Convergence of the dimensional assessment of personality pathology (DAPP-BQ) and the five-factor personality inventory for the international classification of diseases 11th edition (FFiCD) in the context of the five-factor model and personality disorders

The current manuscript presents the convergence of the Dimensional Assessment of Personality Pathology (DAPP-BQ), using its short form the DAPP-90, and the Five-Factor Personality Inventory for International Classification of Diseases (ICD-11), the FFiCD, in the context of the five-factor personality model and the categorical approach of personality disorders (PDs). The current manuscript compares the predictive validity of both the FFiCD and the DAPP-90 regarding personality disorder scales and clusters. Results demonstrate a very high and meaningful convergence between the DAPP-90 and the FFiCD personality pathology models and a strong alignment with the FFM. The DAPP-90 and the FFiCD also present an almost identical predictive power of PDs. The DAPP-90 accounts for between 18% and 47%, and the FFiCD between 21% and 47% of PDs adjusted variance. It is concluded that both DAPP-90 and FFiCD questionnaires measure strongly similar pathological personality traits that could be described within the frame of the FFM. Additionally, both questionnaires predict a very similar percentage of the variance of personality disorders.

An Evolutionary Psychological Approach Toward BDSM Interest and Behavior

Bondage/discipline, Dominance/submission, and Sadism/Masochism (BDSM) have gained increased attention and discussion in recent years. This prevalence is accompanied by a shift in perceptions of BDSM, including the declassification of sadomasochism as a paraphilic disorder. Evolutionary psychology offers a unique perspective of why some individuals are interested in BDSM and why some prefer certain elements of BDSM over others (e.g., dominance versus submission). In this paper, we examine BDSM from an evolutionary standpoint, examining biopsychosocial factors that underlie the BDSM interests and practice. We articulate this perspective via an exploration of: proximate processes, such as the role of childhood experiences, sexual conditioning, and physiological factors; as well as ultimate explanations for power play and pain play dimensions of BDSM, highlighting the potential adaptive advantages of each. While BDSM may not be adaptive in itself, we examine the literature of sex differences in BDSM role preferences and argue that these preferences may stem from the extreme forms of behaviors which enhance reproductive success. In the realm of pain play, we explore the intersection of pain and pleasure from both physiological and psychological perspectives, highlighting the crucial role of psychological and play partner factors in modulating the experience of pain. Finally, we encourage future research in social sciences to utilize evolutionary frameworks to further explore the subject and help alleviate the mystification surrounding BDSM. This multifaceted exploration of BDSM provides valuable insights for clinicians, kink-identified individuals, and scholars seeking to understand the evolutionary perspectives of human sexual behavior and preferences.

Assessing the impact of transitioning to 11th revision of the International Classification of Diseases (ICD-11) on comorbidity indices

OBJECTIVES

This study aimed to support the implementation of the 11th Revision of the International Classification of Diseases (ICD-11). We used common comorbidity indices as a case study for proactively assessing the impact of transitioning to ICD-11 for mortality and morbidity statistics (ICD-11-MMS) on real-world data analyses.

MATERIALS AND METHODS

Using the MIMIC IV database and a table of mappings between the clinical modification of previous versions of ICD and ICD-11-MMS, we assembled a population whose diagnosis can be represented in ICD-11-MMS. We assessed the impact of ICD version on cross-sectional analyses by comparing the populations' distribution of Charlson and Elixhauser comorbidity indices (CCI, ECI) across different ICD versions, along with the adjustment in comorbidity weighting.

RESULTS

We found that ICD versioning could lead to (1) alterations in the population distribution and (2) changes in the weight that can be assigned to a comorbidity category in a reweighting initiative. In addition, this study allowed the creation of the corresponding ICD-11-MMS codes list for each component of the CCI and the ECI.

DISCUSSION

In common with the implementations of previous versions of ICD, implementation of ICD-11-MMS potentially hinders comparability of comorbidity burden on health outcomes in research and clinical settings.

CONCLUSION

Further research is essential to enhance ICD-11-MMS usability, while mitigating, after identification, its adverse effects on comparability of analyses.

Physical multimorbidity in psychiatric patients with personality disorders: Insights within the ICD-11 framework

OBJECTIVE

Recent research has revealed poor physical health among individuals with personality disorders (PDs). We aimed to compare chronic physical illnesses (CPI) and chronic physical multimorbidity (CPM) prevalence between the general population (GEP) and PD patients, and to explore the relationship between CPM and various aspects of PD, predominantly within the ICD-11 framework.

METHODS

This cross-sectional study included 126 PD patients and 126 matched controls from the GEP. Patients were evaluated for the ICD-11 PD severity and maladaptive personality domains, subjective emptiness, and reflective functioning. CPI was assessed using a standardized self-report questionnaire.

RESULTS

PD patients had a higher mean number of CPIs (2.05 vs. 1.02) and a more frequent CPM occurrence (49.2% vs. 26.2%) compared to the matched controls (p < .001). The ICD-11 PD severity (OR = 1.143, p = .007) and maladaptive domain Negative affectivity (OR = 4.845, p = .002), and poor reflective functioning (OR = 1.694, p = .007) were significant predictors of CPM, independent of sociodemographic, clinical and lifestyle factors. Negative affectivity showed the most robust effect on CPM, while smoking did not significantly mediate these relationships.

CONCLUSION

Our study found increased CPM burden in PD patients and a link between CPM and various PD aspects under the ICD-11 framework, highlighting the need for more integrated healthcare.

Should cancer pain still be considered a separate category alongside acute pain and chronic non-cancer pain? Reflections on ICD-11

Introduction

Traditionally, cancer pain has often been viewed as an independent third major category in pain medicine alongside acute pain and chronic non-cancer pain. However, the new chronic pain category MG30 in the eleventh version of International Classification of Diseases (ICD-11) includes cancer-related pain as one of its seven subgroups. In light of this, the aim of the paper is to investigate whether the traditional trichotomy should be replaced by a dichotomy between acute pain and chronic pain, cancer-related pain being part of both groups depending on the duration of pain.

Methods

The rationale for viewing cancer pain as a separate category is reviewed.

Results

Cancer being a deadly disease, cancer pain has a life-and-death and existential dimension that is different from non-cancer pain. It seems sensible to believe that this is an additional dimension to the suffering caused by cancer pain, and that clinicians should therefore take this existential dimension into consideration when assessing pain.

Conclusion

Without challenging the place of chronic cancer-related pain under the MG30 heading, it is concluded that while using ICD-11 in the future, pain clinicians should continue being mindful of the fact that the reality of death shapes the experience of cancer pain. The traditional trichotomy is therefore still valid and mirrors the fact that human beings are vulnerable (acute pain), temporal (chronic pain) and mortal (cancer pain).

Assessing complex PTSD and PTSD: validation of the German version of the International Trauma Interview (ITI)

Background: With the introduction of the ICD-11 into clinical practice, the reliable distinction between Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) becomes paramount. The semi-structured clinician-administered International Trauma Interview (ITI) aims to close this gap in clinical and research settings.Objective: This study investigated the psychometric properties of the German version of the ITI among trauma-exposed clinical samples from Switzerland and Germany.Method: Participants were 143 civilian and 100 military participants, aged M = 40.3 years, of whom 53.5% were male. Indicators of reliability and validity (latent structure, internal reliability, inter-rater agreement, convergent and discriminant validity) were evaluated. Confirmatory factor analysis (CFA) and partial correlation analysis were conducted separately for civilian and military participants.Results: Prevalence of PTSD was 30% (civilian) and 33% (military) and prevalence of CPTSD was 53% (civilians) and 21% (military). Satisfactory internal consistency and inter-rater agreement were found. In the military sample, a parsimonious first-order six-factor model was preferred over a second-order two-factor CFA model of ITI PTSD and Disturbances in Self-Organization (DSO). Model fit was excellent among military participants but no solution was supported among civilian participants. Overall, convergent validity was supported by positive correlations of ITI PTSD and DSO with DSM-5 PTSD. Discriminant validity for PTSD symptoms was confirmed among civilians but low in the military sample.Conclusions: The German ITI has shown potential as a clinician-administered diagnostic tool for assessing ICD-11 PTSD and CPTSD in primary care. However, further exploration of its latent structure and discriminant validity are indicated.

Prolonged grief disorder symptomology in three African countries: A network analysis and comparison

Background

Bereavement is a globally prevalent life stressor, but in some instances, it may be followed by a persistent condition of grief and distress, codified within the 11th edition of the International Classification of Diseases (ICD-11) as prolonged grief disorder (PGD). Network analysis provides a valuable framework for understanding psychological disorders at a nuanced symptom-based level.

Aim

This study novelly explores the network structure of ICD-11 PGD symptomology in a non-Western sample and assesses the replication of this across three African country sub-samples in these data.

Methodology

Network models were estimated using the "Inventory of Complicated Grief-Revised" in a sample of trauma-exposed individuals who experienced bereavement throughout life (N = 1,554) from three African countries (Ghana, n = 290; Kenya, n = 619; Nigeria, n = 645). These networks were statistically evaluated using the network comparison test.

Results

It was found that "Feelings of Loss" and "Difficulty moving on" were the most central symptoms in the combined sample network. These findings were largely consistent for the Ghana and Nigeria sub-samples, however, network structure differences were noted in the Kenya sub-sample.

Conclusion

The identified PGD network highlights particular indicators and associations across three African samples. Implications for the assessment and treatment of PGD in these cultural contexts warrant consideration.

Methodologies and key considerations for implementing the International Classification of Diseases-11th revision morbidity coding: insights from a national pilot study in China

OBJECTIVE

The aim of this study was to disseminate insights from a nationwide pilot of the International Classification of Diseases-11th revision (ICD-11).

MATERIALS AND METHODS

The strategies and methodologies employed to implement the ICD-11 morbidity coding in 59 hospitals in China are described. The key considerations for the ICD-11 implementation were summarized based on feedback obtained from the pilot hospitals. Coding accuracy and Krippendorff's alpha reliability were computed based on the coding results in the ICD-11 exam.

RESULTS

Among the 59 pilot hospitals, 58 integrated ICD-11 Coding Software into their health information management systems and 56 implemented the ICD-11 in morbidity coding, resulting in 3 723 959 diagnoses for 873 425 patients being coded over a 2-month pilot coding phase. The key considerations in the transition to the ICD-11 in morbidity coding encompassed the enrichment of ICD-11 content, refinement of tools, provision of systematic and tailored training, improvement of clinical documentation, promotion of downstream data utilization, and the establishment of a national process and mechanism for implementation. The overall coding accuracy was 82.9% when considering the entire coding field (including postcoordination) and 92.2% when only one stem code was considered. Krippendorff's alpha was 0.792 (95% CI, 0.788-0.796) and 0.799 (95% CI, 0.795-0.803) with and without consideration of the code sequence, respectively.

CONCLUSION

This nationwide pilot study has enhanced national technical readiness for the ICD-11 implementation in morbidity, elucidating key factors warranting careful consideration in future endeavors. The good accuracy and intercoder reliability of the ICD-11 coding achieved following a brief training program underscore the potential for the ICD-11 to reduce training costs and provide high-quality health data. Experiences and lessons learned from this study have contributed to WHO's work on the ICD-11 and can inform other countries when formulating their transition plan.

Complex posttraumatic stress disorder in adolescence: A two-year follow-up study

BACKGROUND

Complex posttraumatic stress disorder is a new diagnosis in the 11th edition of the International Classification of Diseases (ICD-11). There is a need for a better understanding of complex PTSD in children and adolescents.

OBJECTIVE

The study aimed to estimate the factors associated with chronic complex PTSD versus recovery of complex PTSD in adolescents in a 2-year follow-up study.

METHOD

In total, 66 adolescents, mean age 14.5, 73% female, identified as having complex PTSD using self-report at baseline recruited from a general population sample, were included in the study. The International Trauma Questionnaire - Child and Adolescent Version (ITQ-CA) was used for the assessment of complex PTSD.

RESULTS

Overall, 36% of the study sample has been identified as having chronic complex PTSD over 2 years, 10% met the criteria for PTSD at a 2-year follow-up, and 54% recovered. A higher risk for chronic complex PTSD was associated with exposure to more traumatic events and more life-stressors over the 2 years, low social network, low positive social support, bullying at school, and loneliness.

CONCLUSION

The study found that around one-third of the traumatized youth had a prolonged trajectory of complex PTSD symptoms, which were associated with negative life experiences and social difficulties.

Development of the complex trauma screener: A brief measure of ICD-11 PTSD and complex PTSD

The purpose of this study was to develop the Complex Trauma Screener (CTS), a brief screener (seven items) of the ICD-11 trauma disorders that can be used in "quick-paced" facilities. We examined the factor structure of the CTS in two separate samples: civilian college students (N = 823) and military veterans (N = 130) who reported exposure to at least one traumatic event. Confirmatory factor analyses (CFAs) supported two highly-correlated factors (post-traumatic stress disorder [PTSD] and Disturbances in Self-Organization [DSO]) that loaded on the ICD-11-consistent items. The model fit indices indicated good to excellent model fit in both samples, and the internal consistencies for the scales were borderline to good (α = 0.68-0.86). Supplementary analyses supported the gender invariance of the CFA model in the civilian student sample, as well as convergent (with another trauma inventory) and discriminant validity (with borderline disorder features, depression, and mania) of the CTS in both samples. The CTS is, to our knowledge, the shortest instrument designed to measure the ICD-11 trauma disorders and is ideal for "fast-paced" facilities that have significant assessment time restraints. The CTS is, therefore, is a psychometrically-validated instrument that can help mental health professionals efficiently screen adults for ICD-11 trauma disorders.

Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective

INTRODUCTION

The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior."

OBJECTIVES

To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them.

METHODS

A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues.

RESULTS

CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed.

CONCLUSIONS

Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

Corrigendum: Convergence between the dimensional PD models of ICD-11 and DSM-5: a meta-analytic approach

[This corrects the article DOI: 10.3389/fpsyt.2023.1325583.].

A network analysis of ICD-11 Complex PTSD, emotional processing, and dissociative experiences in the context of psychological trauma at different developmental stages

Objective

Traumatic experiences are a significant risk factor for psychological disturbances, including disorders such as complex posttraumatic stress disorder, emotion-processing problems, and trauma-related dissociative experiences. The present investigation examined the coexistence of these symptoms using a network analysis model.

Method

This study included a sample of 406 people referred to comprehensive health centers in Tehran from September to December 2023 with psychopathological syndromes. Variables were assessed using The International Trauma Questionnaire, International Measurement of Exposure to Traumatic Event checklist, Baker Emotional Processing Questionnaire, and Dissociative Experiences. A regularized partial correlation network and Glasso algorithm, in combination with Extended Bayesian information criteria, were applied to estimate the network structure.

Results

Signs of unprocessed emotions and disturbance in self-organization symptoms were the most important symptoms in the symptom network, forming strong connections with other nodes. Thereby, these two symptoms can be regarded as the most important clinical manifestations in the symptom network following traumatic experiences. Three distinct symptom communities were identified: the community of traumatic experiences (childhood, adolescence, adulthood), the community of dissociative experiences (amnesia, depersonalization/derealization, and absorption), and the community of emotional processing (suppression, unpleasant emotional experience, Signs of unprocessed emotions, avoidance, and emotional control, posttraumatic stress disorder symptoms and disturbance in self-organization symptoms). The strongest edges observed were between childhood trauma-adolescence trauma (0.473) in the community of traumatic experiences, between amnesia and depersonalization/derealization (0.644) in the community of dissociative experiences, and between disturbance in self-organization symptoms and unprocessed emotions (0.324) in the community of emotional processing, indicating the recurrent occurrence of these symptoms.

Conclusion

In this study, disturbance in self-organization symptoms was identified as the central psychopathologic symptom in individuals experiencing traumas at different developmental stages. It seems that adolescent trauma and not childhood trauma plays a more decisive role in the symptoms that a person manifests after traumatic experiences. Also, posttraumatic stress disorder symptoms and disturbance in self-organization symptoms were recognized in the cluster of emotional processing symptoms and can have substantial roles in prioritizing therapeutic measures.

Improving Quality of ICD-10 (International Statistical Classification of Diseases, Tenth Revision) Coding Using AI: Protocol for a Crossover Randomized Controlled Trial

BACKGROUND

Computer-assisted clinical coding (CAC) tools are designed to help clinical coders assign standardized codes, such as the ICD-10 (International Statistical Classification of Diseases, Tenth Revision), to clinical texts, such as discharge summaries. Maintaining the integrity of these standardized codes is important both for the functioning of health systems and for ensuring data used for secondary purposes are of high quality. Clinical coding is an error-prone cumbersome task, and the complexity of modern classification systems such as the ICD-11 (International Classification of Diseases, Eleventh Revision) presents significant barriers to implementation. To date, there have only been a few user studies; therefore, our understanding is still limited regarding the role CAC systems can play in reducing the burden of coding and improving the overall quality of coding.

OBJECTIVE

The objective of the user study is to generate both qualitative and quantitative data for measuring the usefulness of a CAC system, Easy-ICD, that was developed for recommending ICD-10 codes. Specifically, our goal is to assess whether our tool can reduce the burden on clinical coders and also improve coding quality.

METHODS

The user study is based on a crossover randomized controlled trial study design, where we measure the performance of clinical coders when they use our CAC tool versus when they do not. Performance is measured by the time it takes them to assign codes to both simple and complex clinical texts as well as the coding quality, that is, the accuracy of code assignment.

RESULTS

We expect the study to provide us with a measurement of the effectiveness of the CAC system compared to manual coding processes, both in terms of time use and coding quality. Positive outcomes from this study will imply that CAC tools hold the potential to reduce the burden on health care staff and will have major implications for the adoption of artificial intelligence-based CAC innovations to improve coding practice. Expected results to be published summer 2024.

CONCLUSIONS

The planned user study promises a greater understanding of the impact CAC systems might have on clinical coding in real-life settings, especially with regard to coding time and quality. Further, the study may add new insights on how to meaningfully exploit current clinical text mining capabilities, with a view to reducing the burden on clinical coders, thus lowering the barriers and paving a more sustainable path to the adoption of modern coding systems, such as the new ICD-11.

TRIAL REGISTRATION

clinicaltrials.gov NCT06286865; https://clinicaltrials.gov/study/NCT06286865.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54593.

Improvements in Neoplasm Classification in the International Classification of Diseases, Eleventh Revision: Systematic Comparative Study With the Chinese Clinical Modification of the International Classification of Diseases, Tenth Revision

BACKGROUND

The International Classification of Diseases, Eleventh Revision (ICD-11) improved neoplasm classification.

OBJECTIVE

We aimed to study the alterations in the ICD-11 compared to the Chinese Clinical Modification of the International Classification of Diseases, Tenth Revision (ICD-10-CCM) for neoplasm classification and to provide evidence supporting the transition to the ICD-11.

METHODS

We downloaded public data files from the World Health Organization and the National Health Commission of the People's Republic of China. The ICD-10-CCM neoplasm codes were manually recoded with the ICD-11 coding tool, and an ICD-10-CCM/ICD-11 mapping table was generated. The existing files and the ICD-10-CCM/ICD-11 mapping table were used to compare the coding, classification, and expression features of neoplasms between the ICD-10-CCM and ICD-11.

RESULTS

The ICD-11 coding structure for neoplasms has dramatically changed. It provides advantages in coding granularity, coding capacity, and expression flexibility. In total, 27.4% (207/755) of ICD-10 codes and 38% (1359/3576) of ICD-10-CCM codes underwent grouping changes, which was a significantly different change (χ21=30.3; P<.001). Notably, 67.8% (2424/3576) of ICD-10-CCM codes could be fully represented by ICD-11 codes. Another 7% (252/3576) could be fully described by uniform resource identifiers. The ICD-11 had a significant difference in expression ability among the 4 ICD-10-CCM groups (χ23=93.7; P<.001), as well as a considerable difference between the changed and unchanged groups (χ21=74.7; P<.001). Expression ability negatively correlated with grouping changes (r=-.144; P<.001). In the ICD-10-CCM/ICD-11 mapping table, 60.5% (2164/3576) of codes were postcoordinated. The top 3 postcoordinated results were specific anatomy (1907/3576, 53.3%), histopathology (201/3576, 5.6%), and alternative severity 2 (70/3576, 2%). The expression ability of postcoordination was not fully reflected.

CONCLUSIONS

The ICD-11 includes many improvements in neoplasm classification, especially the new coding system, improved expression ability, and good semantic interoperability. The transition to the ICD-11 will inevitably bring challenges for clinicians, coders, policy makers and IT technicians, and many preparations will be necessary.

Practical implications of ICD-11 personality disorder classifications

Personality disorders (PDs) are associated with an inferior quality of life, poor health, and premature mortality, leading to heavy clinical, familial, and societal burdens. The International Classification of Diseases-11 (ICD-11) makes a thorough, dramatic paradigm shift from the categorical to dimensional diagnosis of PD and expands the application into adolescence. We have reviewed the recent literature on practical implications, and severity and trait measures of ICD-11 defined PDs, by comparing with the alternative model of personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), by mentioning the relevance in forensic and social concerns, and by referencing the developmental implication of life span, especially in adolescence. Study results strongly support the dimensional utility of ICD-11 PD diagnosis and application in adolescence which warrants early detection and intervention. More evidence-based research is needed along the ICD-11 PD application, such as its social relevance, measurement simplification, and longitudinal design of lifespan observation and treatment.

Associations between olfactory reference disorder and social phobia - results of an internet-based study

Despite the similar clinical features of Olfactory Reference Disorder (ORD) and Social Phobia (SP), or studies showing elevated comorbidity of the two disorders, and the conceptualization of ORD as a form of SP in the East Asian culture, to our knowledge, the relationship between ORD and SP has not been investigated. This study examined the association of ORD according to the 11th revision of the International Classification of Diseases (ICD-11) and SP in 225 German university / college students who completed self-ratings with regard to socio-demographic data and symptoms of SP and ORD within an anonymous internet-based survey. Symptoms of SP were assessed with the Social Phobia Inventory (SPIN). Symptoms of ORD according to the ICD-11 were assessed with the Olfactory Reference Disorder Questionnaire (ORDQ), developed for this study. In our sample, 86.6% of the participants who met the self-rated features for ORD also met the self-rated criteria for current SP. ORD severity scores were significantly related to SP. Participants with and without self-reported ORD differed significantly in their SP total scores. SP severity was also significantly correlated with poorer insight of ORD-related beliefs, greater ORD-related avoidance of intimate relationships and higher levels of shame and fear of rejection due to body odor. These preliminary findings indicate that ORD could be closely related to SP and highlight the need for future research on the relationship of ORD and SP in order to gain a better understanding of the development, maintenance, treatment and classification of ORD.

Pain as a disease in the new International Classification of Diseases (ICD-11): Latin American expert consensus

Aims: Pain diagnoses in the 10th version of the International Classification of Diseases (ICD-10) did not adequately support the current management of pain. Therefore, we aimed to review the new 11th revision (ICD-11) in order to analyze its usefulness for the management, coding, research and education of chronic pain from a Latin American perspective. Methods: The Latin American Federation of Associations for the Study of Pain convened a meeting of pain experts in Lima, Peru. Pain specialists from 14 Latin American countries attended the consensus meeting. Results: In ICD-11, chronic pain is defined as pain that persists or recurs longer than 3 months and is subdivided into seven categories: chronic primary pain and six types of chronic secondary pain. Chronic primary pain is now considered a disease in itself, and not a mere symptom of an underlying disease. Conclusion: The novel definition and classification of chronic pain in ICD-11 is helpful for better medical care, research and health statistics. ICD-11 will improve chronic pain management in Latin American countries, for both the pain specialist and the primary care physician.

Dissociative Symptoms in Complex Posttraumatic Stress Disorder: A Systematic Review

The 11th revision of the International Classification of Diseases (ICD-11) introduced Complex Posttraumatic Stress Disorder (CPTSD) as a sibling disorder to PTSD. Dissociative symptoms have been implicated in the severity of ICD-11 CPTSD; however, no reviews have investigated how dissociation has been measured in studies investigating CPTSD, nor the relationship between CPTSD and dissociation. This systematic review aimed to identify measures used to assess dissociative symptoms in studies that have assessed CPTSD according to ICD-11 criteria and to synthesize the relationship between these constructs. PsycINFO, PubMed, Scopus and Web of Science were searched on March 31, 2021. Seventeen articles met inclusion criteria. CPTSD was most frequently measured by a version of the International Trauma Questionnaire. Twelve measures were used to assess for dissociative symptoms, the most common being the Dissociative Symptoms Scale and the Dissociative Experiences Scale. The relationship between CPTSD and dissociative symptoms was moderate-to-strong, but inconsistently reported. Further research is needed to determine the most appropriate measure(s) of dissociation in CPTSD.

Can personality disorder be accurately assessed in older age? A differential item functioning analysis of ICD-11 inventories

OBJECTIVES

The contested categorical personality disorder (PD) criteria are not well suited to inform PD diagnoses in older adults. Yet, the classification of PDs is undergoing a critical transition phase with a paradigm shift to a dimensional approach for diagnosing PDs. No special attention was given to the expression of PDs in older age when the dimensional ICD-11 model was developed. Given that PDs are highly prevalent in older adults, there is an urgent need to examine if ICD-11 related instruments are able to adequately assess for PDs in older adults.

METHODS

The age-neutrality of ICD-11 measures was examined in a sample of 208 Dutch community-dwelling adults (N = 208, M age = 54.96, SD = 21.65), matched on sex into 104 younger (age range 18-64) and 104 older (age range 65-93) adults. An instrument is considered not to be age-neutral if a collective large level of differential item functioning (DIF) exists in a group of items of an instrument (i.e., 25% or more with DIF). We therefore set out to detect possible DIF in the following ICD-11 self-report measures: the Standardized Assessment of Severity of Personality Disorder (SASPD), the Personality Inventory for ICD-11 (PiCD), and the Borderline Pattern Scale (BPS).

RESULTS

DIF analyses using a non-parametric odds ratio approach demonstrated that SASPD, PiCD, and BPS were age-neutral with less than 25% of items showing DIF. Yet, impact of DIF at scale level, examined by way of differential test functioning (DTF), indicated a DTF effect on the SASPD total score.

CONCLUSIONS

These results of age-neutrality of the PiCD and BPS are promising for measuring ICD-11 traits and the borderline pattern. Yet, the age-neutral measurement of PD severity requires further research. With a rapidly aging population, its accurate assessment across the entire adult life span, including older age, is a prerequisite for an adequate detection of PDs.

Trajectories of pain and opioid use up to one year after surgery: analysis of a European registry

BACKGROUND

Long-term opioid use after surgery is a crucial healthcare problem in North America. Data from European hospitals are scarce and differentiation of chronic pain has rarely been considered.

METHODS

In a mixed surgical cohort of the PAIN OUT registry, opioid use and chronic pain were evaluated before surgery, and 6 and 12 months after surgery (M6/M12). Subgroups with or without opioid medication and pre-existing chronic pain were analysed. M12-chronic pain was categorised as chronic postsurgical pain (CPSP) meeting the ICD-11 definition, chronic pain related to surgery not meeting the ICD-11 definition, and chronic pain unrelated to surgery. Primary endpoint was the rate of M12 opioid users. Variables associated with M12 opioid use and patient-reported outcomes were evaluated.

RESULTS

Of 2326 patients, 5.5% were preoperative opioid users; 4.4% and 3.5% took opioids at M6 and M12 (P<0.001). Chronic pain before operation and at M6/M12 was reported by 41.2%, 41.8%, and 34.7% of patients, respectively (P<0.001). The rate of M12 opioid users was highest in group unrelated (22.3%; related 8.3%, CPSP 1.5%; P<0.001). New opioid users were 1.1% (unrelated 7.1%, related 2.3%, CPSP 0.7%; P<0.001). M12 opioid users reported more pain, pain-related physical and affective interference, and needed more opioids than non-users. The predominant variable associated with M12 opioids was preoperative opioid use (estimated odds ratio [95% confidence interval]: 28.3 [14.1-56.7], P<0.001).

CONCLUSIONS

Opioid use was low in patients with CPSP, and more problematic in patients with chronic pain unrelated to surgery. A detailed assessment of chronic pain unrelated or related to surgery or CPSP is necessary.

CLINICAL TRIAL REGISTRATION

NCT02083835.

Prolonged grief disorder in ICD-11 and DSM-5-TR: differences in prevalence and diagnostic criteria

Background

Prolonged grief disorder (PGD) was recently included as a disorder in the ICD-11 and DSM-5-TR. Although both classification systems use the same name, the criteria content, and diagnostic approach vary. This study aimed to estimate the respective prevalence of PGDICD-11 and PGDDSM-5-TR and examine the diagnostic agreement while varying the diagnostic algorithm of PGDICD-11 (bereavement vs. symptom period; varying number of accessory symptoms).

Methods

A representative sample of the German general population (N = 2,509) was investigated, of which n=1,071 reported the loss of a close person. PGD symptoms were assessed with the Traumatic Grief Inventory - Self Report Plus (TGI-SR+).

Results

The point prevalence of PGD among the bereaved varied between 4.7%-6.8%, depending on the criteria and diagnostic algorithm. The prevalence of PGDDSM-5-TR was significantly lower than the prevalence of PGDICD-11. The diagnostic agreement between both criteria sets was substantial and increased after the number of accessory symptoms for PGDICD-11 was increased from one to three. The most common symptoms were intrusive thoughts/images related to the deceased person, longing for the deceased person, and difficulty accepting the loss.

Conclusion

The results demonstrate that the prevalence of PGD significantly varies depending on the application of the diagnostic algorithm and criteria. PGD affects a substantial proportion of the general population and should be addressed by healthcare providers. However, applying the minimum ICD-11 criteria could lead overestimating the prevalence. Therefore, further harmonizing the ICD-11 and DSM-5-TR criteria and diagnostic algorithm for PGD seems appropriate.

Development of a Korean version of simple, intuitive descriptions for clinical use of the generic functioning domains in the ICD-11 Chapter V

PURPOSE

To develop a Korean version of simple, intuitive descriptions (SIDs) for clinical use of the generic functioning domains in the International Classification of Disease 11th revision (ICD-11) Chapter V.

METHODS

The initial Korean SID version proposal for the International Classification of Functioning, Disability, and Health (ICF) Rehabilitation set was translated following the Italian version. The remaining 17 codes were developed using original ICF descriptions; WHO Disability Assessment Schedule, Model Disability Survey, Korean Classification of Functioning, Disability, and Health; and previous studies. The final proposal for the Korean version of SIDs was selected through virtual conferences and three rounds of voting.

RESULTS

This study developed SIDs for the 47 generic functioning domains in the Chapter V of ICD-11. However, the SID for 20 of the 47 codes was confirmed in vote A, for 23 codes in vote B and for the remaining 4 in the final vote. All experts agreed with the final SID proposal.

CONCLUSIONS

This is the first study in South Korea to attempt the development of SIDs for ICD-11 Chapter V. Therefore, the findings of this study could be used to evaluating of disability, functioning when ICD-11 is adopted for use in Korean clinical settings.

Clinical cut scores for the Persian version of the personality inventory for DSM-5

BACKGROUND

The cut points of psychological tools to diagnose clinical conditions are not universal and depend on the region and prevalence of the disorder. Thus, we aimed to identify the cutoff points of the Persian original version of the personality inventory for DSM-5 (PID-5; 220 items) that would optimally distinguish nonclinical from clinical groups.

METHODS

Both nonclinical (N = 634, 73% female, 34.0 ± 10.8 years) and clinical (N = 454, 29% female, 29.5 ± 7.4 years) samples from the West of Iran participated in the study. Data were analyzed using receiver operating characteristic (ROC) and Youden's index was used to determine the cutoff scores across the PID-5 domains and facets. The means and standard deviations of both the clinical male and female were compared with the nonclinical group using Cohen's d and independent t-tests.

RESULTS

All the PID-5 algorithms and facets significantly distinguished clinical from nonclinical samples with some unique findings for male and female samples. The mean score of all the PID-5 algorithms and facets in the clinical male and female samples were respectively 1.0-2.0 SD and 0.5-1.0 SD above the mean for the nonclinical counterparts. A score higher than 1.5 on ranging from 0 to 3 in each domain or facet indicated clinical status.

CONCLUSION

Raw cutting scores throughout the PID-5 algorithms can be well used to diagnose any pathology of personality and the severity of the disorder in clinical patients. The cut scores provide a useful tool for the clinical use of the original version of PID-5 in Iran.

Examining accurate diagnosis of complex PTSD in ICD-11

BACKGROUND

Complex posttraumatic stress disorder (complex PTSD), the most frequently suggested new category for inclusion by mental health professionals, has been included in the Eleventh Revision of the World Health Organization's International Classification of Diseases (ICD-11). Research has yet to explore whether clinicians' recognition of the distinct complex PTSD symptoms predicts giving the correct diagnosis. The present study sought to determine if international mental health professionals were able to accurately diagnose complex PTSD and identify the shared PTSD features and three essential diagnostic features, specific to complex PTSD.

METHODS

Participants were randomly assigned to view two vignettes and tasked with providing a diagnosis (or indicating that no diagnosis was warranted). Participants then answered a series of questions regarding the presence or absence of each of the essential diagnostic features specific to the diagnosis they provided.

RESULTS

Clinicians who recognized the presence or absence of complex PTSD specific features were more likely to arrive at the correct diagnostic conclusion. Complex PTSD specific features were significant predictors while the shared PTSD features were not, indicating that attending to each of the specific symptoms was necessary for diagnostic accuracy of complex PTSD.

LIMITATIONS

The use of written case vignettes including only adult patients and a non-representative sample of mental health professionals may limit the generalizability of the results.

CONCLUSIONS

Findings support mental health professionals' ability to accurately identify specific features of complex PTSD. Future work should assess whether mental health providers can effectively identify symptoms of complex PTSD in a clinical setting.

An ICD for the Digital World: What Does the ICD-11 Research Show?

The 11th revision of the International Classification of Diseases (ICD) is now available for use. A literature search was conducted to review and summarize the research conducted to date. In addition to the ease of integration into electronic health records using standard digital tools such as uniform resource identifiers and application programming interfaces, ICD-11 and the World Health Organization provided linearization for mortality and morbidity, ICD-11-MMS, promise improved backward compatibility to ICD-10; increased availability in multiple languages; greater detail for clinical use, including traditional Chinese medicine; and enhanced maintenance for continued relevance. The studies reviewed here support the superior content and utility of ICD-11-MMS. Meaningful planning for implementation has begun, including the provision of a framework. It is time for the world to adopt a digitally prepared ICD.

Responding to concerns related to the measurement of ICD-11 complex posttraumatic stress disorder using the International Trauma Questionnaire

BACKGROUND

A recent study in this journal by Frewen et al. (2023) provided a critical analysis of the most widely used measure of ICD-11 Complex Posttraumatic Stress Disorder (CPTSD), the International Trauma Questionnaire (ITQ). The article was a thoughtful review and gave voice to several widely held concerns about the nature of CPTSD as it is represented in ICD-11 and measured by the ITQ. The primary concern expressed by Frewen et al. was that the symptom profile of ICD-11 CPTSD, as represented in the ITQ, is too simple and fails to provide adequate coverage of the construct.

OBJECTIVE

Despite its quality, the article included several misunderstandings about the nature of ICD-11 CPTSD, and the function of the ITQ, that we wish to clarify.

PARTICIPANTS

Not applicable.

SETTING

Not applicable.

RESULTS

In this article, we provide a description of what ICD-11 PTSD and CPTSD are, a review of the process that led to their inclusion in ICD-11, how the ITQ was developed and refined to measure these constructs. We then provide responses to several of the most important concerns raised by Frewen et al. CONCLUSIONS: We highlight the clinical utility of the ICD-11 descriptions of PTSD and CPTSD and discuss how the ITQ can be used as part of a suite of clinical assessments to accurately describe and understand common experiences of psychological distress that often result from exposure to traumatic life events.

The smoldering pandemic: Prevalence of prolonged grief disorder. A cross-sectional study of bereaving adults during the COVID pandemic in Pakistan

The world continues to face unprecedented psycho-social challenges after the COVID-19 pandemic. Prolonged Grief Disorder (PGD) is a young psychiatric condition describing grief exceeding standard cultural, social, and religious norms. We assessed the prevalence of PGD in Pakistan along with its correlation to anxiety, depression, and psychological distress. The prevalence of PGD was estimated to be 15 % with grief intensity correlating with depression, anxiety, and serious mental illness. People who were closely related to the deceased were more likely to experience severe PGD symptoms. Discussions about grief and measures to curb its psychological effects are crucial in the post-pandemic world.

Extension, translation and preliminary validation of the Northoff Scale for Subjective Experience in Catatonia (NSSC)

BACKGROUND

In the last two decades, much neuroscientific research has been done on the pathomechanisms of catatonia. However, catatonic symptoms have mainly been assessed with clinical rating scales based on observer ratings. Although catatonia is often associated with strong affective reactions, the subjective domain of catatonia has simply been neglected in scientific research.

METHODS

The main objective of this study was to modify, extend and translate the original German version of the Northoff Scale for Subjective Experience in Catatonia (NSSC) and to examine its preliminary validity and reliability. Data were collected from 28 patients diagnosed with catatonia associated with another mental disorder (6A40) according to ICD-11. Descriptive statistics, correlation coefficients, internal consistency and principal component analysis were employed to address preliminary validity and reliability of the NSSC.

RESULTS

NSSC showed high internal consistency (Cronbach's alpha = 0.92). NSSC total scores were significantly associated with Northoff Catatonia Rating Scale (r = 0.50, p < .01) and Bush Francis Catatonia Rating Scale (r = 0.41, p < .05) thus supporting its concurrent validity. There was no significant association between NSSC total score and Positive and Negative Symptoms Scale total (r = 0.26, p = .09), Brief Psychiatric Rating Scale (r = 0.29, p = .07) and GAF (r = 0.03, p = .43) scores.

CONCLUSION

The extended version of the NSSC consists of 26 items and was developed to assess the subjective experience of catatonia patients. Preliminary validation of the NSSC revealed good psychometric properties. NSSC is a useful tool for everyday clinical work to assess the subjective experience of catatonia patients.

A head-to-head comparison of eight unique personality systems in predicting somatization phenomenon

BACKGROUND

If somatization is an independent personality trait, it is not clear whether it is specific to the temperament or maladaptive spectrum of personality. We aimed at the head-to-head comparison of temperament and maladaptive systems and spectra of personality to predict both somatization and somatic symptom and related disorders (SSRD).

METHODS

The samples included 257 cases with SSRD (70.8% female) and 1007 non-SSRD (64.3% female) from Western Iran. The Personality Inventory for DSM-5 (PID-5), Personality Diagnostic Questionnaire-4 (PDQ-4), Temperament and Character Inventory (TCI), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), Affective and Emotional Composite Temperament Scale (AFECTS), and Positive Affect and Negative Affect Model (PANAS) was used to data collection. A somatization factor plus temperament and maladaptive spectra of personality were extracted using exploratory factor analysis. Several hierarchical linear and logistic regressions were used to test the predictive systems and spectra.

RESULTS

All personality systems jointly predict both somatization and SSRD with a slightly higher contribution for temperament systems. When the temperament and maladaptive spectra were compared, both spectra above each other significantly predicted both somatization (R2 = .407 versus .263) and SSRD (R2 = .280 versus .211). The temperament spectrum explained more variance beyond the maladaptive spectrum when predicting both the somatization factor (change in R2 = .156 versus .012) and SSRD (change in R2 = .079 versus .010).

CONCLUSION

All temperament and maladaptive frameworks of personality are complementary to predicting both somatization and SSRD. However, the somatization is more related to the temperament than the maladaptive spectrum of personality.

Do We Need a Novel Framework for Classifying Psychopathology? A Discussion Paper

Introduction

The ICD-11 and DSM-5 are the leading systems for the classification of mental disorders, and their relevance for clinical work and research, as well as their impact for policy making and legal questions, has increased considerably. In recent years, other frameworks have been proposed to supplement or even replace the ICD and the DSM, raising many questions regarding clinical utility, scientific relevance, and, at the core, how best to conceptualize mental disorders.

Method

As examples of the new approaches that have emerged, here we introduce the Hierarchical Taxonomy of Psychopathology (HiTOP), the Research Domain Criteria (RDoC), systems and network approaches, process-based approaches, as well as a new approach to the classification of personality disorders.

Results and Discussion

We highlight main distinctions between these classification frameworks, largely related to different priorities and goals, and discuss areas of overlap and potential compatibility. Synergies among these systems may provide promising new avenues for research and clinical practice.

Convergence between the dimensional PD models of ICD-11 and DSM-5: a meta-analytic approach

In the current diagnostic systems, the International Classification of Diseases-11th rev. (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders-5th ed. (DSM-5), the evaluation and diagnosis of personality disorder (PD) aim at dimensional examination of the severity of its dysfunction and the stylistic features that accompany it. Since their implementation, or even before, several measures have been developed to assess PD severity and traits in both models. Thus, convergent validity metrics have been reported with various PD measures; however, the convergence of the same constructs included in the measures of these two models remains undefined. The objective of the present review was to examine whether there is a sufficient relationship between PD measures of the ICD-11 and DSM-5 AMPD in the general population. For this meta-analytic review, systematic searches were conducted in Web of Science, PubMed, Scopus, and Google Scholar. We included studies that reported Pearson's r correlations without restrictions on language, age, sex, setting, type of sample, or informant of the measures. We excluded associations with anankastia, psychoticism or the borderline pattern because they were not comparable between one dimensional model and the other. We examined the quality of the evidence with the JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies, and performed the random effects meta-analysis with the 'meta' package of the RStudio software. Of the 5,629 results returned by the search, 16 studies were eligible; and showed moderate quality. The risk of bias was manifested by not specifying the details of the sample, the recruitment environment, and the identification and control of confounding factors. Thirteen studies provided two or more correlations resulting in a total of 54 studies for meta-analysis. The overall effect size estimate (correlation) was moderate for the overall model (r = 0.62, 95% CI [0.57, 0.67], p < 0.0001, I2 = 97.6%). For the subgroup of associations, ICD-11 severity model and DSM-5 AMPD severity model, the correlation was also moderate (k = 10, r = 0.57, 95% CI [0.48; 0.66]; I2 = 92.9%); as for the subgroup of associations, ICD-11 traits model and DSM-5 AMPD traits model (k = 44, r = 0.63, 95% CI [0.57; 0.69], I2 = 97.9%). The convergent validity between measures of PD severity and traits between one diagnostic system and another has been demonstrated in this review and they can probably be used interchangeably because they also measure the same constructs. Future research can address the limitations of this study and review the evidence for the discriminant validity of these measures.

A Four-Item Questionnaire to Measure Problematic Social Media Use: The Social Media Disorder Test

While the use of video games and social media is an enjoyable recreational activity for most users, a minority develop problematic patterns of use. In the ICD-11, for the first time, there is a category of "disorders due to addictive behaviors" (including gaming disorder). The scientific literature also suggests a potential for the problematic use of social media. Economic screening tools for this are still needed. A very economical questionnaire to record gaming disorder is the ICD-11-based Gaming Disorder Test (GDT). The purpose of the present survey was to investigate the psychometric properties of an adapted questionnaire (Social Media Disorder Test, SMDT) to assess problematic social media use (PSMU). Therefore, 443 youths (mean age: 20.11 years) were examined with the SMDT and other measures regarding PSMU, self-control, and psychopathology. A confirmatory factor analysis (CFA) and reliability and correlation analyses were conducted. For the SMDT, we observed very good fit indices in the CFA, suggesting a one-factor structure; the reliability coefficient was 0.90, and we found the first indications for criterion validity. If the results can be confirmed, the SMDT, with its four questions, would be a very economical instrument to measure PSMU based on the ICD-11 criteria for behavioral addictions.

Interpreting and coding causal relationships for quality and safety using ICD-11

Many circumstances necessitate judgments regarding causation in health information systems, but these can be tricky in medicine and epidemiology. In this article, we reflect on what the ICD-11 Reference Guide provides on coding for causation and judging when relationships between clinical concepts are causal. Based on the use of different types of codes and the development of a new mechanism for coding potential causal relationships, the ICD-11 provides an in-depth transformation of coding expectations as compared to ICD-10. An essential part of the causal relationship interpretation relies on the presence of "connecting terms," key elements in assessing the level of certainty regarding a potential relationship and how to proceed in coding a causal relationship using the new ICD-11 coding convention of postcoordination (i.e., clustering of codes). In addition, determining causation involves using documentation from healthcare providers, which is the foundation for coding health information. The coding guidelines and examples (taken from the quality and patient safety domain) presented in this article underline how new ICD-11 features and coding rules will enhance future health information systems and healthcare.

Identifying Relationships Between Difficulties with Emotion Regulation and Compulsive Sexual Behavior

Emotion dysregulation is an associated feature of compulsive sexual behavior disorder (CSBD), now recognized by the World Health Organization. Previous studies have identified associations between trait emotion dysregulation and CSBD. Given that difficulties with emotion regulation (DERS) is comprised of several facets (e.g., difficulty with impulse control and lacking awareness of one's feelings when upset), and that these facets differentially relate to other mental health concerns, the present study aimed to examine how DERS facets relate to compulsive sexual behavior (CSB). The present study also considered interpersonal emotion regulation via attachment avoidance and attachment anxiety. Hierarchical regression was conducted, first accounting for demographic covariates, then adding attachment styles, and finally all DERS subscales. Results indicated that, among a large, diverse, online U.S. sample (N = 915; Mage = 39.21, SD = 0.81; 54.3% men), difficulty controlling impulses when upset, difficulty with clarity of emotions, and non-acceptance of emotions were significantly positively associated with CSB (small to moderate effects). Attachment anxiety and avoidance were also significantly positively associated with CSB, although their effects were minimal when adding DERS facets. Overall, this study supports the theorized impact of emotion dysregulation on CSB. Assessment of individual differences in DERS and intervening on these concerns are important for treating CSB.

Surfacing undiagnosed disease: consideration, counting and coding

The diagnostic odyssey for people living with rare diseases (PLWRD) is often prolonged for myriad reasons including an initial failure to consider rare disease and challenges to systemically and systematically identifying and tracking undiagnosed diseases across the diagnostic journey. This often results in isolation, uncertainty, a delay to targeted treatments and increase in risk of complications with significant consequences for patient and family wellbeing. This article aims to highlight key time points to consider a rare disease diagnosis along with elements to consider in the potential operational classification for undiagnosed rare diseases during the diagnostic odyssey. We discuss the need to create a coding framework that traverses all stages of the diagnostic odyssey for PLWRD along with the potential benefits this will have to PLWRD and the wider community.

Psychometric evaluation of the Swedish Traumatic Grief Inventory Self-Report Plus (TGI-SR+) in bereaved parents

The International Classification of Diseases Eleventh Edition (ICD-11), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), now include prolonged grief disorder (PGD). Since criteria for PGD in both classification systems differ from prior proposed grief disorders and each other, the validation of a single instrument to screen for prolonged grief (PG) symptoms of both new diagnoses is critical for bereavement research and care. Therefore, we evaluated the psychometric properties of the Swedish version of the Traumatic Grief Inventory Self-Report Plus (TGI-SR+). Two-hundred and forty-eight bereaved parents completed questions about sociodemographic and loss-related variables, the TGI-SR+, and symptom measures of post-traumatic stress (PTS), depression and an older measure of PG symptoms, the Prolonged Grief Disorder-13 (PG-13). Confirmatory factor analyses showed that a one-factor model best fit DSM-5-TR and ICD-11 PG symptoms and the analyses of the internal consistency and inter-item correlations showed that these symptoms could be reliably assessed. In support of convergent validity, DSM-5-TR and ICD-11 PG symptoms correlated with symptoms of PTS, depression and PG assessed with the PG-13. In support of known-groups validity, DSM-5-TR and ICD-11 PG symptoms were higher among lower educated (vs. higher educated) participants and related negatively to time since loss. ROC analyses showed optimal cut-off score of ≥71 and ≥72 to determine probable caseness for DSM-5-TR and ICD-11 PGD, respectively. Results support the reliability and validity of the Swedish TGI-SR+ as a screening instrument for PG in research and bereavement care.

Behavioral addictions in the ICD-11: An important debate that is anticipated to continue for some time

The Journal of Behavioral Addictions featured a debate on the topic of "behavioral addictions in ICD-11" in 2022. Three main debate papers were published and a total of eleven commentaries. One main topic of considerations in the three debate papers and in the majority of commentaries was compulsive sexual behavior disorder. The debate was balanced, collegial and conducted at a high scientific level. Although there are some disagreements regarding specific details, all authors consider more research on behavioral addictions as important. This scientific debate has been and continues to be enormously important to behavioral addiction research and clinical practice.

ICD-11 personality disorder features in the danish general population: Cut-offs and prevalence rates for severity levels

INTRODUCTION

Prevalence rates and correlates of personality disorders (PD) are relevant to health care policy and planning.

OBJECTIVES

To present normative data for self-reported ICD-11 personality disorder (PD) features including tentative cut-off scores and prevalence rates for severity levels along with psychosocial correlates.

METHODS

The Personality Disorder Severity ICD-11 (PDS-ICD-11) scale and criterion measures of impairment were administered to a social-demographically stratified sample of Danish citizens (N = 8,941) of which 3,044 delivered complete data. Item-Response Theory (IRT) was employed to indicate cut-offs based on standard deviations from the latent mean.

RESULTS

The unidimensionality of the PDS-ICD-11 score was supported and IRT analysis suggested norm-based thresholds at latent severity levels. Expected associations with criterion measures were found.

CONCLUSION

The normative data portray ICD-11 PD features in the general population and allow for interpretation of PDS-ICD-11 scores (e.g., scores of 12, 16, and 19 may indicate mild, moderate, and severe dysfunction), which may inform health care policy and planning. A total weighted prevalence of 6.9 % of the Danish general population is estimated to have clinically significant personality dysfunction, proportionally composed of Mild (4.8 %), Moderate (1.2 %), and Severe (0.9 %) levels. Future research should corroborate these findings using relevant clinical samples and methods.

Assessing the validity and reliability of the International Anxiety Questionnaire and the International Depression Questionnaire in two bereaved national samples

The International Anxiety Questionnaire (IAQ) and International Depression Questionnaire (IDQ) are self-report measures of ICD-11 Generalized Anxiety Disorder (ICD-11 GAD) and ICD-11 Single Episode Depressive Disorder (ICD-11 DD). This study tested the psychometric properties of these scales in two samples of bereaved adults from the United Kingdom and the Republic of Ireland. Confirmatory factor analysis (CFA) was used to test the combined dimensionality and measurement invariance of the IAQ and IDQ across the United Kingdom (n = 1012) and Irish (n = 1011) samples. Differential item functioning (DIF) was tested using multiple indicator multiple cause (MIMIC) modelling while convergent validity was also assessed. CFA results supported a correlated two-factor model in both samples. The MIMIC model showed that the IDQ item "Had recurrent thoughts of death or suicide" showed DIF and the effect was small. Internal reliability of the scales were high and convergent validity was supported. The prevalence of ICD-11 GAD was 18.6% and 16.1% and ICD-11 DD was 13.8% and 10.5% in the United Kingdom and Irish samples, respectively. Findings of the study provide support for the validity, measurement invariance, and reliability of the IAQ and IDQ among two bereaved national samples.

Somatic symptom distress and ICD-11 prolonged grief in a large intercultural sample

Background: Grief is a multi-faceted experience including emotional, social, and physical reactions. Research in ICD-11 prolonged grief disorder (PGD) in different cultural contexts has revealed different or potentially missing grief symptoms that may be relevant.Objective: This study thus aimed to explore the prevalence of somatic symptom distress and its associations with grief and negative affect in a culturally diverse sample of bereaved individuals with symptoms of PGD.Methods: Based on cross-sectional survey data from the Measurement and Assessment of Grief (MAGIC) project, this study included 1337 participants (mean age 23.79 yrs, 76.1% female) from three regions (USA: 62.3%, Turkey/Iran: 24.2%, Cyprus/Greece: 13.5%), who experienced a loss of a significant other. Associations between somatic symptom distress (Somatic Symptom Scale, SSS-8), symptoms of PGD (International Prolonged Grief Disorder Scale, IPGDS-33), anxiety (Generalized Anxiety Disorder Questionnaire, GAD-7), depression (Patient Health Questionnaire, PHQ-9) as well as demographic and loss related characteristics were investigated. Three hundred and thirteen participants (23.4%) scored above the proposed cut-off for clinically severe PGD.Results: 'High' or 'very high' levels of somatic symptom distress were more frequent in a possible PGD group (58.2%), than in a non-PGD group (22.4%), p < .001, as divided per cut-off in the IPGDS. In a multiple regression analysis, PGD symptoms were significantly but weakly associated with somatic symptom distress (β = 0.08, p < .001) beyond demographics, loss-related variables, and negative affect. Negative affect (anxiety and depression) mediated the relationship of PGD symptoms with somatic symptom distress and the indirect effect explained 58% of the variance.Conclusions: High levels of somatic symptom distress can be observed in a substantial proportion of bereaved across cultures. Our findings suggest that PGD is related to somatic symptom distress partly and indirectly through facets of negative affect.

A practical strategy to use the ICD-11 for morbidity coding in the United States without a clinical modification

OBJECTIVE

The aim of this study was to derive and evaluate a practical strategy of replacing ICD-10-CM codes by ICD-11 for morbidity coding in the United States, without the creation of a Clinical Modification.

MATERIALS AND METHODS

A stepwise strategy is described, using first the ICD-11 stem codes from the Mortality and Morbidity Statistics (MMS) linearization, followed by exposing Foundation entities, then adding postcoordination (with existing codes and adding new stem codes if necessary), with creating new stem codes as the last resort. The strategy was evaluated by recoding 2 samples of ICD-10-CM codes comprised of frequently used codes and all codes from the digestive diseases chapter.

RESULTS

Among the 1725 ICD-10-CM codes examined, the cumulative coverage at the stem code, Foundation, and postcoordination levels are 35.2%, 46.5% and 89.4% respectively. 7.1% of codes require new extension codes and 3.5% require new stem codes. Among the new extension codes, severity scale values and anatomy are the most common categories. 5.5% of codes are not one-to-one matches (1 ICD-10-CM code matched to 1 ICD-11 stem code or Foundation entity) which could be potentially challenging.

CONCLUSION

Existing ICD-11 content can achieve full representation of almost 90% of ICD-10-CM codes, provided that postcoordination can be used and the coding guidelines and hierarchical structures of ICD-10-CM and ICD-11 can be harmonized. The various options examined in this study should be carefully considered before embarking on the traditional approach of a full-fledged ICD-11-CM.

Gaming disorder and stigma-related judgements of gaming individuals: An online randomized controlled trial

BACKGROUND AND AIMS

The inclusion of gaming disorder (GD) in the International Classification of Diseases 11th Revision (ICD-11) has generated scholarly debate, including claims about its potential stigmatizing effects on the wider gaming population. The present study aimed to estimate the effect of addiction-based and non-addiction-based conceptualizations of problem gaming on stigma of gamers.

DESIGN

This preregistered experiment involved a 2 (health information: addiction-related or non-addiction-related) × 3 (vignette: problem, regular or casual gamer) randomized, between-subjects design.

SETTING

An international sample of participants was recruited via Prolific in June and July 2021.

PARTICIPANTS

Participants were eligible (n = 1228) if they were aged 35 to 50 years, played video games for no more than 6 hours per week and did not endorse DSM-5 or ICD-11 criteria for GD.

INTERVENTION AND COMPARATOR

Participants were provided with an explanation of problem gaming as related to either an addictive disorder (i.e. 'addiction' explanation) or personal choice and lifestyle factors (i.e. 'non-addiction' explanation).

MEASUREMENTS

The Attribution Questionnaire (AQ) and Universal Stigma Scale (USS) assessed stigma toward each gamer vignette. Vignettes described a problem gamer (with features of GD); a regular gamer (frequent gaming; some life interference); and a casual gamer (infrequent gaming; no life interference).

FINDINGS

Problem gamer vignettes (mean [M] = 113.3; 95% CI = 111.5-115.4) received higher AQ stigma ratings than regular (M = 94.0; 95% CI = 91.9-95.9) and casual gamers (M = 80.1; 95% CI = 78.2-82.1). Although significant, the effect of health information type on AQ stigma ratings was negligible (addiction group [M = 97.6; 95% CI = 95.9-99.1], non-addiction group [M = 94.1; 95% CI = 92.6-95.8]). However, the addiction information group scored lower on USS blame and responsibility than the non-addiction information group with at least a small effect (99.1% confidence).

CONCLUSIONS

Framing of problem gaming as an addictive disorder or non-addictive activity appears to have a negligible effect on stigma of different gamers among middle-age adults with minimal gaming experience. The concept of 'gaming addiction' seems unlikely to be an important influence on public stigma of gaming.

Impact of the ICD-11 on the accuracy of clinical coding in Korea

Background: ICD-11 was officially released at the World Health Assembly on 25 May 2019. Objective: To find effective ways to increase the accuracy of coding for diagnostic terms in Korea for a stable transition from Korean modification of ICD-10 (7th Revision of Korean Classification of Disease, KCD-7) to ICD-11. Method: A total of 27 skilled Korean health information managers performed KCD-7 and ICD-11 coding simultaneously (line coding [56]; case coding [17]). Accuracy rates and percentage agreements were calculated, and granularity and difficulty of the ICD-11 were rated by participants. Results: The average accuracy rate of line coding was 71.6 % in ICD-11 and 80.2% in KCD-7, which was similar to results in other studies. The mean percentage agreements for ICD-11 and KCD-7 for line coding were 64.2% and 72.1%, respectively; while for case coding it was 15.3% and 26.6%. Selection criteria for the case scenarios may have influenced the low agreements in case coding. Cluster coding, changes of terms in ICD-11 and removal of codes used in ICD-10 contributed to low agreement in ICD-11 (46.6% of participants reported that granularity of ICD-11 was similar to ICD-10, while 36.9% reported that ICD-11 had finer granularity). In terms of difficulty, 15.3% of participants found line coding difficult and 10.9% found case coding difficult. Conclusion: Provision of more detailed reference guidelines and efficient training for coding professionals by the World Health Organization would enable ICD-11 to be an excellent tool for gathering relevant information about diseases in Korea.

Assessment tools for complex post traumatic stress disorder: a systematic review

Appropriate screening tools are required to accurately detect complex post traumatic stress disorder (CPTSD). This systematic review aimed to assess and compare measurement tools. A literature search using key words 'complex post traumatic stress disorder', 'PTSD', and 'assessment' was undertaken on Embase and PsychINFO during February 2022 by two reviewers. Inclusion criteria included full text papers between 2002-2022 which evaluated CPTSD using assessment tools. Exclusion criteria included reviews, editorials, meta-analyses, or conference abstracts. Twenty-two papers met selection criteria. Thirteen studies used the International Trauma Questionnaire (ITQ). Two studies each evaluated CPTSD with the International Trauma Interview (ITI) or Symptoms of Trauma Scale (SOTS). The Developmental Trauma Inventory (DTI), Cameron Complex Trauma Interview (CCTI), Complex PTSD Item Set additional to the Clinician Administered PTSD Scale (COPISAC), Complex Trauma Questionnaire (ComplexTQ), and Scale 8 of the Minnesota Multiphasic Personality Inventory Scale (MMPI) were used by a single study each. The ITQ was the most thoroughly investigated, validated across different populations, and is a convenient questionnaire for screening within the clinical setting. Where self-report measures are inappropriate, the ITI, SOTS, and COPISAC are interview tools which detect CPTSD. However, they require further validation and should be used alongside clinical history and examination.

Comparing ICD-11 and DSM-5 eating disorder diagnoses with the Munich eating and feeding disorder questionnaire (ED-Quest)

OBJECTIVE

The new ICD-11 eating disorders (ED) guidelines are similar to the DSM-5 criteria. One difference to the DSM-5 is the inclusion of subjective binges in the definition of bulimia nervosa (BN) and binge-eating disorder (BED). The aim of this study was to identify differences between the ICD-11 guidelines and DSM-5 ED criteria, which could impact access to medical care and early treatment.

METHOD

Data of 3863 ED inpatients who completed the Munich Eating and Feeding Disorder Questionnaire were analyzed using standardized diagnostic algorithms for DSM-5 and ICD-11.

RESULTS

Agreement of diagnoses was high (Krippendorff's α = .88, 95% CI [.86, .89]) for anorexia nervosa (AN; 98.9%), BN (97.2%) and BED (100%), and lower for other feeding and eating disorders (OFED; 75.2%). Of the 721 patients with a DSM-5 OFED, 19.8% were diagnosed with AN, BN or BED by the ICD-11 diagnostic algorithm, reducing the number of OFED diagnoses. One-hundred and twenty-one patients received an ICD-11 diagnosis of BN or BED because of subjective binges.

DISCUSSION

For over 90% of patients, applying either DSM-5 or ICD-11 diagnostic criteria/guidelines resulted in the same full-threshold ED diagnosis. Sub-threshold and feeding disorders exhibited a discrepancy of 25%.

PUBLIC SIGNIFICANCE STATEMENT

For about 98% of inpatients, the ICD-11 and DSM-5 agree on the same specified eating disorder diagnosis. This is important when comparing diagnoses made by different diagnostic systems. Including subjective binges in the definition of bulimia nervosa and binge-eating disorder contributes to improved ED diagnoses. Clarifying the wording of diagnostic criteria at several places could further increase this agreement.

Distribution and clinical comparison of restrictive feeding and eating disorders using ICD-10 and ICD-11 criteria

OBJECTIVE

Within the eleventh edition of the International Classification of Diseases (ICD-11), diagnostic criteria for feeding and eating disorders were revised and new diagnoses including avoidant/restrictive food intake disorder (ARFID) are classifiable; however, nothing is known about how these changes affect the prevalence of feeding and eating disorders. This study compared the distribution and clinical characteristics of restrictive feeding and eating disorders between ICD-10 and ICD-11.

METHOD

The Eating Disorder Examination (EDE), its child version, and the EDE ARFID module were administered to N = 82 patients (0-17 years) seeking treatment for restrictive feeding and eating disorders and their parents. Clinical characteristics were derived from medical records, questionnaires, and objective anthropometrics.

RESULTS

The number of residual restrictive eating disorders (rrED) significantly decreased from ICD-10 to ICD-11 due to a crossover to full-threshold disorders, especially anorexia nervosa (AN) or ARFID. Patients reclassified to ICD-11 ARFID were younger, had an earlier age of illness onset, more restrictive eating behaviors, and tended to have more somatic comorbidities compared to those reclassified to ICD-11 AN. Patients with rrED according to both ICD-10 and ICD-11 were younger, had an earlier age of illness onset, less shape concern, and more somatic comorbidities than patients who were reclassified from ICD-10 rrED to ICD-11 AN or ARFID.

DISCUSSION

This study highlights the inclusive approach of ICD-11 criteria, paving the way for more targeted treatment, and ARFID's high clinical relevance. Future studies considering nonrestrictive feeding and eating disorders across the life span may allow further analyses on diagnostic crossover.

PUBLIC SIGNIFICANCE

Changes in diagnostic criteria for restrictive eating disorders within the newly published ICD-11 led to an increase in full-threshold disorders, while the number of rrED was significantly lowered compared to ICD-10 criteria. The results thus highlight the diagnostic utility of ICD-11 criteria and may help providing adequate treatment to children and adolescents with rrED.

The structure of ICD-11 post traumatic stress disorder in a clinical sample of refugees based on the International Trauma Interview

BACKGROUND

The ICD-11 proposes fundamental changes to the PTSD diagnostic criteria, prompting thorough validation. While this is ideally carried out based on diagnostic interviews, most-and in the case of transcultural psychiatry all-studies have relied on self-reported measures. In this study, we used the International Trauma Interview (ITI) to assess the factor structure of ICD-11 PTSD symptoms in a sample of trauma-affected refugees.

METHOD

The ITI was administered with a sample of refugees (n = 198), originating mainly from the Greater Middle East. The symptom ratings were subjected to a confirmatory factor analysis (CFA), comparing the ICD-11 concordant three-factor model with alternative two- and one-factor models.

RESULTS

The overall fit was adequate for both the two- and three-factor models, but favored the two-factor model. Results for both models indicated local misspecifications and that item 5, hypervigilance, displayed a suboptimal loading.

CONCLUSION

The results generally support the use of the ITI in a severely trauma-affected refugee population, albeit with particular attention needed in the administration of item 5. The superior fit of a two-factor model warrants further testing across populations.