Overview of the ICD-11 for Mental Health

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The International Classification of Diseases (ICD-11) is a global categorization system for physical and mental illnesses published by the World Health Organization (WHO); the ICD-11 is a revised version of the ICD-10 and the first update to be developed and published in two decades.

Development and Release of the ICD-11

The new version of the ICD was released on June 18, 2018 as a preliminary version that is expected to be approved the World Health Assembly in 2019 and then used as the official reporting system by member states beginning January 1, 2022.

This release is an advance preview intended to allow countries to plan how they will use the new ICD-11, train health professionals in its use, and obtain necessary translations. It's important also to note that anyone can submit an evidence-based proposal for ICD revisions and that these are processed in an open and transparent way.

This version was the result of work completed over the course of a decade involving 300 specialists divided into 30 work groups across 55 countries who provided input. Given that health care workers joined collaborative meetings, it can be assumed that the ICD-11 takes into consideration practical applications in addition to theoretical concepts, particularly in the area of mental health.

Following the approval of the ICD-11, the WHO's Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for the mental, behavioral, and neurodevelopmental disorders listed in the ICD-11.

The ICD-11 covers diseases, medical conditions, mental health disorders, etc. and is used for coding for insurance purposes, for statistical tracking of illnesses, and as a global health categorization tool that can be used across countries and in different languages.

Improvements in the ICD-11

How specifically was the ICD-11 been improved in relation to the ICD-10? Improvements were made in terms of the approach to categorization and coding structure, international usage, and digital-readiness and user-friendliness.

Coding Structure

In terms of general improvements, the ICD-11 has a more sophisticated structure than the ICD-10. With around 55,000 codes that can be used to classify diseases, disorders, injuries, and causes of death, the ICD-11 offers a fine level of detail in coding these illnesses. In this way, a key feature of the revised system is that it provides a simple coding structure that makes it easier to record various conditions with specificity.

International Applicability

The ICD-11 offers guidance for its use with different cultures as well as translations into 43 different languages. In this way, the revised system provides a common coding language that can be used by healthcare professionals and researchers worldwide, which will aid in international comparisons and usage.

Digital-Ready and User-Friendly

The new ICD-11 was designed to be electronic and user-friendly for a global audience. It runs on a central platform and can connect to any software. In addition, it can be used in a machine readable format, expanding its potential uses in the digital age.

Dimensional Approach

The ICD-11 is based on a dimensional approach that is better at capturing change over time, is consistent with research evidence, and will aid recovery from illness. This dimensional approach also helps to reduce artificial comorbidity, which refers to a person being diagnosed with more than one illness when in fact their symptoms are all part of the same illness. To aid this dimensional approach, the new system includes two new chapters and a new set of categories.

ICD-11 vs. DSM-5

What are the differences between the ICD-11 and the DSM-5? The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published on May 18, 2013 by the American Psychiatric Association. Compared to the DSM-5, the ICD-11 is broader both in its scope and its authorship.

While the DSM-5 is published by the APA and has a rather narrow scope focused on North America, the ICD-11 draws its authorship globally and is open to the public for submissions. The ICD-11 also covers medical diseases in addition to mental disorders.

Finally, there are specific differences in the way different disorders are treated between the two bodies of categorization. For example, attention-deficit hyperactivity disorder (ADHD) was only just added to the ICD-11 (was not in the ICD-10), while it has long been diagnosed in North America according to the DSM-5.

Changes in the ICD-11

This new version of the ICD-11 involved several changes to the mental health disorders that are listed, including some that may be considered controversial and others that may be long overdue in the eyes of clinicians. The following sections detail the diagnoses that were either added or deleted in the new ICD-11.

Added Diagnoses

Gaming disorder: Gaming disorder is newly defined in the ICD-11 as “a pattern of persistent or recurrent gaming behaviour (‘digital gaming’ or ‘video-gaming’).”

Compulsive Sexual Behavior Disorder: Compulsive sexual behavior disorder is defined in the ICD-11 as "characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour." However, it is classified as an impulse control disorder rather than an addictive disorder.

Prolonged Grief Disorder: Prolonged grief disorder is defined in the ICD-11 as grief that extends beyond what most people would consider to be a reasonable amount of time.

Complex PTSD: The definition of complex post-traumatic stress disorder (PTSD) in the ICD-11 involves the three symptoms of PTSD (re-experiencing, avoiding reminders, and a heightened sense of threat/arousal) along with problems in emotion regulation, shame, guilt, and interpersonal conflict (such that it affects the person's entire life).

Attention Deficit Disorder: Attention-deficit hyperactivity disorder (ADHD) was finally added to the ICD-11 after not being included in the ICD-10. Given that this diagnosis has primarily been made in the United States due to it being included in the DSM-5, this is a significant change that may impact rates of ADHD diagnoses worldwide.

Deleted Diagnoses

Gender Incongruence: Gender incongruence is no longer listed as a mental disorder but rather a sexual health condition to avoid stigma about it being a psychological rather than medical condition.

Acute Stress Disorder: Acute stress disorder is no longer included as a mental disorder and instead is now classified as a reaction to trauma (factor influencing health). This is in contrast to the DSM-5.

Personality Disorders: The section on personality disorders has been completely overhauled. There is now one diagnosis of "personality disorder" as it was found that there was much overlap in clinical practice. This diagnosis is labeled as mild, moderate, or severe, and measured in terms of six trait domain areas to retain some of the earlier specificity of the diagnosis. This is a fairly significant departure from the original ICD personality disorder diagnosis.

What's Included in the ICD-11

The ICD-11 includes an implementation package with the following components that can be used to help ease the transition and better use the categorization system:

  • Transition tables from ICD-10 to ICD-11
  • Translation tool
  • Coding tool
  • Web services
  • Manual
  • Training material

All of these tools are accessible to those who register on the ICD-11 platform online.

List of Mental Health Disorders in the ICD-11

Within the ICD-11, each mental, behavioral, and neurodevelopmental disorder listed includes a description with guidance on meaning that you can access through the website. The following is a list of each of the disorders currently included in the ICD-11 available online:

  • Neurodevelopmental disorders  
  • Schizophrenia or other primary psychotic disorders
  • Catatonia
  • Mood disorders
  • Anxiety or fear-related disorders
  • Obsessive-compulsive or related disorders
  • Disorders specifically associated with stress
  • Dissociative disorders
  • Feeding or eating disorders
  • Elimination disorders
  • Disorders of bodily distress or bodily experience
  • Disorders due to substance use or addictive behaviours
  • Impulse control disorders
  • Disruptive behaviour or dissocial disorders
  • Personality disorders and related traits
  • Paraphilic disorders
  • Factitious disorders
  • Neurocognitive disorders
  • Mental or behavioural disorders associated with pregnancy, childbirth and the puerperium

A Word From Verywell

While it may sound confusing that there are two systems for diagnosing mental health disorders, the important thing to remember is that the DSM-5 is primarily used in the United States while the ICD is used internationally and for insurance coding purposes.

However, with this new revision of the ICD, it could be that it becomes the new standard for diagnosis. Indeed, the move toward a dimensional approach is more in keeping with current research evidence and is in line with approaches to treatment and recovery that emphasize improvement rather than the presence or absence of a disorder.

If you've been diagnosed with an illness, be sure to ask your provider what diagnostic system was used for categorization and what specific disorder (and code) applies so that you have this information for future visits with health professionals or for your insurance provider.

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