ICD 11 electronic version. WHO publishes new international classification of diseases
The history of the study of personality and its disorders goes back about two thousand years. The first attempt to find out what determines individual differences in people's behavior was made by Hippocrates, and during this time, of course, a lot has changed.
For more than a hundred years, psychiatry has been using an established paradigm, the foundations of which were laid by Emil Kraepelin. In 1904, he described 7 types of “psychopathic personality,” the names of which were given according to their similarity with the manifestations of major mental disorders: Schizoid - reminiscent of schizophrenia, cycloid - echoes the iconic manifestations of manic-depressive psychosis, and so on. Later, Kurt Schneider develops this idea, voicing one of the main signs of a psychopathic personality: the inability to form and maintain relationships with people. He identifies 9 types of personality disorders based on his extensive clinical practice, and most of them are still present in one form or another in the classification of disorders to this day.
But any paradigm is sooner or later questioned, and, apparently, with the advent of DSM-5 and ICD-11, the time has come for personality disorders (PD). The latest classifications offer a new approach that abolishes all specific categories of PD, except one: the very fact of having a personality disorder.
What is this all for?
Many psychiatrists will ask this question, because the system works. But the developers of the new international classification of diseases do not think so. For example, half of patients who meet criteria for one personality disorder also show evidence of other personality disorders. Some personality disorders are too rare, while at the same time, a significant cohort of people with serious personality disorders do not fit into the criteria for any of the existing personality disorders. Patients with the same diagnosis can differ strikingly from each other, both in personal qualities and in the severity of their condition. In addition, currently in the ICD there is a dichotomous division of the population into people with and without LC. In fact, there is an intermediate category of “character accentuations,” which, although it was identified quite a long time ago, previously had no place in the classification of diseases. This deprives psychiatrists of the ability to reliably record subsyndromal changes.
But the most important reason for such global changes is that the RLs of the ICD-10 and DSM-IV sample are based mainly on anecdotal clinical experience, which is practically not supported by evidence-based evidence confirming their existence as discrete categories. Existing descriptions of PD have ignored the core personality traits that are currently established and have a consistent structure regardless of the presence or absence of a personality disorder.
Now, in order. What to do about it?
Step one.
And the easiest. Because at this stage there are practically no changes. The first step is to determine whether the patient meets the general definition of a personality disorder. According to the idea of the new classification, this diagnosis can be made by both a psychiatrist and a doctor of the primary network, since the approach to the definition does not have serious differences from ICD-10. Using the following criteria, without going into categories, the specialist establishes Availability personality disorder:
- the presence of progressive disturbances in the way a person thinks and feels about himself, others and the world around him, which manifests itself in inadequate ways of cognition, behavior, emotional experiences and reactions;
- the identified maladaptive patterns are relatively rigid and are associated with pronounced problems in psychosocial functioning, which is most noticeable in interpersonal relationships;
- the disorder manifests itself in a variety of interpersonal and social situations (i.e., is not limited to specific relationships or situations);
- the disorder is relatively stable over time and has a long duration. Most often, a personality disorder first appears in childhood and clearly manifests itself in adolescence.
If the disorder is first detected in adulthood, the qualifier “late onset” may be used. This qualifier should be used in cases where the history does not provide clear evidence of detectable disorders at an earlier age.
It is very important to determine the area of detected violations. Problems in interpersonal interaction in personality disorders are characterized by general disturbances in relationships with people that interfere with mutual understanding. This needs to be understood because most mental disorders are related in one way or another to social dysfunction. Thus, difficulty in completing tasks, organizing life's responsibilities, free time, maintaining adequate relationships at work, as well as lack of harmony in the family, are very different from the disorders associated with the inability to get along with the rest of the human race, which is exactly what is observed for personality disorders. A person whose life is turned upside down by a family feud does not necessarily have a personality disorder. A diagnosis should only be made if there is clear evidence of widespread deterioration in relationships with everyone around them.
Step two: determining the severity of RL.
Currently, personality disorders are an exclusively qualitative category, which often leads to the fact that two patients with the same diagnosis can be strikingly different from each other. ICD-11 offers 3 degrees of severity of personality changes (see Table 1), each of which can include one or several pathological signs. Ranking by severity takes into account that although LC is supposed to be a lifelong diagnosis, its severity may change over time.
Tab. 1 Degrees of severity of personality disorders in ICD-11
Degree of expression | Main characteristics |
Mild severity of personality disorders | - there are pronounced difficulties in constructing a significant part interpersonal relationships and in fulfilling expected professional and social roles; The ability to perform certain social or professional roles and maintain some relationships is retained; Not associated with causing significant harm to self or others. |
Average severity of personality disorders | - serious problems are observed in most interpersonal relationships and in fulfilling expected professional and social roles; These problems are found in a wide range of situations, most of which are compromised to some degree; Often involves a history or expected future harm to oneself or others, but NOT to a degree that would cause long-term harm or be life-threatening. |
Severe severity of personality disorders | - serious problems in interpersonal functioning, affecting all areas of life; The person's general social dysfunction becomes profound and the ability and/or willingness to perform expected occupational and social roles is absent or seriously compromised; Often involves a history and expectation of future serious harm to oneself or others to a degree that may cause long-term harm or be life-threatening. |
In addition, a subthreshold level of disorder is identified, which corresponds to the familiar concept of “personality accentuations” and is designated as “personality difficulty” (complex/difficult personality) (see Table 2). “Personality difficulty” will not be a diagnosis, and, in its essence, will correspond to the existing code Z in ICD-10. Registration of accentuations is necessary, since its presence increases the risk of the need for medical intervention in certain conditions, for example, under stress or in certain conditions environment. At the same time, it is necessary to understand that some cases of mild personality disorders may not require specialist supervision. According to modern epidemiological estimates, 1 out of 14 people in the population suffers from a personality disorder, and treatment of each, firstly, is not necessary, and secondly, incurs huge economic costs. The presence of ranking by severity will allow a more professional approach to identifying indications for therapeutic interventions.
Tab. 2 Dimensional system for classifying personality disorders by severity.
Degree of expression | Name | Main characteristics |
0 | Lack of radar | No personality disorders |
1 | Personality difficulty (accentuation) | There are some disorders that manifest themselves in limited range of situations, but not all the time |
2 | Disorder personalities |
The presence of a clearly expressed personality disorders manifesting themselves in a wide spectrum situations |
3 | Integrated radar | several domains and appearing in all situations |
4 | Severe RL | The presence of pronounced problems affecting (usually) multiple domains and occurs in all situations resulting in significant risk to self or others |
The difficult-to-understand comorbidity of different types of personality disorder has been eliminated, which may lead to a decrease in the number of patients with unspecified/mixed personality disorder. The designation of “complex personality disorder” reflects a universal finding in research on this topic that as the problem becomes more pronounced, the diagnostic boundaries between different personality disorders become blurred.
Step three.
Where you need to forget everything you knew before. The classification we are familiar with implies that personality disorders are discrete and qualitatively different syndromes and, at their core, work according to an all-or-nothing scheme. The changes that affected the problem of personality disorders in ICD-11 indicate that PDs are maladaptive variants of personal qualities that can imperceptibly transform into normal ones, or one into another, being a kind of continuum without any strict distinctions.
The new approach was based on the line started by G. Allport, G. Eysenck and R. Cattell about the dispositional (from the English disposition - predisposition) model of human personality or the so-called “Big Five”. The essence of this model is that the levels of dominance of the described personality traits form a person’s individuality and, in turn, predetermine the ability to adapt this personality. Empirically, using scales, questionnaires and expert assessments, five properties were identified (see Table 3).
Tab. 3 Comparative characteristics of the Big Five domains and RDOC
The same idea was taken up by the developers of the alternative RDOC classification. The features identified by these researchers can fully prove the validity of both the Big Five theories and the domains used in ICD-11 (see Table 4) and DSM 5.
Tab. 4 Personality trait domains ICD-11.
ICD-11 domain | Characteristics |
Negative affective features signs of negative affectivity (neuroticism in Big Five) |
Characterized by a tendency to exhibit a wide range of distressing emotions, including anxiety, anger, self-loathing, irritability, vulnerability, depression, and other negative emotional states, often in response to even relatively minor actual or perceived stressors. |
Dissocial features dissocial symptoms (antagonism – contrasted goodwill in Big Five) |
The core of the dissocial trait domain is disregard for social obligations and conventions and the rights and feelings of others; traits in this domain include: callousness, lack of empathy, hostility and aggression, ruthlessness, and an inability or unwillingness to maintain prosocial behavior, often manifested by an overly positive view of the self and a tendency to manipulate and exploit others. |
Features of disinhibition disinhibitory signs (impulsiveness - contrasted integrity in Big Five) |
The disinhibitory trait domain is characterized by a persistent tendency to act impulsively in response to immediate internal or external stimuli without consideration of long-term consequences; traits in this area include: irresponsibility, impulsiveness without considering risks or consequences, distractibility, and recklessness. |
Anankastic features anancaste signs (conservatism - contrasted openness to experience Big Five) |
This domain is characterized by having a narrow focus on controlling and regulating one's own behavior and that of others to ensure that things conform to an individual's ideal; Traits in this area include: perfectionism, perseveration, emotional and behavioral limitations, stubbornness, conscientiousness, orderliness, following rules and obligations. |
Features of detachment signs of isolation (low level extraversion in Big Five) |
Emotional and interpersonal distance, manifested in noticeable social isolation and/or indifferent attitude towards people; isolation with very little or no attachments, including avoidance not only of intimate relationships but also of close friends; Traits of this domain include: aloofness or coldness towards other people, reserve, passivity and lack of self-confidence, as well as reduced experience in experiencing and expressing emotions (especially positive ones), to the extent of weakening the ability to experience pleasure. |
The DSM has a similar domain model: negative affective, dissocial, disinhibited, and detached domain traits; and instead of anancast, the domain of psychoticism, which is absent in ICD-11.
Each of the domains can be found both in relatively healthy members of the population and among patients with a personality disorder, but in patients with PD they indicate the focus in which the disorder manifests itself to a greater extent. For a diagnostician, it will be necessary to identify the characteristics of domains in a particular patient, even if the clinical picture reveals phenomena characteristic of all five domains. The proposed innovations will help eliminate the temptation to make a diagnosis that bypasses a comprehensive personality assessment. The need for such a vague diagnosis as “mixed personality disorder” is lost. Modern studies examining this approach are identifying specific therapies that may be effective when symptoms of individual domains predominate. For example, the domain of disinhibitory symptoms requires structured psychological intervention, patients with signs of the domain of negative affectivity respond well to cognitive behavioral therapy, and patients with dissocial symptoms are resistant to therapeutic interventions and are more likely to require social changes.
Prepared by: Chesnokova O.I.
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New international classification of diseases (ICD-11). It contains approximately 55,000 unique injury, disease, and cause of death codes. This classification forms a common language for physicians around the world.
“ICD is a special source of pride for WHO. It allows us to better understand the causes of disease and death, and to take action to prevent suffering and save lives,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
ICD-11 has been in development for over ten years. Its updated version contains significant improvements compared to previous versions. For the first time, it is presented entirely electronically and has a much more convenient format. Many healthcare workers took part in its development and presented their proposals at conferences. In total, the ICD group at WHO headquarters received more than 10,000 proposals for revision of certain provisions.
ICD-11 will be presented to the World Health Assembly in May 2019 for adoption by WHO Member States and will come into force on 1 January 2022. This version is being published for preview purposes to enable participating countries to formulate their plans for its use, prepare translations of it, and train health professionals throughout the country.
ICD is also used by insurance companies, since the amount of compensation depends on its codes. In addition, the ICD is used by national health program managers; data scientists; and those who track progress in global health and determine the allocation of resources for the health system.
The new version (ICD-11) also reflects progress in medicine and scientific achievements. For example, codes related to antimicrobial resistance are more consistent with the Global Antimicrobial Resistance Surveillance System (GLASS).
ICD-11 will also help to better collect data on safety in healthcare, meaning that some of the factors that influence health outcomes, such as some potentially hazardous hospital practices, can be identified and reduced.
The new ICD also includes new chapters on traditional medicine: despite the fact that millions of people around the world use traditional medicine, it has not yet been classified in this system. Another new chapter, on sexual health, brings together disorders that were previously classified in other ways (for example, gender nonconformity was previously considered a mental disorder) or were described differently. Gambling disorder has been added to the section on addictive disorders.
“A key principle in revising the codes was to simplify the coding structure and electronic toolkit, which will make it easier for health professionals to record disorders,” said Dr Robert Jakob, head of the WHO Terminology and Classification Standards Group.
Dr Lubna Alansari, WHO assistant director-general for health system measurement, says the ICD is the cornerstone of health information and ICD-11 will provide an updated version of disease understanding.
Flag of the World Health Organization
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On Monday, the World Health Organization published the eleventh edition of the International Classification of Diseases (ICD-11). It included 55 thousand diseases, injuries and disorders, including gambling addiction. A section of traditional medicine also appeared.
The International Classification of Diseases (ICD) is now used in more than one hundred countries and translated into 43 languages. It allows data to be collated and shared globally in a consistent and standardized way - across hospitals, areas and countries and over defined periods of time. This is convenient for collecting statistics on mortality and morbidity of the population, as well as for analyzing the prevalence of various diseases. The latest version of the ICD was adopted 27 years ago, in 1990. Now WHO has presented a new, eleventh edition, which has been in the works for more than ten years.
The new version of the ICD has become completely electronic for the first time. More than one and a half thousand specialists were involved in its creation. Now ICD-11 consists of 26 sections, which include a chapter on traditional medicine, due to its widespread use. In addition, there is a chapter on sexual health: it brings together diseases and conditions that in the past were classified in other categories (for example, gender dysphoria (a condition associated with transgenderism) was previously defined as a mental disorder) or described differently. The list of addiction-related disorders included gaming addiction - a pattern of constant or repetitive behavior when playing online or offline games, which is accompanied by a violation of control over the game (frequency, duration, etc.), relegating other hobbies and daily activities to the background. , as well as the need to continue to play (including progressively), despite the appearance of negative consequences. The disorder can be diagnosed if the individual's behavior causes disturbances in personal, family, social and other areas and is observed for at least 12 months.
In addition, how the disease began to be defined by dangerous gaming (hazardous gaming). It is described as gambling, online or offline, that significantly increases the risk of harmful physical or mental consequences to the person or others . It is included in the class of factors influencing the health status of the population and visits to health care institutions.
According to Vladimir Poznyak, a member of the WHO department who proposed the new diagnosis, the organization is trying to follow the trends and innovations that occur both in society and in the professional environment. He said listing gaming disorder as a disease means that health care providers and systems will be more "aware of the existence of this condition" while increasing the likelihood that "people who suffer from this disorder can get appropriate help." .
ICD-11 will be presented to the World Health Assembly in May 2019 for approval by WHO Member States. The new classification will come into force on January 1, 2022.
The fact that WHO intends to include gaming addiction in the list of disorders back in December 2017. Then the initiative caused an ambivalent attitude from experts. While some scientists' work suggests positive effects, such as cognitive performance in older adults, others show negative effects, such as college students becoming more suicidal.
Kristina Ulasovich
Frequently asked questions about ICD-11
What is the International Classification of Diseases (ICD)?
The International Classification of Diseases (ICD) is the global standard methodology for collecting data on mortality and morbidity. It organizes and encodes health information used for statistics and epidemiology, health management, resource allocation, monitoring and evaluation, research, primary health care, prevention and treatment. It provides insight into the overall health situation of countries and populations.
The 11th version of the ICD is currently being developed through an innovative, collaborative process. For the first time, WHO is calling on experts and users to participate in the revision process on an online platform. This will allow the classification to be developed based on user input and taking into account their needs.
Who uses the ICD?
Users include physicians, nurses, other health care providers, academic researchers, health information managers and coders, health information technology workers, policy makers, insurance companies, and patient organizations.
All Member States use the ICD, which has been translated into 43 languages. Most countries (117) use this system to report mortality, a key indicator of health status.
All Member States are expected to use the latest version of the ICD to report mortality and morbidity statistics (in accordance with the WHO Nomenclature Rules adopted by the World Health Assembly in 1967).
Why is the ICD so important?
The ICD is important because it provides a common language for reporting and monitoring diseases. It allows data to be collated and shared globally in a consistent and standardized way – across hospitals, areas and countries and over defined periods of time. It simplifies the collection and storage of information for analysis and evidence-based decision making.
Why is the ICD being revised?
The ICD is being revised to better reflect scientific progress in health care and medical practice. With advances in information technology, ICD-11 will be available for use in e-health devices and information systems.
What are the features of this revision process?
- The ICD-11 revision process allows for web-based collaborative editing with the participation of all stakeholders. To ensure quality, incoming information will be reviewed for accuracy and relevance.
- The revision will be free to download online for personal use (and available in printed form for a fee).
- Information about the revision process will be available in many languages.
- Definitions, signs and symptoms, and other disease-related content will be defined in a structured manner to more accurately record them.
- The revision is compatible with e-health devices and information systems.
How can I participate in the ICD-11 revision?
Experts and interested parties are invited to provide comments and suggestions, and to participate in field testing of the revised classification. Participants will have the opportunity to make structured contributions that will be peer-reviewed by experts in the field. WHO welcomes the active participation of academic researchers, health information system managers, health care providers and other parties interested in the classification.
Guidance on how to participate in the review process is available on the online review platform.
Why is my contribution important?
Because different views on healthcare and knowledge coming from every corner of the world will contribute to creating a better classification that takes into account the needs of users. The consistency, comparability and usefulness of the classification will be improved through input from multiple parties.
The overall process will lead to global consensus on the definition and reporting of diseases and health-related problems. This is an opportunity to engage in international collaboration that will ensure more consistent and systematic collection of health information.
Where to begin?
To get started, register for counting on the web portal. The web portal will be open for comments for the next three years and adopted changes will be published immediately.
After registration you will be able to do the following:
- make comments regarding the structure and content of the classification and its implementation;
- make proposals for changing ICD categories;
- propose definitions of diseases;
- participate in on-site testing;
- contribute to translation into different languages.
Today, the World Health Organization (WHO) releases a new version of its International Classification of Diseases (ICD-11).
The ICD serves as the basis for tracking trends and maintaining health statistics worldwide and contains approximately 55,000 unique codes for injuries, diseases and causes of death. Thanks to it, healthcare professionals around the world have a common language that allows them to exchange information on health issues.
“ICD is a product that WHO is rightfully proud of,” said the WHO Director-General
Dr. Tedros Adhanom Ghebreyesus. “It enables us to understand the variety of reasons why people get sick and die, and to take action to prevent suffering and save lives.”
ICD-11, whose preparation lasted over ten years, differs from previous versions in a number of important improvements. It is published for the first time in completely electronic form and has a much more reader-friendly format. It also received input from an unprecedented number of health professionals who participated in joint meetings and made suggestions. The ICD Group at WHO headquarters received more than 10,000 proposals for changes to the Classification.
ICD-11 will be presented for adoption by Member States at the World Health Assembly in May 2019 and will enter into force on 1 January 2022. This release is preliminary and exploratory in nature and will enable countries to develop plans for the use of the new version, prepare its translations and conduct nationwide training of health professionals.
The ICD is also used by health insurance companies, which use ICD codes to determine compensation payments; managers of national health programs; data collection specialists; and all those who monitor trends in global health and make decisions about the allocation of resources in this area.
The new ICD-11 reflects progress in medicine and the achievements of scientific thought. Thus, codes related to antimicrobial resistance are now more consistent with the Global Antimicrobial Resistance Surveillance System (GLASS) criteria. ICD-11 also allows for more effective recording of data related to health safety and, accordingly, the identification and prevention of unwanted events that may cause harm to health, such as unsafe practices in hospitals.
The new ICD also includes new chapters, in particular on folk (traditional) medicine: although traditional medicine is used by millions of people around the world, it has not yet been included in this classification system. Another new chapter on sexual health brings together disorders that were previously classified in other categories (for example, gender nonconformity was listed under mental disorders) or described differently. Gaming disorder has been added to the addictive disorders section.
“A key principle of this revision was to simplify the code structure and electronic tools so that health professionals can more easily and comprehensively record different diseases,” says Dr Robert Jakob, WHO Group Leader for Classifications, Terminology and Standards .
According to Dr. Lubna A. Al-Ansary, Assistant Director General for Metrics and Measurement, “ICD is the cornerstone of health information, and ICD-11 will provide an updated view of disease typology.” .
Note to editors:
ICD-11 is compiled in conjunction with international nonproprietary names of pharmaceutical products accepted by WHO and can be used for the purposes of registration of oncological diseases. ICD-11 was designed for use in a wide range of languages: a central multilingual platform provides functionality and data presentation in all languages into which it is translated. Transition tables from ICD-10 and vice versa help you switch to ICD-11. WHO will assist countries in preparing to use the new ICD-11.