LIMITED UTILITY OF ICD-10 AND DSM-IV CLASSIFICATION OF DISSOCIATIVE AND CONVERSION DISORDERS IN INDIA

Studies of psychiatric out-patients from India have found that diagnos is of some of the subcategories of the dissociative and conversion dis orders of the ICD and DSM classificatory systems are rarely made in th is setting. Moreover, it was found that a significant percentage of pa tients seen in psychiatric practice may not fit into the defined subca tegories of dissociative (conversion) disorders of these systems of cl assification. We studied the prevalence of various ICD-10 and DSM-TV c ategories of dissociative (conversion) disorders and our own proposed category of 'brief dissociative stupor' (BDS), among all the in-patien ts of a psychiatric unit in a general teaching hospital, over a 2-year period. There were 18 patients who fulfilled our criteria for BDS and 18 patients in the second group which included all of the remaining s ubjects with a diagnosis of any other subcategory of dissociative diso rder according to ICD-10. Our analysis revealed that there were no pat ients with a diagnosis of dissociative amnesia, fugue, stupor, trance and possession disorders or identity disorders. There were significant ly more female patients in the BDS group, and they also had significan tly more comorbid Axis-I diagnoses and panic attacks. Since 50% of our patients fulfilled the criteria for BDS, there is clearly a need for further studies to establish the prevalence of this subcategory in pat ients from other centres. The classification of these patients with th is phenomenology is problematic. Inclusion of a subcategory of dissoci ative non-epileptic seizures, instead of dissociative convulsions, sho uld improve the classification of dissociative (conversion) disorders.