ICD-11 Updates

Published: 23 April 2019

Details

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 4th edition.

Rs. 10,000 off on PrepLadder 2019 video pack. Offer ends soon

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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 disorderʼ 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 disordersʼ that includes-

a) Trichotillomania - It involves recurrent pulling of oneʼs 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 oneʼs 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 disorderʼ is the newer name for ‘somatoform

disorderʼ 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 ‘alienationʼ 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 personʼs
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 personʼs 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 disordersʼ 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

disorderʼ 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 individualʼs
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 retardationʼ in ICD-11 is ‘Disorders of

Intellectual developmentʼ

2. In ICD-11, a newer diagnosis of ‘Autism spectrum disorderʼ has

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

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.

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