Mental or Physical classification -WHO decides?


The World Health Organisation (WHO) has developed a classification system called the International Classification of Diseases (ICD) using a combination of alphabetic & numerical codes. The version used in the UK is the 10th and commonly referred to as the ICD-10.  It is used within the acute sector of the NHS and provides a ‘diagnosis’ of disease, disorder or other health condition.


Who decides the classification of a disorder or disease?

Classifications are approved by The World Health Assembly, the highest decision-making body of the (WHO). The ‘Assembly’ consists of representatives from 192 WHO member States.


Are WHO classifications important?     

Yes. If you are deemed to be suffering from: a heart problem you may be referred to – a cardiologist; a mental problem - a psychiatrist or psychologist; a neurological disorder – a neurologist. In addition, if you are diagnosed with a mental disorder your entitlement to certain benefits may be affected.


What is the classification for ME/CFS?  (Myalgic Encephalomyelitis - Chronic Fatigue Syndrome)

M.E/CFS is classified in the ICD -10 as a neurological disorder under Diseases of the Nervous System, as are Multiple Sclerosis and Epilepsy. The classification code for ME/CFS is G93.3.


WHO Collaborating Centres 

There are over 1,000 institutions around the world designated as Collaborating Centres, the Institute of Psychiatry, London is one of them. These Collaborating Centres are allowed to make adaptations to WHO publications but have absolutely no authority to alter/modify classifications.


Mental or physical?

Multiple Sclerosis (once known as creeping paralysis) was once considered a mental disorder caused by female hysteria and the removal of women’s ovaries or wombs was not unheard of.  This view meant little or no extensive research was conducted into the mysteries of MS, until very recent times. This led to the misguided conclusion in 1920 that men were more susceptible to MS, because women were mistakenly diagnosed as suffering with hysteria. Only recently has research shown MS to be neurobiological rather than psychological, resulting in a very different attitude towards MS patients. Other disorders once considered psychiatric: Parkinson’s disease, asthma, and epilepsy - to name a few.


Is history repeating itself? 

In October 2001 it was discovered that CFS/ME had been ‘unofficially’ reclassified as a mental disorder in a U.K adaptation of a WHO publication, the ‘WHO Guide to Mental Health in Primary Care’, developed by the Collaborating Centre of the Institute of Psychiatry, London.  It was included under the classification F48.0 relating to mental, behavioural and neurotic disorders (neurasthenia).

Despite numerous complaints being made to the Collaborating Centre of the Institute of Psychiatry, and ICD-10 classifications being mandatory in the UK, sales of the book were allowed to continue unabated for years until almost all 30,000 copies had been sold. Then and only then was an erratum slip issued.  This misclassification also led to CFS/ME being wrongly classified as a mental disorder in the NHS Mental Health Data Manual.  It is noteworthy that CFS/ME has once again been included in the 2nd edition of the ‘Guide’. However, the title of the book has been (conveniently) altered to include both mental and neurological disorders, and a few neurological disorders added.

Submission to Gibson Inquiry January 2006