Michael First: Differences between ICD-11 Classification of Mental & Behavioural Disorders and DSM-5

The speaker, Michael, introduces himself as a professor and a research psychiatrist, highlighting his role in the ICD-11 revision. He mentions the upcoming approval of ICD-11 by the World Health Assembly and aims to provide an overview of the differences between DSM-5 and ICD-11. The harmonization process between the two classifications is discussed, emphasizing the efforts to minimize differences and the formation of a shared organizational framework known as the meta structure. The presentation also touches on the timeline differences that prevented direct collaboration between the DSM-5 and ICD-11 work groups.

This paragraph delves into the successful harmonization efforts, such as the shared meta structure and cross-membership in workgroups between DSM-5 and ICD-11. Despite these efforts, timeline differences prevented face-to-face meetings between the work groups. The ICD-11 work group was tasked with aligning their definitions with DSM-5 where possible but allowing for differences when necessary. Specific examples of differences, such as the duration criteria for schizophrenia and the addition of new disorders like Disruptive Mood Dysregulation Disorder (DMDD) in DSM-5, are highlighted. The paragraph also mentions the ICD-11's decision not to include DMDD but instead to add a specifier to Oppositional Defiant Disorder.

The speaker provides a detailed comparison of the meta structure of DSM-5 and ICD-11, noting the similarities and differences in their organizational frameworks. Differences in groupings, such as the single grouping for mood disorders in ICD-11 versus separate groupings in DSM-5, are discussed. The ICD-11's approach to diagnostic guidelines, which are more flexible than DSM-5's strict criteria, is explained. The expectation is that despite surface-level differences, the ICD-11 guidelines will identify similar patient groups as DSM-5 due to this flexibility.

The speaker discusses significant changes in ICD-11, including the reclassification of sleep-wake disorders into their own chapter and the creation of a new chapter for conditions related to sexual health. The latter change aimed to facilitate the removal of gender dysphoria from the mental disorders section while ensuring continued insurance coverage for related conditions. The speaker lists the conditions included in these new chapters, emphasizing the ICD-11's efforts to streamline and make the classification system more logical and comprehensive.

This paragraph focuses on the differences in how DSM-5 and ICD-11 present diagnostic definitions. While DSM-5 uses specific diagnostic criteria, ICD-11 provides general definitions for online use and more detailed diagnostic guidelines for mental health professionals. The ICD-11 guidelines are designed to be more flexible, avoiding strict time intervals and allowing clinicians to use their judgment. The speaker compares the panic disorder criteria in both systems to illustrate the differences in flexibility and application.

The speaker highlights significant changes in ICD-11, including the placement of substance-induced mental disorders within their respective substance sections. The differences in how ICD-11 and DSM-5 handle substance use disorders are discussed, with ICD-11 retaining the categories of harmful pattern of use and substance dependence, while DSM-5 introduces a new category called substance use disorder with varying levels of severity. The speaker also discusses the differences in the classification of schizophrenia, including the minimum duration criteria and the list of active phase symptoms.

The speaker addresses the classification of personality disorders in ICD-11, which has moved away from categorical approaches to a dimensional one, with trait domains and severity levels. This is contrasted with DSM-5's categorical approach. The speaker also outlines additional disorders present in ICD-11 but not in DSM-5, such as olfactory reference syndrome, complex PTSD, prolonged grief disorder, trance disorder, and partial dissociative identity disorder. Conversely, disorders in DSM-5 not present in ICD-11 are also mentioned, including global developmental delay, social communication disorder, and acute stress disorder.

The speaker concludes by summarizing the key differences between ICD-11 and DSM-5, emphasizing that while the two systems are very similar, they are not identical. He encourages the audience to seek out more detailed resources for a deeper understanding of the distinctions. The presentation serves as an introductory guide, providing a foundation for further exploration of the topic.