ICD-11 Updates

Recently, the WHO has released a new International Classification of Diseases (ICD-11).

These updates are very important from PGMEE point of view.

For the benefit of students preparing for the exams, Dr.Praveen Tripathi has systematically compiled the changes chapter-wise according to the video recorded lectures in the app and Review of Psychiatry 4^th edition. 

ICD-11 Updates

CHAPTER 2- Schizophrenia And Related Disorders

1. The subtypes of schizophrenia (paranoid, catatonic, hebephrenic etc.) have been removed. The types of schizophrenia that have been described in ICD-11 are according to the course of illness and include-

a) Schizophrenia, first episode- If patients meet diagnostic criterion of schizophrenia and there have been no past episodes

b) Schizophrenia, multiple episodes- If patients meet diagnostic criterion of schizophrenia, and there has been at least one episode in the past. Between the last and current episode, there was significant remission of symptoms

c) Schizophrenia, continuous- If patient has bee fulfilling the diagnostic criterions of schizophrenia for almost the entire duration of illness (duration should be more than one year)

2. NEW DIAGNOSIS- Catatonia has been made a separate diagnostic category

Chapter 3- Mood Disorders

NEW DIAGNOSIS- Two types of Bipolar disorders (Bipolar type I disorder and Bipolar type II disorder) have been included in the formal classification

Chapter 4- Neurotic, Stress-related And Somatoform Disorders

1. NEW DIAGNOSIS-‘Hoarding disorder’ has been made a separate diagnosis (it's no longer a subtype of obsessive-compulsive disorder)

2. NEW DIAGNOSIS -Olfactory reference syndrome: Its a new diagnostic entity added in ICD-11. It is characterised by preoccupation with the belief that one is emitting a foul body odour or breath that in reality is either unnoticeable or only slightly noticeable to others. The person who has the preoccupation feels self conscious and may also believe that others are taking notice of the odour and talking about it. The patient may repeatedly check the odour or try to mask it or may start avoiding the social situations

3. NEW DIAGNOSIS- ICD-11 has added a category of ‘body focussed repetitive disorders’ that includes-

a) Trichotillomania - It involves recurrent pulling of one’s own hair leading to significant hair loss, accompanied by unsuccessful attempts to decrease or stop the behaviour.

b) Excoriation disorder- It involves recurrent picking of one’s own skin leading to skin lesions, associated with unsuccessful attempts to decrease or stop the behaviour.

4. NEW DIAGNOSIS Complex PTSD- A new diagnostic category has been added. Complex PTSD may develop following exposure to an event or series of events of extremely threatening nature (usually in cases where the event is repetitive, e.g. in cases of slavery, repeated childhood sexual or physical abuse, prolonged domestic violence). In complex PTSD, in addition to the symptoms of PTSD, the following are seen-

a) severe abnormalities of affect regulation (i.e. severe emotional regulation disturbances)

b) belief about oneself as being a defeated and worthless person and feelings of shame and guilt for the event

c) Inability to feel close to others and sustain a relationship

5. Bodily distress disorder’ is the newer name for ‘somatoform disorder’ in ICD-11

6. NEW DIAGNOSIS- Body Integrity dysphoria-It is characterized by an intense and persistent desire to become physically disabled in a significant way (e.g. amputation of a limb or become blind). The patients report a sense of ‘alienation’ from a body part and a discomfort with the currently non-disabled body part.

They have a preoccupation with becoming physically disabled and may pretend to be disabled (pretenders) or may request a surgical amputation.

Chapter 5- Substance Abuse

1. NEW DIAGNOSIS Single episode of harmful use - A single episode of use of alcohol that has caused damage to a person’s physical or mental health or has resulted in behavior leading to harm to the health of others.

2. Harmful pattern of use- Definition has been expanded. A pattern of alcohol use that has caused damage to a person’s physical or mental health or has resulted in behavior leading to harm to the health of others.

3. Gambling disorder and Gaming disorder- ICD-11 has included gambling disorder & gaming disorders, like addictive behavior disorders, and they have been classified along with substance-related disorders

Chapter -6 Organic Mental Disorders

The group name ‘Neurocognitive disorders’ has been used instead of organic mental disorders of ICD-10

Chapter 7- Personality Disorders

The older classification of personality disorders (e.g. schizoid, paranoid, narcissistic, etc) has been removed. According to ICD-11, personality disorders would only be divided according to the severity of symptoms-

• Mild Personality Disorder
• Moderate Personality Disorder
• Severe Personality Disorder

Chapter 8- Eating Disorders

1. NEW DIAGNOSIS- In ICD-11, a newer diagnosis of Binge eating disorder’ has been added. It is characterized by episodes of binge eating, without the presence of any compensatory behavior

2. In Anorexia Nervosa - Definition criterion has been updated. It is characterized by significantly low body weight for the individual’s height, age and developmental stage (body mass index (BMI) less than 18.5 kg/m2 in adults and BMI-for-age under the fifth percentile in children and adolescents.

3. NEW DIAGNOSIS- Avoidant restrictive food intake disorder is a new diagnosis that has been included in both ICD-11 and DSM-5. It is characterized by the following-

4. Insufficient intake of quantity or variety of food, that results in weight loss (or inability to gain weight) and nutritional deficiency.

5. The patient may report a lack of interest in eating or may avoid food due to sensory characteristics (e.g not liking the smell or taste of food)

6. There is no disturbance of body image (This characteristic helps in differentiating anorexia nervosa, restrictive type from Avoidant -restrictive food intake disorder.

Chapter- 10 Child Psychiatry

1. The newer name for ‘mental retardation’ in ICD-11 is ‘Disorders of Intellectual development’

2. In ICD-11, a newer diagnosis of ‘Autism spectrum disorder’ has been introduced in place of ‘Pervasive developmental disorders’. In ICD-10, the broader category of pervasive developmental disorder included various types such as autism, rett’s syndrome, asperges’s syndrome and childhood disintegrative disorders. In ICD-11, all these have been clubbed under the diagnosis of ‘autism spectrum disorder’. DSM-5 also has a similar diagnosis of ‘autism spectrum disorder’

3. In both ICD-11 & DSM-5, in autism spectrum disorders, language dysfunction has been removed as a core criterion. Only impaired social interaction and repetitive, restrictive behaviors form the core criterion now.

Stay tuned for more updates..

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