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69.1 It is only recently that psychiatric classification has been codified with the use of standard and operationally defined categories. Table 2 summarises the two common classifications which differ in some of the terms used and in the precise criteria. They are, however, designed to be compatible and can generally be seen as interchangeable.⁵ Although these classifications are now well established, there are many doctors and lawyers who are not familiar with them and who continue to use a variety of traditional terms from both medicine and psychiatry which are no longer accepted as being meaningful or useful. Many of these terms are to some extent pejorative and lack any evidence-base; they include terms such as post-traumatic neurosis, compensation neurosis and functional overlay.

69.2 Even though there remain some conceptual and practical difficulties with modern classifications, they do have a substantial basis in clinical experience and systematic reviews and provide operationally defined categories.

TABLE 2 Classification of psychiatric disorder

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Two compatible internationally accepted systems:

ICD-10: WHO International classification of diseases (10th edition)

DSM-IV: American Psychiatric Association: Diagnostic and Statistical Manual (4th edition)

- Both systems used in the United Kingdom

- Operationally defined syndromes: symptoms rather than aetiology