Summary
The psychiatric classification systems ICD-10 and DSM-III-R were compared by applying both sets of diagnostic criteria to the same sample of patients suffering from affective and psychotic disorders. Four independent raters assessed diagnoses according to both systems to 100 written case records which had been prepared in a traditional, standard format. The International Diagnostic Checklists (IDCL) were employed to rate relevant psychopathological signs and symptoms and to apply diagnostic decision rules. The results showed that ICD-10 yielded a generally higher reliability for all main disorders except for bipolar disorder. Overall reliability was κ=0.53 for diagnoses according to DSM-III-R and 0.59 for diagnoses according to ICD-10. Agreement was best for affective disorders, moderate for schizophrenia and inacceptable for schizoaffective disorder. Insufficient boundaries were found in both systems between schizoaffective disorder on one side and schizophrenia and bipolar disorder on the other side. The different duration criteria for schizophrenia of six months in DSM-III-R and one month in ICD-10 tend to have considerable consequences for frequency rates of schizophrenia in a typical clinical setting.
Similar content being viewed by others
References
Albus M, Strauß A, Stieglitz R-D (1990) Schizophrenia, schizotypal and delusional disorders (Section F2): results of the ICD-10 field trial. Pharmacopsychiat 23 [Suppl IV]:155–159
American Psychiatric Association, APA (1987) Diagnostic and statistical manual of mental disorders, 3rd edn (revised). APA, Washington
Bishop YMM, Feinberg SE, Holland PW (1975) Discrete multivariate analysis: theory and practice. Cambridge MA: MIT Press
Burnam NA, Karno M, Hough RL, Escobar JI, Forsythe AB (1983) The Spanish Diagnostic Interview Schedule. Reliability and comparison with clinical diagnoses. Arch Gen Psychiatry 40:1189–1196
Cohen J (1960) A coefficient of agreement for nominal scales. Educat Psychol Meas 20:37–46
Cooper JE (1988) The structure and presentation of contemporary psychiatric classifications with special reference to ICD-9 and 10. Br J Psychiat 152 [Suppl 1]:21–28
Dilling H, Freyberger HJ, Malchow P (1990) Design of the ICD-10 field trial in German-speaking countries. Pharmacopsychiat 23 [Suppl IV]:142–145
Fleiss JL (1971) Measuring nominal scale agreement among many raters. Psychol Bull 76:378–382
Fleiss JL (1981) Statistical methods for rates and proportions, 2nd ed. New York, Wiley
Freyberger HJ, Albus M, Stieglitz R-D (1990) ICD-10 field trial in German-speaking countries — summary of the quantitative empirical results. Pharmacopsychiat 23 [Suppl IV]:192–196
Grove WM, Andreasen NC, McDonald-Scott P, Keller MB, Shapiro RW (1981) Reliability studies of psychiatric diagnosis. Theory and practice. Arch Gen Psychiatry 38:408–413
Helzer JE, Robins LN, Taibleson M, Woodruff RA, Reich T, Wish ED (1977) Reliability of psychiatric diagnosis, I. A methodological review. Arch Gen Psychiatry 34:129–133
Hiller W, Zaudig M, Mombour W (1990a) Development of diagnostic checklists for use in routine clinical care. Arch Gen Psychiatry 47:782–784
Hiller W, Bose M von, Dichtl G, Agerer D (1990b) Reliability of checklist-guided diagnoses for DSM-IIIR affective and anxiety disorders. J Affect Disord 20:235–247
Hyler SE, Williams JBW, Spitzer RL (1982) Reliability in the DSM-III field trials. Interview v case summary. Arch Gen Psychiatry 39:1275–1278
Maier W, Philipp M, Zaudig M (1990) Comparison of the ICD-10-classification system with the ICD-9-and the DSM-III-R-classification of mental disorders. Pharmacopsychiat 23 [Suppl IV]:183–187
Mombour W, Spitzner S, Reger KH, Cranach M von, Dilling H, Helmchen H (1990) Summary of the qualitative criticisms made during the ICD-10 field trial and remarks on the German translation of ICD-10. Pharmacopsychiat 23 [Suppl IV]:197–201
Sartorius N (1988) International perspectives of psychiatric classification. Br J Psychiat 152 [Suppl 1]:9–14
Semler G, Wittchen H-U, Joschke K, Zaudig M, Geiso T von, Kaiser S, Cranach M von, Pfister H (1987) Test-retest reliability of a standardized psychiatric interview (DIS/CIDI) Eur Arch Psychiatr Neurol Sci 236:214–222
Shrout PE, Spitzer RL, Fleiss JL (1987) Quantification of agreement in psychiatric diagnosis revisited. Arch Gen Psychiatry 44:172–177
Spitznagel EL, Helzer JE (1985) A proposed solution to the base rate problem in the kappa statistic. Arch Gen Psychiatry 42:725–728
Sprock J (1988) Classification of schizoaffective disorder. Compr Psychiat 29:55–71
Wittchen H-U, Essau CA, Zerssen D von, Krieg J-C, Zaudig M (1992) Lifetime and six-month prevalence of mental disorders in the Munich follow-up study. Eur Arch Psychiatry Clin Neurosci 241:247–258
WHO, World Health Organization (1990a) ICD-10, Chapter V (F), Mental and behavioural disorders (including disorders of psychological development), diagnostic criteria for research (1990 draft). Geneva, WHO
WHO, World Health Organization (1990b) ICD-10, Chapter V (F), Mental and behavioursal disorders (including disorders of psychological development), clinical descriptions and diagnostic guidelines (1990 draft). Geneva, WHO; German ed: Dilling H, Mombour W, Schmidt MH (eds) (1991) Weltgesundheits-organisation: Internationale Klassifikation psychischer Störungen, ICD-10, Kapitel V (F), Klinisch-diagnostische Leitlinien. Bern, Huber
Zaudig M, Stieglitz R-D, Gastpar M, Rösinger C (1990) Mood (affective) and schizoaffective disorders (Section F3): results of the ICD-10 field trial. Pharmacopsychiat 23 [Suppl IV]: 160–164
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hiller, W., Dichtl, G., Hecht, H. et al. An empirical comparison of diagnoses and reliabilities in ICD-10 and DSM-III-R. Eur Arch Psychiatry Clin Nuerosci 242, 209–217 (1993). https://doi.org/10.1007/BF02189965
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02189965