Why the ICD Is More Widely Used Internationally Than the DSM-5-TR

Beyond Psychiatry: One System for the Whole Body

The ICD’s greatest strength may be its simplicity of integration.
While the DSM covers only mental disorders, the ICD covers everything from depression to diabetes. This means a patient’s physical and mental health data live in one system, allowing a holistic picture of health that’s vital for public policy, hospital systems, and research.

In contrast, the DSM’s specialized psychiatric focus makes it a powerful tool for clinicians and researchers, however less practical for national healthcare databases or general medical use (APA, 2022).

ICD utilization demonstrates how mental and physical health intertwine. For educators and students, that connection is essential for understanding the patient as a whole person.

Built for the World, Not Just One Country

The ICD’s design is inherently global. Each revision, including ICD-11, is shaped by experts from over 100 countries. Field tests take place in community clinics and hospitals across continents to ensure the criteria are usable, understandable, and culturally sensitive (Reed et al., 2019).

DSM-5-TR incorporates cross-cultural research, but its foundation remains largely U.S.-centric. ICD-11, on the other hand, was built with clinical utility in mind. Its diagnostic guidelines encourage flexible, realistic judgment rather than strict symptom counting (First et al., 2021).

The ICD allows adaptability between clinicians in different countries to recognize the same disorder in culturally specific ways and still speak the same diagnostic language.

The Policy Powerhouse

Behind every mental health initiative, from suicide prevention to epidemiological tracking, lies a spreadsheet full of ICD codes.
Governments use ICD data to set public health budgets, measure disease burden, and evaluate health outcomes. Without those codes, mental health would be invisible in global data.

This policy connection also means that DSM diagnoses often need “translation” into ICD terms for official reporting or insurance purposes (WHO, 2022). In effect, even DSM users depend on the ICD to make their work visible in national and global health systems.

The Bigger Picture

Two Systems, One Goal

It’s tempting to say that the DSM and ICD are gradually merging into one seamless global system. In reality, the picture is far more complicated.

While both manuals share a goal of improving diagnostic accuracy and reducing stigma, they remain shaped by different forces,  political, economic, and cultural. The ICD reflects the WHO’s global health mission, emphasizing accessibility, cross-cultural use, and integration with general medicine. The DSM, developed by the American Psychiatric Association, reflects a U.S. professional and research framework that is deeply embedded in academic psychiatry, insurance systems, and legal standards.

Even where the two systems now share terminology and conceptual overlap, as in depression, anxiety, or trauma disorders, the pathways to adoption diverge sharply. The ICD-11 depends on national health ministries, digital infrastructure, and translation resources, which many low and middle-income countries still lack. The DSM-5-TR, meanwhile, remains entrenched in U.S. medical training, research funding structures, and insurance coding practices that make change slow and costly (APA, 2022).

Many clinicians also express philosophical resistance to convergence. Some view ICD’s clinical flexibility as too broad, risking diagnostic inflation; others find DSM’s symptom-count precision too rigid for real-world cases (Reed et al., 2019). These professional debates are not mere academic quibbles, they reflect deep differences in how mental illness is conceptualized across cultures.

So while the ICD and DSM may be inching toward each other conceptually, structural barriers and professional inertia make full harmonization unlikely in the near term. Instead, what’s emerging is a pragmatic bilingualism: clinicians, educators, and students learning to navigate both systems, sometimes within the same case, or even the same patient record.

Speaking a Shared and Evolving Language of Care

Ultimately, the ICD’s international dominance isn’t about which system “wins.” It’s about which one fits the world’s health structures, resources, and realities. For educators and trainees, fluency in both systems and awareness of their pitfalls, is part of becoming a competent global clinician.

Simulation-based learning, such as Symptom Media’s diagnostic case studies, gives students the chance to experience those tensions firsthand: choosing between ICD and DSM frameworks, wrestling with gray areas, and seeing how cultural and structural factors shape diagnosis.

Mental health doesn’t exist in a confined box and neither do the systems that define it. Understanding both the convergence and the friction between DSM and ICD is the key to navigating the future of global psychiatry with insight and empathy.