What research compares outcomes for patients diagnosed with ICD‑11 pDID versus DSM‑5 DID/OSDD classifications?
Executive summary
There is no direct, peer‑reviewed body of research in the supplied reporting that compares clinical outcomes for patients diagnosed under an ICD‑11 "pDID" label versus DSM‑5 DID/OSDD labels; the literature provided instead examines broader ICD‑11 vs DSM‑5 harmonization, dimensional models for personality disorder, trait measures, and diagnostic accuracy, which offer indirect but incomplete evidence relevant to outcome differences [1] [2] [3]. Any firm claim that one system produces better patient outcomes for dissociative disorders specifically is therefore unsupported by the sources provided.
1. What the supplied literature actually compares: systems, traits and diagnostic accuracy
The material assembled focuses largely on macro‑level differences between ICD‑11 and DSM‑5, the shift from categorical to dimensional models, and the psychometric performance of severity/trait measures rather than head‑to‑head outcome trials for specific syndromes such as DID/OSDD [1] [3] [2]. Systematic reviews and comparative papers document efforts to harmonize taxonomy and test the sensitivity/specificity of severity measures (overall Se = 0.84, Sp = 0.69 reported for some PD severity measures), but they caution about bias and non‑representative sampling that limit generalizability [2]. Several empirical studies validate trait inventories that map across both frameworks, supporting convergent measurement of dysfunction and traits but not directly linking diagnostic label to downstream treatment outcomes [4] [5].
2. What clinicians and reviewers say about potential outcome implications
Authors argue that ICD‑11’s shorter duration qualifiers and emphasis on severity/dimensionality were designed to encourage earlier and presumably better‑timed interventions, a change intended to improve outcomes—but that assertion is programmatic and based on rationale rather than disorder‑specific outcome trials presented here [1]. Reviews of practical implications emphasize that ICD‑11’s dimensional approach could aid early intervention in adolescence and reshape forensic and social applications, yet they also note the practical gap: lack of structured clinical interviews developed specifically for ICD‑11 complicates direct outcome research and clinical translation [3].
3. What is known about cross‑system comparability and why DID/OSDD remain an evidence gap
Multiple comparative studies show the two systems are “largely commensurate” for several constructs and that short instruments can span trait domains across ICD‑11 and DSM‑5, suggesting measurement overlap that could, in principle, support comparable treatment planning [6] [4]. However, the supplied literature repeatedly flags methodological limitations—case‑control designs, biased index tests, nonuniform cutoffs, and absence of cross‑cultural validation—that weaken any inference that diagnostic label alone drives outcome differences [2]. Crucially, none of the provided sources reports prospective outcome studies that track patients labeled under ICD‑11 pDID versus DSM‑5 DID/OSDD to compare response to psychotherapies, function, relapse, or mortality.
4. Alternative viewpoints, implicit agendas and next empirical steps
Stakeholders pushing for harmonization (WHO, APA) emphasize utility and clinical translation, but their differing priorities—global morbidity coding and insurance/epidemiology for WHO versus clinical research and reimbursement forces for APA—shape what gets studied and funded, potentially biasing which disorders receive outcome research attention [1] [7]. The literature suggests logical next steps: developing validated ICD‑11 structured interviews [3], conducting representative diagnostic‑cohort studies that avoid case‑control bias [2], and running prospective comparative effectiveness research for dissociative presentations specifically; the current evidence base in the provided reporting stops short of those designs.