gms | German Medical Science

Background/research question: While developing the PICO scheme for a systematic literature review on outpatient supported living for intellectually disabled people, conceptual vagueness in the International Statistical Classification of Diseases and Related Health Problems (ICD-10) became apparent in the definition of the population of interest. This can include two young people whose language and linguistic development are comparable but not age appropriate. One was born with Down Syndrome which is classified as ‘Congenital malformations, deformations, chromosomal abnormalities’ (Q90) and is considered a mental disability. The other was diagnosed with mild mental retardation which is classified as F70 under ‘Mental and behavioural disorders’, a mental illness. The latter seems to indicate a malfunction or disturbance which may be somehow cured or corrected, whereas Down Syndrome as congenital abnormality sounds like a status one must come to terms with. This interpretation is supported by the entry for F70 in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) edited by the American Psychiatric Association, which is ‘Intellectual Developmental Disorder’. Down Syndrome as congenital abnormality has no entry. Our aim was to investigate whether selected translations help to improve the understanding of the Q and F classifications of ICD-10, and whether ICD-11 will represent further development.

Methods: Descriptive analysis by comparing conceptual attributions in ICD-10, DSM-5, and ICD-11 in five Central European languages.

Results: Our comparison revealed that the ICD-10 classifications F70-79 show serious semantic differences between countries. The classification ‘mental retardation’ is the same in the Romance languages Italian, Spanish, and French, but the German and Dutch terms show a different understanding with ‘intelligence reduction’ and ‘feeble-mindedness’. Concerning the F80-89 classifications, the descriptions fluctuate between psychic and psychological disorders. There are no changes regarding those inconsistencies in ICD-11, but the descriptions of F-diagnoses are more specific, which may result in more target-oriented therapies.

Conclusion: The same manifestation can lead to different conceptual attributions with potentially stigmatising effects due to the ICD-10 classification of an underlying condition. This also generates different expectations of relatives, caregivers, treating physicians, and in society. Regarding symptom-oriented and patient-centred care, the ICD-10 may pose a hurdle.

Competing interests: The authors have no conflicts of interest to declare.