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International Classification of Diseases and Related Health Problems (ICD)

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International Classification of Diseases and Related Health Problems (ICD) is the standard diagnostic tool for epidemiology, health management and clinical purposes; it is used to monitor and diagnose of diseases and other health problems, including mental health problems.[1] The ICD has been used in World Health Organization Member States from 1994 and the current version is the ICD-10. In the United States and the some of UK the DSM-5 manual is used instead.

See also: DSM

ICD-10 updates

The ICD-10-CM is the "clinical modification" of the ICD-10, designed for the United States. ICD-10-CM will replace ICD-9-CM on October 1, 2014. This is used for clinical coding of health conditions, although the primary psychiatric manual in the US remains the Diagnostic and Statistical Manual In this the term dissociative identity disorderPrior to the DSM-IV, dissociative identity disorder was known as multiple personality disorder, which was from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, even though the ICD-11 is expected to change it. The term is misleading. No one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual switches from one distinct state to another distinct state, which distinguished it from OSDD/DDNOS, BPD and PTSD. {{Rp|557-570,487-494,471-486}} {{See also| Dissociative Identity Disorder}} is used instead of multiple personality disorder.[2]

ICD-11 Beta (currently being discussed and revised)

The ICD 11 is currently in the form of a Beta draft with descriptions of mental health and behavioral disorders not yet included; this is not a final version and is updated daily. The final version is expected to be released in 2017. [3][4]

Last updated: 19 February 2014

Dissociative Disorders in the ICD-11 Beta

All the '5B2' coded dissociative disorders have symptoms which "are of sufficient severity to produce significant impairment in personal, family, social, educational, occupational or other important areas of functioning," and "are not better explained by another mental and behavioural disorder, are not due to the direct effects of a substance or medication, and are not due to a neurological condition, sleep-wake disorder, or other disorder or disease." KB76 Dissociative disorder due to disorder or disease classified elsewhere does not include these conditions, and is of organic cause.[4]

5B20 Dissociative disorders of movement or sensation

"Dissociative disorders of movement or sensation are characterized by chronic or intermittent: 1) loss of particular sensations; 2) loss of volitional and intentional control of movements; or 3) intruding sensations or movements."[4]

5B21 Cognitive dissociative disorders

"Cognitive dissociative disorders are characterized by marked or severe deficiency of the normal integrationIntegration (state of unification) occurs in the minds of all individuals and is a process rather than an end product. "If integration is impaired, the result is chaos, rigidity, or both. Chaos and rigidity can then be seen as the red flags of blocked integration and impaired development of the mind." {{Rp|9}} The natural process of the mind is to link differential parts (distinct modes of information processing) into a functional and unified self. No child has unified personality when born, in fact, they need years of sufficient nurturing for the parts of their personality to integrate. {{Rp|394}} "Integration is more like making a fruit salad than like making a smoothie: It requires that elements retain their individual uniqueness while simultaneously linking to other components of the system. The key is balance of differentiation and linkage." {{Rp|199}} Integration is the normal process that occurs in early childhood, but if interrupted by trauma, the child may not be able to integrate. {{Rp|143}} of thoughts, memories, emotions, identity, and behavior. The symptoms include inability or disability to access knowledge or experiences or to control mental functions (e.g., dissociative amnesia, depersonalization, [[derealizationDepersonalization disorder includes derealization, since the two often co-occur. ]). They can also include unbidden intrusionsParts of the [[personality]] influence each other, whether they are aware of others or not. Any part may intrude on, and influence the experience of the part that is functioning in daily life, without taking full control of functioning. {{Rp|27}} In dissociative identity disorder and other disorders, dissociative symptoms are felt when one dissociated state intrudes into the experience of another. Intrusions occur in perceptions, ideas, wishes, needs, movements and behaviors. {{Rp|18}} In partial dissociation, amnesia is not present. {{Rp|228}} into consciousness and behavior with accompanying deficits in continuity of subjective experience (e.g., assumption of a new identity)."[4]

5B22 Trance"periods of absence-like staring and unresponsiveness; well documented in severely dissociative people for over 100 years"{{Rp|229}} and possession disorder

"Trance and possession disorder is characterized by a temporary loss of both the sense of personal identity and full awareness of the surroundings. In some instances, the individual acts as if taken over by a spirit, deity, other person, or ‘force’. Attention and awareness may be limited to or concentrated upon only one or two aspects of the immediate environment, and there is often a limited but repeated set of movements, postures, and utterances. Only trance"periods of absence-like staring and unresponsiveness; well documented in severely dissociative people for over 100 years"{{Rp|229}} or possession phenomena that are involuntary or unwanted, and that intrude into ordinary activities by occurring outside (or being a prolongation of) religious or other culturally accepted situations should be included here."

Exclusions states associated with: schizophrenia, psychoactive"A psychoactive drug or substance affects mental processes, e.g. cognition or affect. " This includes both legal and illegal substances or drugs, but does not necessarily mean only those which produce dependence.The ICD diagnostic manual uses the term psychoactive substance use disorders to defined being clinically relevant use (for example intoxication, harmful use, the cause of a psychotic disorder). Examples include alcohol, cannabis and stimulants. {{Rp|53-54}} substance intoxication, postconcussional syndrome, acute and transient psychoticA person experiencing psychosis, or a characteristic of psychosis. {{Rp|24}} disorders, organic personality disorder.[4]

5B23 Dissociative identity disorderPrior to the DSM-IV, dissociative identity disorder was known as multiple personality disorder, which was from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, even though the ICD-11 is expected to change it. The term is misleading. No one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual switches from one distinct state to another distinct state, which distinguished it from OSDD/DDNOS, BPD and PTSD. {{Rp|557-570,487-494,471-486}} {{See also| Dissociative Identity Disorder}} (formerly multiple personality disorderPrior to the DSM-IV, dissociative identity disorder was known as multiple personality disorder, which was from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, even though the ICD-11 is expected to change it. The term is misleading. No one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}})

"Dissociative identity disorder is characterized by the presence of two or more insufficiently integrated conscious and self-conscious subsystems of the personalityEvery individual has a personality that is composed of many diverse, fragmentary and generally illusory images of [[Personality|self]]. (see multiples) The DSM-IV uses the term identity in its definition of dissociation. (see identity) {{Rp|127}}. Each of these subsystems has its own pattern of conceiving, perceiving, and relating to self, the body, and the environment. They can manifest in a sequence, or in parallel. The disorder may include cognitive, behavioral, sensory and motor dissociative symptoms. In some cases, one major dissociative identity predominantly controls the individual’s behavioral and mental actions, but is recurrently intruded and influenced by the actions of one or more other dissociative identities. In other cases, two or more dissociative identities recurrently influence each other, and at least two of these take executive controlThe state that has control of an individual at that moment has executive control, and the dissociated state most often in executive control is commonly called the host. {{Rp|27}} for substantial periods of time."[4]

5B2Y Other specified dissociative disorders

Not described yet.

5B2Z Dissociative disorders, unspecified

Not described yet.

KB76 Dissociative disorder due to disorder or disease classified elsewhere

"A disorder characterized by a partial or complete loss of the normal integration between memories of the past, awareness of identity and immediate sensations, and control of bodily movements (see F44.-), but arising as a consequence of an organic disorder." Exclusions: dissociative [conversion"The development of symbolic physical symptoms and distortions involving the voluntary muscles or special sense organs; not under voluntary control and not explained by any physical disorder." Sadock (2008). Functional Neurological Symptom Disorder is the new name for Conversion Disorder in the DSM-5 manual, and is part of the Somatic Symptom and Other Related Disorders category. Somatization Disorder was removed during the changes, but is represented in this category. {{Rp|11}}Conversion symptoms are most common in conversion disorder, but also seen in a variety of mental disorders." {{Rp|23}}"Conversion disorders" is the ICD-10 category includes somatoform dissociation within dissociative disorders of movement and sensation. {{Rp|9}}{{See also| Somatoform Disorders}}] disorders, nonorganic or unspecified.[4]

Disorders specifically associated with stress in the ICD-11 Beta

This category is equivalent to Trauma and Stressor-related disorders in the DSM-5.

5B10 Post-traumatic stress disorder

"PTSD is a disorder that develops following exposure to an extremely threatening or horrific event or series of events characterized by: 1. reexperiencing the traumatic event(s) in the present in the form of vivid intrusive memories, flashbacks, or nightmares, with each episode of reexperiencing accompanied by fear or horror; 2. avoidance of thoughts and memories of the event(s), or avoidance of activities or situations reminiscent of the event(s); and 3. a state of perceived current threat in the form of excessive hypervigilance"Excessive attention to and focus on all internal and external stimuli."{{Rp|26} A pattern presenting with fight or flight reactions is common in individuals with unprocessed trauma memories. {{Rp|217}} A PTSD symptom. Hypervigilance is an arousal symptom within PTSD and acute stress disorder."Excessive attention to and focus on all internal and external stimuli."{{Rp|26} A pattern presenting with fight or flight reactions is common in individuals with unprocessed trauma memories. {{Rp|217}} A PTSD symptom. Hypervigilance is an arousal symptom within PTSD and acute stress disorder. or enhanced startle reactions.

The symptoms must last for at least several weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning." Also known as "traumatic neurosisNeurosis is an emotional disorder. Neurotic refers to a person displaying a symptom of emotional distress, which could range from anxiety, panic attacks depression, and lying, to promiscuity. {{Rp|97}} This historical term referred to a very large group of conditions, which were later divided between Mood Disorders, Dissociative Disorders, Anxiety Disorders, Somatization Disorder and Personality Disorder. Neurosis was removed from the DSM completely because it suggested a "cause" common to the categories under that term, and to "reduce confusion" {{Rp|272}}".[4]

5B11 Complex post-traumatic stress disorder

"Complex PTSD is a disorder that arises after exposure to a stressor typically of an extreme or prolonged nature and from which escape is difficult or impossible. The disorder is characterized by the coreThe terms "core" and "original" were used back in history to mean the part that body was born with, but today we know there is no such part. Many also incorrectly assume the host or ANP is what they call the core. {{Rp|59}} {{Rp|80, 87-88}} (see personality and alters) (see personality)Note: Outside of the dissociative disorders the term core is used by some to mean an individuals "suchness;" a part that is "beneath narrative and memory, emotional reactivity and habit." {{Rp|208-209}} symptoms of PTSD as well as the development of persistent and pervasive impairments in affective, self and relational functioning, including difficulties in emotion regulation, beliefs about oneself as diminished, defeated or worthless, and difficulties in sustaining relationships."

Other terms for complex post-traumatic stress disorder: Personality change after: concentration camp experiences, Personality change after: disasters, Personality change after: prolonged: captivity with an imminent possibility of being killed, Personality change after: prolonged: exposure to life-threatening situations such as being a victim of terrorism, Personality change after: torture. Exclusions: post-traumatic stress disorder.[4]

5B12 Prolonged grief disorder

"Prolonged grief disorder is a disturbance in which, following the death of a person close to the bereaved, there is persistent and pervasive yearning or longing for the deceased, or a persistent preoccupation with the deceased that has persisted for an abnormally long period of time following the loss, clearly beyond the normative response for grieving within the individuals’ religious and cultural context, and is sufficiently severe to cause significant impairment in the person’s personal, family, social, educational, occupational or other important areas of functioning. The response can also be characterized by difficulty accepting the death, feeling one has lost a part of one’s self, anger about the loss, guilt, or difficulty in engaging with social or other activities. The persistent grief response goes far beyond expected social or cultural norms, and depends on cultural and contextual factors."[4]

5B13 Adjustment disorder

"Adjustment disorder is a maladaptive reaction to identifiable psychosocial stressor(s) or life change(s) characterized by preoccupation with the stressor and failure to adapt. The failure to adapt may be manifested by a range of symptoms that interfere with everyday functioning, such as difficulties concentrating or sleep disturbance. Symptoms of anxiety, depression, and impulse control or conduct problems are commonly present and may be the presenting feature. The symptoms emerge within a month of the onset of the stressor(s) and tend to resolve in 6 months unless the stressor persists for a longer duration. In order to be diagnosed, Adjustment disorder must be associated with significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning."

Also known as Culture shock, Grief reaction, Hospitalism in children. Excludes separation anxiety disorder of childhood.[4]

5B14 Reactive attachmentThe communication of emotion between an infant and their primary caregiver(s) is essential to shaping the developing mind. "Emotion serves as a central organizing process within the brain. In this way, an individual's abilities to organize emotions - a product in part, of early attachment relationships directly shapes the ability of the mind to integrate experience and to adapt to future stressors." {{Rp|9}} Interruption in the attachment pattern of young children with their caretaker(s) has been shown to be a primary precursor to Dissociative Disorder pathology. (see etiology) {{Rp|85}} {{Rp|97}} disorder

"Reactive attachment disorder is characterized by grossly abnormal attachment behaviours in early childhood, occurring in the context of a history of grossly inadequate child care (e.g., severe neglect, maltreatment, institutional deprivation). Even when an adequate primary caregiver is newly available, the child does not turn to the primary caregiver for comfort, support and nurture, rarely displays security-seeking behaviours towards any adult, and does not respond when comfort is offered. Reactive attachment disorder can only be diagnosed in children, and features of the disorder develop within the first 5 years of life. However, the disorder cannot be diagnosed before the age of 1 year (or a mental age of less than 9 months), when the capacity for selective attachments may not be fully developed, or in the context of Autism spectrum disorder."

Excluded asperger syndrome, maltreatment syndromes, disinhibited"(1) Removal of an inhibitory effect, as in the reintroduction of the inhibitory function of the cerebral cortex by alcohol (2) In psychiatry, a greater freedom to act ion accordance with inner drives or feelings and with less regard for restrains dictated by cultural norms or one's superego" {{Rp|24}} attachment disorder of childhood and normal variation in pattern of selective attachment.[4]

5B15 Disinhibited social engagement disorder

"Disinhibited social engagement disorder is characterized by grossly abnormal social behaviour, occurring in the context of a history of grossly inadequate child care (e.g., severe neglect, institutional deprivation). The child approaches adults indiscriminately, lacks reticence to approach, will go away with unfamiliar adults, and exhibits overly familiar behaviour towards strangers. Disinhibited social engagement disorder can only be diagnosed in children, and features of the disorder develop within the first 5 years of life. However, the disorder cannot be diagnosed before the age of 1 year (or a mental age of less than 9 months), when the capacity for selective attachments may not be fully developed, or in the context of Autism spectrum disorder."

May also be known as: Institutional syndrome, Affectionless psychopathy. Excluded Asperger syndrome, hospitalism in children, hyperkinetic disorders and reactive attachment disorder of childhood.[4]

5B1Y Other specified disorders specifically associated with stress

No description yet.[4]

5B1Z Disorders specifically associated with stress, unspecified

No description yet. Also known as reaction to severe stress, and adjustment disorders.[4]

ICD-10

Currently in use until the ICD-11 publication.

Trauma and Stressor-related Disorders in the ICD-10

the ICD-10 are classified within neuroticNeurosis is an emotional disorder. Neurotic refers to a person displaying a symptom of emotional distress, which could range from anxiety, panic attacks depression, and lying, to promiscuity. {{Rp|97}} This historical term referred to a very large group of conditions, which were later divided between Mood Disorders, Dissociative Disorders, Anxiety Disorders, Somatization Disorder and Personality Disorder. Neurosis was removed from the DSM completely because it suggested a "cause" common to the categories under that term, and to "reduce confusion" {{Rp|272}}, stress-related and somatoformSomatoform Dissociation - refers to dissociative symptoms that involve the body; these symptoms are characteristic of dissociative disorders. {{Rp| 9}}Somatoform or somatic symptoms are physical symptoms that resemble, but cannot be explained by, a medical symptom or the direct effects of a substance. {{Rp| 9}} These include bodily sensations such as numbness/loss of sensation, inability to feel pain and dizziness. They are strongly linked to past trauma. {{See also | Somatoform Disorders}} disorders, under the Reaction to severe stress, and adjustment disorders subcategory.[5] They stated to have a direct cause, which must be one (or both) "an exceptionally stressful life event producing an acute stress reaction", or "a significant life change leading to continued unpleasant circumstances that result in an adjustment disorder", although the life events causing the disorder does not [5] They are described as "maladaptive responses to severe or continued stress" which "interfere with successful coping mechanisms and therefore lead to problems of social functioning".[5]
  • F43.0 Acute stress reaction
  • F43.1 Post-traumatic stress disorder
  • F43.2 Adjustment disorders (including culture shock, grief and hospitalisation in children)
  • F43.8 Other reactions to severe stress
  • F43.9 Reaction to severe stress, unspecified

Dissociative Disorders in the ICD-10

Dissociative disorders in the ICD-10 are classified within neurotic, stress-related and somatoform disorders, which also includes Acute stress reaction (F43.0) and Post-traumatic stress disorder (F43.1). They are under the Dissociative (conversion) disorders subcategory.

Dissociative disorders are classified under codes F44[6] and are also referred to as conversion disorders. The dissociative disorders are:

ICD-10 Languages

The ICD-10 is available in multiple languages including the official World Health Organisation languages (Arabic, Chinese, English, French, Russian and Spanish) and has been translated into 36 others.

ICD-10 Online

References

  1. ^ World Health Organization, (2010). International classification of diseases 10th revision, version: 2010. World Health Organization..
  2. ^ AAPC AAPC: Naming Conventions in ICD 10 Coding Systems. retrieved on 16 January 2014
  3. ^ World Health Organisation http://www.who.int: ICD-11 Factsheet. retrieved on 18 April 2014
  4. ^ a b c d e f g h i j k l m n o World Health Organization World Health Organization: ICD-11 Beta. retrieved on 16 January 2014
  5. ^ a b c World Health Organisation, (2010). ICD-10 Classification of Mental and Behavioural Reaction to severe stress, and adjustment disorders.
  6. ^ World Health Organisation, (2010). ICD-10 Classification of Mental and Behavioural Disorders Dissociative (conversion) disorders.
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