Discussion about ICD-11

I made a new thread to discussion about ICD-11, to keep it away from other people's posts that has nothing to do with it.

There are too diagnostic systems, I'm sorry if the term is not correct, in that case please tell what is. I do believe people understand what I mean. Part of the countries use DSM5, for example USA, part ICD10, and it will change into ICD-11 in 01/01/2022. ICD-10 is used for example where we live in, in Europe.

One big important change is that in ICD-11 cPTSD will now become official diagnosis, which is great news, hopefully it will become official in DSM too.

This is what I found about Dissociative disorders:

The ICD‐11 dissociative disorders grouping corresponds to ICD‐10 dissociative (conversion) disorders, but has been significantly reorganized and simplified, to reflect recent empirical findings and to enhance clinical utility. Reference to the term “conversion” is eliminated from the grouping title68. ICD‐11 dissociative neurological symptom disorder is conceptually consistent with ICD‐10 dissociative disorders of movement and sensation, but is presented as a single disorder with twelve subtypes defined on the basis of the predominant neurological symptom (e.g., visual disturbance, non‐epileptic seizures, speech disturbance, paralysis or weakness). ICD‐11 dissociative amnesia includes a qualifier to indicate whether dissociative fugue is present, a phenomenon that is classified as a separate disorder in ICD‐10.

The ICD‐11 divides ICD‐10 possession trance disorder into the separate diagnoses of trance disorder and possession trance disorder. The separation reflects the distinctive feature in possession trance disorder wherein the customary sense of personal identity is replaced by an external “possessing” identity attributed to the influence of a spirit, power, deity or other spiritual entity. In addition, a greater range of more complex behaviours may be exhibited in possession trance disorder, while trance disorder typically involves the repetition of a small repertoire of simpler behaviours.

ICD‐11 dissociative identity disorder corresponds to the concept of ICD‐10 multiple personality disorder and is renamed to be consistent with currently used nomenclature in clinical and research contexts. The ICD‐11 also introduces partial dissociative identity disorder, reflecting the fact that the preponderance of ICD‐10 unspecified dissociative disorders is accounted for by presentations in which non‐dominant personality states do not recurrently take executive control of the individual's consciousness and functioning.

Depersonalization and derealization disorder, located in the other neurotic disorders grouping in the ICD‐10, is moved to the dissociative disorders grouping in the ICD‐11.

The part with bolded taxt was part AndiKirkwood made claims about, telling that there will be no alters in OSDD anymore. This is why it's not true:

OSDD is DSM5 diagnose, it doesn't exist in ICD-10 at all, and can not change when ICD-10 will be changed into ICD-11. DSM5 is totally separate diagnostic system. DSM used to have dx called Dissociative Disorder Not Otherwise Specified in it before, shortly DD NOS. It was divided into two separate diagnoses, that are called Other Specified Dissociation Disorder or shortly OSDD. OSDD is like it's name tells specified disorders, like OSDD 1a and OSDD1b, that are similar to DID, but not fully meet the criteria. Rest of what used to be DDNOS is now called Unspecified Dissociation Disorder and like the name tells, then it has not been specified into any group. But non of that has nothing to do with ICD-10 or ICD-11. These are DSM5 diagnoses, and they will remain like they are now.

ICD-11 will be similar than DSM5 is. Like the bold text tells, what used to be called Unspecified Dissociative Disorder, will now mean exactly ONLY that, like it means in DSM5. There will be new name to disorders that are similar to DID, but not fully meet the criteria, called Partial Dissociative Identity Disorder, basically partial DID. Name is good one and it's similar to what OSDDs are in DSM5.

Now nobody who has "almost DID but not quite", will be called to have Unspecified DD anymore, in DSM or in ICD. That's the change, ICD will have it's own "OSDD", dx similar to it called Partial DID. That is completely different thing from OSDD diagnose not being dx to people with parts anymore, like was claimed.

I don't want to fight, I just don't want false information to be spread in here, especially not to people who are new to DID. I believe it was misunderstanding and not meant to hurt anyone tho, but since it was inaccurate, here are the real changes that ICD-11 will bring in about two years to countries that use it.

Flor

thanks Flor this is a great help.

Of course all countries using a singe set of diagnostic criteria would help even more. I mean what gives with the duplication?

ICD 11 already in use some places. can we do links? write in bar ICD 11 and it will show you the ICD 11 website its gots the whole book on it. my teacher brought laptop in so we can sees the book and look things up. the date 2012 is jest when it takes affect world wide and those who is where they go by WHO ways. peoples, doctors, psychaitrists psychology therapist can use the book any time by using the book thats online already.

I agree that Partial DID is a much more fitting name for OSDD--maybe the next DSM will be willing to include it.

Thanks for clarifying things, Flor.

MeMyselfMaureen, yes, it would be convenient to be word wide thing. Here's a link to countries which currently use ICD: https://www.who.int/countries/en/ There is more than 100, which is why I won't publish the list in here.

I don't know how this will be or is with ICD-11. With ICD-10 there were actually several versions of it. Some countries had their own version with adaptations compared to the original WHOs version. That means that there can be some differences depending where you live in, between your country's version compared to other countries. With ICD-10 those countries were Australia, Brazil, Canada, China, Czech Republic, France, Germany, Hungary, Korea, Netherlands, Russia, South Africa, Sweden, Thailand, United Kingdom and United States. Australian version (ICD-10-AM) is also used in New Zealand, the Republic of Ireland and Saudi Arabia. Rest of the 117 countries use the WHO's original version. That makes things even more complicated, all the different adaptations.

Please notice that some countries can use both, ICD and DSM. I don't know how that works, if someone wants to find out how they're used in your country, you need to google that yourself or ask from someone who knows. I'm not that person. I don't know how widely DSM is used, I didn't find any list easily. it's originally from US and ICD is made by WHO.

Now back to the Andi's posts that I made this for:

I takes it you dont knows about the new ICD 11 book. its got lots of problems in it that has alters and dissociation stuff added to them likes borderline personality disorder can now comes with alters, secondary personality changes can have alters, theres also Parcial Dissociative Identity Disorder now that can have alters now, theres neurological problems in there too thats got alters, so can lots of other things too now. and OSDD doent come with alters anymore thats changed too.

To the part about dissociative disorders I answered already.

Personality disorders

Problems with the ICD‐10 classification of ten specific personality disorders included substantial underdiagnosis relative to their prevalence among individuals with other mental disorders, the fact that only two of the specific personality disorders (emotionally unstable personality disorder, borderline type, and dissocial personality disorder) were recorded with any frequency in publicly available databases, and that rates of co‐occurrence were extremely high, with most individuals with severe disorders meeting the requirements for multiple personality disorders16, 17.

The ICD‐11 CDDG ask the clinician to first determine whether the individual's clinical presentation meets the general diagnostic requirements for personality disorder. The clinician then determines whether a diagnosis of mild, moderate or severe personality disorder is appropriate, based on: a) the degree and pervasiveness of disturbances in functioning of aspects of the self (e.g., stability and coherence of identity, self‐worth, accuracy of self‐view, capacity for self‐direction); b) the degree and pervasiveness of interpersonal dysfunction (e.g., understanding others’ perspectives, developing and maintaining close relationships, managing conflict) across various contexts and relationships; c) the pervasiveness, severity and chronicity of emotional, cognitive and behavioural manifestations of personality dysfunction; and d) the extent to which these patterns are associated with distress or psychosocial impairment.

Personality disorders are then further described by indicating the presence of characteristic maladaptive personality traits. Five trait domains are included: negative affectivity (the tendency to experience a broad range of negative emotions); detachment (the tendency to maintain social and interpersonal distance from others); dissociality (disregard for the rights and feelings of others, encompassing both self‐centeredness and lack of empathy); disinhibition (the tendency to act impulsively in response to immediate internal or environmental stimuli without consideration of longer‐term consequences); and anankastia (a narrow focus on one's rigid standard of perfection and of right and wrong and on controlling one's own and others’ behaviour to ensure conformity to those standards). As many of these trait domains may be assigned as part of the diagnosis as are judged to be prominent and contributing to the personality disorder and its severity.

In addition, an optional qualifier is provided for “borderline pattern” . This qualifier is intended to ensure continuity of care during the transition from the ICD‐10 to the ICD‐11 and may enhance clinical utility by facilitating the identification of individuals who may respond to certain psychotherapeutic treatments. Additional research will be needed to determine whether it provides information that is distinct from that provided by the trait domains.

Now there's the changes in nutshell to personality disorders.

I'm not a native English speaker, so if someone who is, can please make sure which one of two options the end of the bold text means, does it mean DID that's been called "multiple personality disorder" in DSM-10 or does it mean they have several "personality disorders". The meaning changes big time in our point of view depending what it means.

In both cases, nothing tells there's any changes concerning dissociated parts in emotionally unstable or dissocial personality disorders. Texts maybe tells that DID is common in people who are diagnosed with severe version of those personality disorders. In that case it says they ALSO have DID, not that alters wold be symptom in their personality disorder.

We already knew that there's huge amount of people with DID that has been diagnosed with emotionally unstable PD, or BPD. Emotionally unstable personality disorder (borderline personality in DSM) is one of the most common misdiagnoses before one gets diagnose having DID. The average amount of other (many times mis)diagnoses before getting DID dx is 4. That's because DID is not diagnosed like it should, there are several psychiatrists and doctors etc who don't believe DID exists and therefor won't diagnose it, but rather something else.

I've been diagnosed with Emotionally unstable personality too. Doctor who diagnosed me admitted that in case I have dissociative disorder, the dx may be false, but still wanted to test me rather having personality disorder and did not test me for dissociation, because she just decided to want that, no matter of what I told about my symptoms and how personality disorder doesn't cover them all, but dissociation does. I was tested for dissociation years later. Because old diagnoses won't be removed, and in the end I met the criteria when I was tested for personality disorder (and so does most people with DID), it will always look like I'm having it, which is false. There can of course be cases where that is not a misdiagnose, but person truly has both. I can not tell, and neither can anyone else, how commonly the severe personality disorder is a misdiagnose for what should've been diagnosed DID in the beginning.

if you goes to the ICD11 and types in borderline personality disorder you will see they took away that name and call all personality disorders mild, moderate or severe and the specifying things say dissociation problems too. 6D11.2 says dissociality in personality disorder or in personality. I seen it on my cousins health files that she showd me and we was in her psychiatrist office for a session cause she wanted to tell me she had alters. and her psychiatrist said she gots alters her personality is is dissociated. you wants more proof take psych class at SUNY college where we are studying psychology and the teacher borught in a ICD 11 for us to look at and look ups things we were reading about in our text books. get the ICD 11 your self and reads it you will see theres lots of disorders now that can have dissociation with it and identiy and personality problems where someone personality is dissociated

Well, actually I founs 3 different types of emotionally unstable PD. One with no addition, one with addition borderline type and one with addition impulsive type. And there are also those 3 severity stages.

I do not understand how that proofs anything about the claims you made. Your cousin has dissociated parts and has also been diagnosed with being antisocial. Dissocial is same thing than antisocial isn't it? Now someone native speaker could help too.

When you make claims, you proof them to be true or you admit you have no proof. It's not MY job to proof you right, which is impossible in case you're not right. I proof my point, you proof yours. That's how conversations work. I found nothing that said it would be part of personality disorder to have alters. Because you claim there is something about that in ICD-11, you give me a link to it. I am interested and I believe there are many people in this forum who are too. Nothing I'm able to find proofs no such things. Now help me to take you seriously and show me the part of ICD-11 where that's been told, I did not find it and it's not my job to try to proof claims I never made, but you did.

Flor

Don't mind the question about dissocial, here's the explanation for what's now called 6D11.2
Dissociality in personality disorder or personality difficulty

Description
The core feature of the Dissociality trait domain is disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality, not all of which may be present in a given individual at a given time, include: self-centeredness (e.g., sense of entitlement, expectation of others’ admiration, positive or negative attention-seeking behaviours, concern with one's own needs, desires and comfort and not those of others); and lack of empathy (i.e., indifference to whether one’s actions inconvenience hurt others, which may include being deceptive, manipulative, and exploitative of others, being mean and physically aggressive, callousness in response to others' suffering, and ruthlessness in obtaining one’s goals).

I understood it right and it's same thing than antisocial. I don't know how that's different from dissocial personality disorder, but they are separate diagnoses. There's nothing about dissociation in the description. I'm not claiming your cousin doesn't have dissociated parts, hopefully she has or will have diagnose about her dissociation disorder as well. Her current diagnose tells her to be antisocial, not dissociative.

The way I read it the new version is reffering to individuals having multiple types of personality disorder.

eg. there are 2 main types of Narsasistic personality. 1 when taken to the extreme can sometimes present as a machiavellian personality. Equaly the highs and lows of Narsasism may lead to Bi-Polar like symptoms if the narsacist has an inconsistant supply. If such a person were to be evaluated they would end up with multiple . personality . disorders ie 3 dx NP, MP& Bipolar

The reason I have read it this way is that medical texts are moving away from MPD to DID in all their descriptions of Discociative dissorders so why would they not state DID if thats what they ment in that paragraph?

Having mutliple types of a disorder is fairly common and called co-morbidity.

For example I have autism, dyslexia, dyspraxia, dyscalcula, prosophagnosia and loactional agnosia.

Obviously all the ones starting with dys- are multiple types of learning disorder. The -agnosias are diferent types of memory disorder and are common co-morbid conditions for people on the lower end of the autistic spectrum.

It could be said that Autistic's with the most server disorders commonly have other unspecified cognative dissorders. That is not the same as saying that autistics have Cognitive Disorder NOS (when a patient has a syndrome of cognitive impairment that does not meet the criteria for delerium, dementia or amnestic disorders.) It is saying that the chance of a low functioning autistic person having other undiagnosed cognative disorders is high.

Grace

I thought so too, but for another reason. Wouldn't it be multiple personality disorder, not disorders, if they'd be referring to MPD? I thought it could be DID, because in ICD-10 it is still called MPD, and the text is about things that were fond during ICD-10 has been in use.

Thanks!

I just discovered that while my autism was assesed using the DSM5 my T has been using the ICD-10 why is the NHS using 2 sets of guidelines?