Overview of the ICD-11 for Mental Health

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The International Classification of Diseases (ICD-11) is the 11th edition of 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. It was officially presented at the World Health Assembly in May 2019 and will be used as the official reporting system by member states beginning January 1, 2022.

The initial release as an advance preview is intended to give member countries time 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 new version is the result of work completed over the course of a decade involving 300 specialists divided into 30 workgroups across 55 countries who provided input. Health care workers joined collaborative meetings to incorporate practical applications in the ICD-11 revision in addition to theoretical concepts, particularly in the area of mental health.

Following the approval and revisions process 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 catalogs known human diseases, medical conditions, and mental health disorders and is used for insurance coding 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

Improvements included in the ICD-11 are intended to address gaps in the ICD-10 and incorporate medical updates, discoveries, or changes in thinking. Key revisions were made to the new ICD in terms of the approach to categorization and coding structure, international usage, 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.

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 use by a global audience. It runs on a central platform and can connect to any software. In addition, it can be a machine-readable format, expanding its potential uses in the digital age.

Dimensional Approach

Another enhancement of the ICD-11 is that it's based on a dimensional approach that makes it better at capturing change over time, is consistent with research evidence, and will improve 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

The ICD-11 and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) share many similarities. Both are authoritative guidebooks for medical professionals to use for the diagnosis and treatment of diseases and disorders. They share a great overlap of material on mental disorders, with the DSM solely focused on mental health concerns, while the ICD covers all parts of the body and mind.

The most recent version of the DSM was published on May 18, 2013, by the American Psychiatric Association (APA). Compared to the DSM-5, the ICD-11 is broader both in its scope and its authorship.

Mental health professionals in the United States are more likely to rely on and be familiar with the DSM, rather than the ICD, mental health classifications as the DSM guidebook is specifically tailored to cover mental health disorders as they are experienced and treated in this country.

While the DSM-5 is published by the APA and has a rather narrow scope and authoritativeness as it's 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.

Another big difference is that the DSM does not code its diagnoses. Mental health professionals in the United States primarily use the DSM for diagnosis but rely on the ICD codes for insurance billing purposes. This can cause confusion and conflict when a disorder is classified differently (or not at all) from one manual to the other.

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 (ADHD 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.

ICD-11 Added Diagnoses

The following diagnoses are now included in the ICD-11.

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.

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 broader problems in emotion regulation, shame, guilt, and interpersonal conflict, such that it affects the person's entire life.

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 behavior." It is classified as an impulse control disorder rather than an addictive disorder.

Gaming Disorder

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

Prolonged Grief Disorder

Prolonged grief disorder is defined in the ICD-11 as grief that extends beyond what most people would consider a reasonable or expected amount of time. Prolonged grief disorder is listed as a proposed disorder in the DSM-5.

ICD-11 Deleted Diagnoses

The following disorders were removed in the new version.

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.

Gender Incongruence

Gender incongruence (gender dysphoria in the DSM) 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.

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:

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

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

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:

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

A Word From Verywell

While it may be 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, this new revision of the ICD could influence or alter standards for diagnosis and disease classification. 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 and for your insurance provider.

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Article Sources
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