Results of the ICD-10 Research Criteria Study in German-Speaking Countries in the Field of Psychosomatics and Psychotherapy

Abstract

Selected results from the section psychotherapy/psychosomatics of the ICD-10 research criteria study are discussed. One hundred thirty diagnosticians from 11 psychosomatics centers took part in this section, assessing 16 video-documented patients in case conferences. The results of the study, which were based on 633 diagnostical assessments, demonstrated sufficient chance-corrected interrater reliability coefficients for the majority of the disorders (kappa ranged from 0.22 to 0.99). System-related problems of the ICD-10 approach were identified concerning depressive and psychosomatic disorders. The results are discussed, following some problematical aspects of the concept of comorbidity and multiaxial approaches. Special reference is given to the work group Operational Psychodynamic Diagnoses’ which has produced a multiaxial system covering important psychodynamic variables.

Conversion disorder: a problematic diagnosis

“…As with the feigning exclusion, a rigid interpretation would leave many patients that clinicians consider to have the condition without a formal diagnosis. Even when such an explanation can be found there is some evidence that this is not reliable in the sense of having high inter-rater reliability 57. When an explanation is reduced to the presence of a stressor, its importance is uncertain due to the considerable problems of establishing causality from a relatively common factor that is also associated with many other psychiatric, and some physical, disorders.…”