If you have ever received a diagnosis such as “F32.1” on a sick note, or read that someone “meets the DSM-5 criteria” for a disorder, you have met the diagnostic manuals. They shape what counts as a mental disorder, who gets treatment and what insurance pays for. Yet most patients never learn how they are made.
This article explains what the ICD and DSM are, how they are developed, how they differ, and why it can be useful for you as a patient to know a little about them.
Two systems, one goal
There are two main classification systems for mental disorders.
- The ICD (International Classification of Diseases) is published by the World Health Organization and covers all diseases, not only mental ones. Its current version, ICD-11, came into effect in 2022 (World Health Organization, 2024).
- The DSM (Diagnostic and Statistical Manual of Mental Disorders) is published by the American Psychiatric Association and covers only mental disorders. Its current version is DSM-5-TR.
The ICD is the official system for health statistics and health care in most countries. The DSM is used a lot in research and in the United States.
What about ICD-10?
Although ICD-11 is now in force internationally, many countries still use ICD-10 in daily practice while they prepare the switch. In Germany, doctors and therapists currently code diagnoses with a German version called ICD-10-GM, which is used for billing with health insurers (Bundesinstitut für Arzneimittel und Medizinprodukte, n.d.). That is why German sick notes and invoices show codes such as F32 for a depressive episode or F41 for other anxiety disorders. The move to ICD-11 will take several years.
How the manuals are made
Neither manual is handed down from nature. Both are developed by groups of experts who review research, clinical experience and feedback, and then agree on how to describe and group mental health problems.
For ICD-11, the WHO organised working groups for each area, and tested the draft guidelines in large field studies with clinicians around the world. In one of these studies, clinicians in 13 countries applied the new guidelines to real patients with common disorders such as depression, anxiety and stress-related disorders, and rated them as easy to use and helpful for their work (Reed et al., 2018). The WHO also aimed to make ICD-11 usable in low-resource settings and across cultures (Reed et al., 2019).
This expert process has strengths and weaknesses. It brings together a lot of knowledge, and it is also influenced by the people involved, their training, their cultural background and sometimes their financial interests. An analysis of the DSM-5 panels found that a large share of panel members had financial ties to the pharmaceutical industry, similar to the previous edition (Cosgrove & Krimsky, 2012).
How they differ
ICD-11 and DSM-5 have moved closer to each other, but they are not identical. A detailed comparison found that the overall structure and many diagnoses are similar, while there are differences in the details, for example in how many symptoms are needed, how long they must last, or which diagnoses exist at all (First et al., 2021). The ICD also uses descriptive guidelines that leave more room for clinical judgement, while the DSM uses more precise lists of criteria.
Some changes in ICD-11 that may matter to you:
- Gender incongruence was moved out of the mental disorders chapter.
- Burnout is described as an occupational phenomenon, not as a medical illness.
- New diagnoses such as complex post-traumatic stress disorder and prolonged grief disorder were added (Stein et al., 2020).
- Personality disorders are now described mainly by their severity rather than by separate types.
What diagnoses are for
Diagnoses in the manuals serve several purposes at once. They give professionals a shared language, so that a psychiatrist in Berlin and a psychologist in Mexico City mean roughly the same thing when they say “panic disorder”. They make research possible, because studies need clear groups to compare treatments. They allow health systems to plan care and decide what to pay for. And for many patients, they offer a name for experiences that felt confusing or isolating.
The limits of categories
Mental health does not divide neatly into boxes. Many people have symptoms of several diagnoses at the same time, or symptoms that do not quite fit any of them. Experiences of distress also vary across cultures, and a set of criteria developed mainly in one part of the world does not always describe people elsewhere well, which is one reason the WHO tested ICD-11 in many countries and languages (Reed et al., 2019). The move in ICD-11 towards describing personality difficulties by severity, rather than by fixed types, reflects growing recognition that many problems are better understood as differences in degree (Stein et al., 2020).
Why diagnoses change
The manuals are revised every few decades, sometimes more often. Some diagnoses disappear, new ones appear, and criteria are adjusted. Homosexuality, for example, was listed as a mental disorder for many years before it was removed. Changes like this show that diagnoses are tools, shaped by research, culture and values. They also show that the manuals can learn and improve.
Why it matters for you as a patient
Knowing this can be useful in several ways.
- A diagnosis describes, it does not explain everything. It names a pattern of experiences that many people share. It does not tell your whole story or why things became difficult.
- Diagnoses can change. Your diagnosis might be revised as you and your therapist understand more, or as the manuals change.
- Codes have practical effects. In Germany, statutory health insurance pays for psychotherapy only when there is a diagnosis that justifies treatment, so a code is part of the paperwork. You have the right to ask which diagnosis has been recorded and what it means.
- You can ask questions. Which criteria did you use? What else did you consider? How sure are you? A good professional will be happy to explain.
More on what diagnoses can and cannot do in Mental health diagnoses: why they help, and how they can hurt.
More about therapy with me.
References
- Bundesinstitut für Arzneimittel und Medizinprodukte. (n.d.). ICD-10-GM. Retrieved November 8, 2026, from https://www.bfarm.de/DE/Kodiersysteme/Klassifikationen/ICD/ICD-10-GM/_node.html
- Cosgrove, L., & Krimsky, S. (2012). A comparison of DSM-IV and DSM-5 panel members’ financial associations with industry: a pernicious problem persists. PLoS Medicine, 9(3), e1001190. https://doi.org/10.1371/journal.pmed.1001190
- First, M. B., Gaebel, W., Maj, M., Stein, D. J., Kogan, C. S., Saunders, J. B., Poznyak, V. B., Gureje, O., Lewis-Fernández, R., Maercker, A., Brewin, C. R., Cloitre, M., Claudino, A., Pike, K. M., Baird, G., Skuse, D., Krueger, R. B., Briken, P., Burke, J. D., . . . Reed, G. M. (2021). An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World Psychiatry, 20(1), 34–51. https://doi.org/10.1002/wps.20825
- Reed, G. M., First, M. B., Kogan, C. S., Hyman, S. E., Gureje, O., Gaebel, W., Maj, M., Stein, D. J., Maercker, A., Tyrer, P., Claudino, A., Garralda, E., Salvador-Carulla, L., Ray, R., Saunders, J. B., Dua, T., Poznyak, V., Medina-Mora, M. E., Pike, K. M., . . . Saxena, S. (2019). Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry, 18(1), 3–19. https://doi.org/10.1002/wps.20611
- Reed, G. M., Keeley, J. W., Rebello, T. J., First, M. B., Gureje, O., Ayuso-Mateos, J. L., Kanba, S., Khoury, B., Kogan, C. S., Krasnov, V. N., Maj, M., de Jesus Mari, J., Sharan, P., Stein, D. J., Zhao, M., Akiyama, T., Andrews, H. F., Asevedo, E., Cheour, M., . . . Medina-Mora, M. E. (2018). Clinical utility of ICD-11 diagnostic guidelines for high-burden mental disorders: results from mental health settings in 13 countries. World Psychiatry, 17(3), 306–315. https://doi.org/10.1002/wps.20581
- Stein, D. J., Szatmari, P., Gaebel, W., Berk, M., Vieta, E., Maj, M., de Vries, Y. A., Roest, A. M., de Jonge, P., Maercker, A., Brewin, C. R., Pike, K. M., Grilo, C. M., Fineberg, N. A., Briken, P., Cohen-Kettenis, P. T., & Reed, G. M. (2020). Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Medicine, 18(1), 21. https://doi.org/10.1186/s12916-020-1495-2
- World Health Organization. (2024). ICD-11 for mortality and morbidity statistics. https://icd.who.int/browse/2024-01/mms/en
This article is exploratory and meant for information and reflection. It cannot capture the full complexity of any individual situation, and your own experience may be different. It does not replace a diagnosis or treatment.
