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Keywords:

  • mental disorders;
  • classification, International Classification of Diseases (ICD);
  • Diagnostic and Statistical Manual of Mental Disorders (DSM);
  • clinical utility;
  • cross-cultural applicability;
  • low- and middle-income (LAMI) countries

Objective

To examine the conceptualizations held by psychiatrists and psychologists around the world of the relationships among mental disorders in order to inform decisions about the structure of the classification of mental and behavioral disorders in World Health Organization's International Classification of Diseases and Related Health Problems 11th Revision (ICD-11).

Method

517 mental health professionals in 8 countries sorted 60 cards containing the names of mental disorders into groups of similar disorders, and then formed a hierarchical structure by aggregating and disaggregating these groupings. Distance matrices were created from the sorting data and used in cluster and correlation analyses.

Results

Clinicians’ taxonomies were rational, interpretable, and extremely stable across countries, diagnostic system used, and profession. Clinicians’ consensus classification structure was different from ICD-10 and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV), but in many respects consistent with ICD-11 proposals.

Conclusions

The clinical utility of the ICD-11 may be improved by making its structure more compatible with the common conceptual organization of mental disorders observed across diverse global clinicians.