Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders
Open accessAbstract
Following approval of the ICD‐11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD‐10 to the ICD‐11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD‐11 Mental, Behavioural and Neurodevelopmental Disorders following ICD‐11’s approval. The development of the ICD‐11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD‐11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture‐related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery‐based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD‐11 classification of mental disorders as compared to the ICD‐10, and the development of two new ICD‐11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD‐11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD‐11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD‐11 and in preparing for implementation in their own professional contexts.
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The ICD-11 classification of mental disorders adds 21 new categories.
“Among the important changes introduced in the ICD-11 classification of mental disorders 6 is the addition of 21 new categories, shown in Table1.”
The development of the ICD-11 CDDR, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders.
“The development of the ICD-11 CDDR, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders 6 .”
Of the disorders in ICD-11 but not DSM-5, eleven are newly added disorders.
“Of those that are in the ICD-11 but not in the DSM-5, eleven are newly added disorders, the rationale for the inclusion of most of which has been previously described in this journal 27 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [27]
Depressed adolescents may not report sadness, but complain of feelings of disquiet and malaise that are overwhelmingly painful.
“Moreover, they may not report sadness, but complain of feelings of disquiet and malaise that are overwhelmingly painful. 95”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [95]
Depressed adolescents are often primarily irritable and unstable, with frequent anger outbursts, sometimes without significant provocation, which may result in a deterioration of their interpersonal relationships.
“Indeed, depressed adolescents are often primarily irritable and unstable, with frequent anger outbursts, sometimes without significant provocation, which may result in a deterioration of their interpersonal relationships. 94,95”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [95]
Prescribing psychotropic drugs without controlled-study indications, such as paroxetine for mild depression or adjustment/demoralization, may cause dependence, major depression, withdrawal, and persistent postwithdrawal disorder.
“This unnecessary prescription may lead to the development of dependence, onset of major depressive episode, withdrawal symptoms at discontinuation, persistent postwithdrawal disorder characterized by mood fluctuations and worsening of anxiety [41].”
From Iatrogenic Factors in Psychopathology (2019) · cites this paper as [61]
The ICD-11 diagnostic guidelines for PTSD adopt a narrow focus on fear circuitry symptoms, comprising re-experiencing, avoidance, and perception of heightened current threat.
“The recently approved ICD-11 diagnostic guidelines for PTSD strategically adopt a narrow focus on fear circuitry symptoms, comprising re-experiencing of the traumatic event, avoidance of reminders, and a perception of heightened current threat (reflected by various forms of arousal) 3 .”
From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [3]
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- Authors
- Reed, G. M., First, M. B., Kogan, C. S., Hyman, S. E., Gureje, O., Gaebel, W., Maj, M., Stein, D. J., Maercker, A., Tyrer, P., Claudino, A., Garralda, E., Salvador‐Carulla, L., Ray, R., Saunders, J. B., Dua, T., Poznyak, V., Medina‐Mora, M. E., Pike, K. M., Ayuso‐Mateos, J. L., Kanba, S., Keeley, J. W., Khoury, B., Krasnov, V. N., Kulygina, M., Lovell, A. M., de Jesus Mari, J., Maruta, T., Matsumoto, C., Rebello, T. J., Roberts, M. C., Robles, R., Sharan, P., Zhao, M., Jablensky, A., Udomratn, P., Rahimi‐Movaghar, A., Rydelius, P., Bährer‐Kohler, S., Watts, A. D., & Saxena, S.
- Affiliations
- Columbia University Irving Medical Center (US)
- University of Ottawa (CA)
- Broad Institute (US)
- University of Ibadan (NG)
- Department of Psychiatry and Psychotherapy, Medical Faculty Heinrich‐Heine University Düsseldorf Germany
- University of Campania "Luigi Vanvitelli" (IT)
- South African Medical Research Council (ZA)
- Department of Psychology University of Zurich Zurich Switzerland
- Centre for Mental Health (GB)
- Department of Psychiatry Universidade Federal de São Paulo (UNIFESP/EPM) São Paulo Brazil
- Centre for Mental Health Imperial College London UK
- Australian National University (AU)
- All India Institute of Medical Sciences (IN)
- The University of Queensland (AU)
- World Health Organization (CH)
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (MX)
- Instituto de Salud Carlos III (ES)
- Kyushu University (JP)
- Virginia Commonwealth University (US)
- American University of Beirut Medical Center (LB)
- Federal Medical Research Centre for Psychiatry and Narcology (RU)
- Inserm (FR)
- Seitoku University (JP)
- The Japanese Society of Psychiatry and Neurology (JP)
- University of Kansas (US)
- Shanghai Jiao Tong University (CN)
- The University of Western Australia (AU)
- Prince of Songkla University (TH)
- Tehran University of Medical Sciences (IR)
- Karolinska Institutet (SE)
- International Federation of Social Workers, Basel Switzerland
- Entabeni Hospital Durban South Africa
- Harvard University (US)
- ORCID
- Reed, Geoffrey M.
- First, Michael B.
- Kogan, Cary S.
- Hyman, Steven E.
- Gureje, Oye
- Stein, Dan J.
- Tyrer, Peter
- Salvador‐Carulla, Luis
- Saunders, John B.
- Dua, Tarun
- Poznyak, Vladimir
- Medina‐Mora, María Elena
- Pike, Kathleen M.
- Ayuso‐Mateos, José L.
- Keeley, Jared W.
- Khoury, Brigitte
- Krasnov, Valery N.
- Kulygina, Maya
- Lovell, Anne M.
- Matsumoto, Chihiro
- Rebello, Tahilia J.
- Roberts, Michael C.
- Robles, Rebeca
- Sharan, Pratap
- Zhao, Min
- Jablensky, Assen
- Udomratn, Pichet
- Rahimi‐Movaghar, Afarin
- Rydelius, Per‐Anders
- Saxena, Shekhar
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2019-01-02
- Volume
- 18
- Issue
- 1
- Pages
- 3-19
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC6313247
- OpenAlex
- W2908444276
- Cited by
- 765
- References
- 19
- Citations by year
- 2026: 46 · 2025: 68 · 2024: 109 · 2023: 108 · 2022: 90 · 2021: 151 · 2020: 150 · 2019: 41 · 2018: 1
- FWCI
- 663.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
- ANU Open Research (Australian National University) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- World Health Organization
- National Institute for Health and Care Research (07/01/26)
- Topics
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- ICD-11, ICD-10, mental disorders classification, personality disorders, primary psychotic disorders, dimensional classification, lifespan approach, comorbidities, neurodevelopmental disorders, behavioural disorders
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