My name is Sam Vaknin. I am the author of Malignant Self-Love, Narcissism Revisited.

The International Classification of Diseases, known as ICD, is published by the World Health Organization in Geneva, Switzerland. It included mental health disorders for the first time in 1948, in its sixth edition.

In 1959, following widespread criticism of its classicatory system and scheme, the World Health Organization commissioned a global survey of taxonomies of mental health problems, which was conducted by Stengel. The survey uncovered great disparities, substantial disagreements as to what constitutes mental illness and how it should be diagnosed.

In other words, there was disagreement regarding diagnostic criteria and another type of disagreement regarding differential diagnosis.

Yet it was not until 1968 that Stengel’s recommendations were implemented in the eighth edition of the ICD.

The ICD-8 was descriptive and operational and did not commit itself to any theory, ideology or etiology. It did not discuss pathogenesis or psychological dynamics.

Still, the ICD-8 sported a confusing plethora of categories and allowed for rampant comorbidity, in other words, multiple diagnoses of multiple mental health disorders in the same patient.

The ICD-10, the current version, was revolutionary. It incorporated the outcomes of numerous collaborative studies and programs, both national and international, and included input from the American Psychiatric Association, the publisher of the Diagnostic and Statistical Manual, the ICD’s equivalent in North America.

Consequently, the ICD and the DSM are now broadly similar.

But as opposed to the Diagnostic and Statistical Manual, the International Classification of Diseases provides two sets of diagnostic criteria for each disorder.

One list is useful to the diagnostician and allows for some latitude, and it is also useful to the practitioner’s exercise of judgment.

The other set is far more precise and strict and is intended to be used by scholars and researchers in their studies.

Yet a third simplified classification is applicable to primary care settings, which contains only broad categories and wide brushstrokes.

So this third set of so-called criteria is dementia, eating disorder, psychotic disorder, without going into details.

The ICD-10 discusses organic substance use-related and stress-related disorders separately.

Chapter F, which deals with mental health disorders, is divided into 10 groups, and each group, in turn, is again divided into 100 subunits.

Thus, F2, for instance, is schizophrenia, F25 is schizoaffective disorder, and F25.1 is schizoaffective disorder of the depressive type.

You get the picture.

An international study carried out in 112 clinical centers in 39 countries demonstrated that the ICD-10 is not a reliable diagnostic tool as far as personality disorders go.

This is known as the Sartorius study, published in 1993.

These findings, however, were not replicated a year later in the USA and in Canada.

There’s still hope for the ICD.