come to jettison the American Psychiatric Association’s diagnostic manual that often handicaps other mental health professionals with definitions and recommendations favoring psychiatrists.

“NAPPP has been promoting the ICD over the DSM for several years now,” Caccavale said. A close ally of NAPPP, the Academy of Medical Psychologists (AMP), also has adopted standards of the ICD-10 rather than those of the DSM-IV-TR.

The ICD-10 also is under review for revisions. The World Health Organization (WHO) anticipates adopting the revisions in the ICD-11 expected to be released in 2014. The NAPPP petition is posted at www.nappp.org along with a detailed rationale as to why NAPPP feels psychologists should drop the DSM.

Caccavale said NAPPP is enlisting sup- port through various listservs but intends sometime this fall to ask the APA Practice Organization (APAPO) to join in the effort.

The plan to ask the APAPO to partner in the effort marks the first time NAPPP has approached APA to work together on practice issues since NAPPP was created in 2006. Several prominent APA members, including Nicholas Cummings, Ph.D., and Jack Wiggins, Ph.D., both former APA presidents, formed NAPPP because of what they saw as inadequate advocacy for practicing psychologists by APA.

While many members of NAPPP retained their APA memberships, at the organizational level the relationship between NAPPP and APA has been strained at best. When told of the coming invitation to join NAPPP in the effort, Katherine C. Nordal, Ph.D., executive director of APA’s Practice Directorate, was noticeably surprised. Without committing the APAPO until the NAPPP proposal is formally presented, Nordal was not averse to considering the benefits of adopting ICD standards.

“There’s certainly a lot of interest in the ICD,” she said. “There are many good things about its functionality.” She noted that when psychologists and other mental health practitioners file for insurance reimbursement, DSM diagnoses must be translated to the corresponding ICD codes.

But, she said, changing to the ICD could present problems for training programs, since historically psychologists have been trained to use the DSM.

In a separate interview, Cynthia D. Belar, Ph.D., executive director for APA’s Education Directorate, said that should not be a great problem because many training programs already include courses on the ICD and for those who were trained in the DSM there are resources for determining the ICD equivalents for diagnoses.

(Ohio Psychology Publications Inc., parent company of The National Psychologist , publishes a “crosswalk” outlining equivalent DSM/ICD codes as an appendix in its 2013 Appointment Calendar for Mental Health Professionals.)

Interest in the ICD was apparent at the APA’s August convention in Orlando where Nordal and Belar were interviewed. Geoffrey Reed, Ph.D., WHO’s senior project officer overseeing revision of the ICD’s Chapter 5: Mental and Behavioral Diseases, spoke at several convention sessions. Reed is a former assistant executive director for APA’s Practice Directorate.

He told The National Psychologist that the ICD or national systems derived from the ICD are used for diagnosing mental disorders in all nations other than the United States, and even in the United States ICD codes are mandatory for electronic health documents. Reed said 14 working groups are studying potential revisions for the mental health chapter of the ICD and psychologists are integrally involved in that work.

Psychologists also are invited to join Internet-based field studies, he said. Caccavale said the looming release of the DSM-5, scheduled for next May, makes timing essential, which is why NAPPP will seek support from the practice affiliate rather than presenting the request to the APA Council of Representatives.

He said the APAPO has mechanisms for adopting change much faster than the APA as a whole, which has a more deliberative process of placing proposals before the council for debate and study before drafting and adopting resolutions.

Criticism of proposed revisions to the DSM are rampant among APA members as evidenced by an open letter launched last October by the Society for Humanistic Psychology, APA’s Division 32, which has been endorsed by about 50 mental health organizations and about 13,000 individual mental health care providers. The letter urges the DSM-5 revisionists to back away from many proposed changes.

Anticipating the request to have APAPO join the movement, the NAPPP petition states, “Petitioners strongly urge the American Psychological Association Practice Organization and the APA Practice Directorate to expend all possible efforts to implement use of ICD-10 by all practicing psychologists.”

The accompanying rationale notes, “The results of psychotherapy treatments using effective evidenced-based treatment methods are questioned when outcomes are judged by unreliable or defective DSM codes. When ICD diagnostic criteria are used interchangeably with DSM criteria even greater confusion occurs.”

The rationale notes that for reimbursement the ICD already is the true standard: “It may come as a surprise to psychologists still using the DSM codes to bill for their services that payers convert these codes to ICD-10-CM that is the official version of ICD in current use in the U.S. and is mandated for third party billing by HIPAA for all electronic billing and reimbursement.”

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