21 new diagnoses have been added to the ICD-11 Clinical Descriptions and Diagnostic Requirements for Mental, Behavioural, or Neurodevelopmental Disorders. As WHO member states begin to transition from using the ICD-10 to the ICD-11 in health care systems, it is important for clinicians to gain an understanding of how these new diagnostic categories have the potential to improve both individual care and public health globally.
New diagnostic categories are proposed and added to classification systems primarily for three reasons: 1) To ensure that clinical conditions are accurately reported and collected in public health and morbidity data; 2) To facilitate identification of clinically important mental disorders so that appropriate, specialized care can be accessed and provided; 3) To stimulate research on effective treatments for these conditions. By introducing new diagnostic categories into the ICD-11, standardized definitions for various conditions are now available for use in diagnostic processes, treatment selection, research studies, and public health data collection systems.
In an article published recently in World Psychiatry, lead authors Dr. Geoffrey M. Reed and Dr. Michael B. First invited experts to share insight on the following four new diagnoses in the ICD-11: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder.
In a series of GCP.Network Perspectives articles, key information for each diagnostic category will be highlighted, beginning here with complex PTSD.
What is Complex Post Traumatic Stress Disorder (Complex PTSD)? In the ICD-11, the diagnosis of complex post traumatic stress disorder (complex PTSD) includes the following essential features:
- Exposure to one or multiple events that are extremely threatening or horrific in nature, from which escape is difficult or impossible.
- Following the traumatic event(s), development of the three core symptoms of PTSD: re-experiencing in the present, avoidance, and an ongoing sense of threat.
- Having persistent difficulties regulating emotions, inability to experience pleasure or positive emotions; persistent beliefs about the self as diminished, defeated, or worthless; and difficulties in maintaining relationships or feeling close with others.
- To view the full version of the diagnostic requirements, the ICD-11 CDDR is available here.
Why was complex PTSD added as a new diagnostic category? For decades, individuals, clinicians, and researchers have described and reported experiences and symptoms beyond those outlined for PTSD in the ICD-10 and DSM-V. In two global surveys conducted by the World Health Organization, complex PTSD was most frequently suggested by psychologist and psychiatrists to be included as a separate diagnosis in the ICD-11. Notably, complex PTSD acknowledges the pervasive symptoms that may result from experiencing chronic, prolonged traumatic events. With dominant and influential symptoms of negative self-concept, affect dysregulation, and disturbance of self-organization, research has indicated that complex PTSD is a distinct diagnosis and not a subtype of PTSD. Complex PTSD is also distinct from borderline personality disorder, as borderline personality disorder is characterized by instability in identity and volatile relationships while complex PTSD tends to be characterized by negative but stable identity, consistent tendency to avoid relationships, and lower levels of impulsivity. In an international ICD-11 field study, clinicians were able to accurately differentiate between PTSD and complex PTSD based on the presence or absence of disturbances in self-organization.
How does this new diagnosis in the ICD-11 improve care provision and public health? With the new diagnosis of complex PTSD, individuals who may have been previously diagnosed with multiple, stigmatizing disorders can now seek treatment with a diagnosis that more accurately captures and validates their experiences. Specialized treatment can also be developed to focus on addressing both core PTSD symptoms and symptoms of negative self-concept and emotional dysregulation that result from experiencing multiple forms of trauma. Furthermore, the inclusion of complex PTSD in the ICD-11 has already prompted a sharp increase in research on the disorder and will further clarify the construct validity of the disorder globally. From a global public health perspective, the ability to collect more accurate data on the prevalence of complex PTSD allows for resources to be more appropriately distributed and helps to ultimately improve the mental health of populations.
To read more about the history, research evidence, and controversies around the inclusion of complex PTSD in the ICD-11, the full article is available online here. GCP.Network members can log in and download a PDF of the article on the Scholarly Output page.
Citation: Reed, G.M., First, M.B., Billieux, J., Cloitre, M., Briken, P., Achab, S., Brewin, C.R., King, D.L., Kraus, S.W. and Bryant, R.A. (2022). Emerging experience with selected new categories in the ICD-11: Complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. World Psychiatry, 21: 189-213. https://doi.org/10.1002/wps.20960