Classification of Psychiatric Disorders PDF

Classification of psychiatric disorders Dr. Mohamed Elhassan Khalid Assistant Professor and Consultant Psychiatrist 9/1/2025  DEFINITIONS: What is illness? Is a subjective psychological awareness of dysfunction at the personal level...

Classification of psychiatric disorders Dr. Mohamed Elhassan Khalid Assistant Professor and Consultant Psychiatrist 9/1/2025  DEFINITIONS: What is illness? Is a subjective psychological awareness of dysfunction at the personal level. What is disease? Refers to an objective physiological or mental disorder at the organic level. Disease : is something that needs to be cured, such as infection, injury, toxic exposure, cell degeneration, etc. Illness: is something that needs to be managed such as feelings of pain, discomfort, distress, weakness, fatigue, etc.  Disease usually causes illness, though one can have a disease without illness. For example, cardiac disease has been called the silent killer because you can have it without knowing it. If you do not know you have it, there will be no effects of illness, but you might die of the disease. Also, one can have an illness without having a diagnosed disease. Chronic pain, for example, often occurs when a person has pain but there is no diagnosable structural damage (subjective psychological awareness of dysfunction.)  What is syndrome? A syndrome is a constellation of symptoms that are unique as a group. It is the combination of symptoms that makes the syndrome specific. Different syndromes may share some symptoms In physical medicine, syndromes existed long before the etiology of these diseases was known. Some of these syndromes have subsequently been shown to be true disease entities because they have one essential cause. Thus, smallpox and measles were carefully described and differentiated by the Arabian physician Rhazes in the tenth century AD.  The best example in psychiatry is Korsakoff's syndrome illustrates the progression from symptom to syndrome to disease. Initially, confabulation and impressionability among alcoholics were recognized by Korsakoff as significant symptoms. Later, other symptoms added such as euphoria, difficulty in registration, confabulation were identified as key features of this syndrome. Finally, the discovery that in the alcoholic amnestic syndrome there was always severe damage to the mammillary bodies confirmed that Korsakoff's psychosis (syndrome) is a true disease with a neuropathological basis.  Any definitive classification of disease must be based on its etiology. The term disorder is used in psychiatry because etiology of majority of psychiatric conditions is unknown. Therefore, modern classifications (DSM and ICD) are syndrome-based classifications. This means that they are based on commonly co-occurring symptoms and not on etiology, psychobiology or prognosis. Both classifications adopt a pragmatic approach( not guided by theory or ideology) to classification that will best enable us:- 1.To care for our patients. 2. To communicate with other health professionals. 3. To carry out high-quality research.  EARLY DISTINCTIONS 1. Organic and Functional The first major classification of mental illness was based on the distinction between disorders arising from disease of the brain and those with no such obvious basis, i.e., Organic versus Functional states These terms are still used, but as knowledge of the neurobiological processes associated with psychiatric disorders has increased, their original meaning has been lost. Schizophrenia and manic depression are typical examples of functional disorders, but the increasing evidence of the role of genetics and of neuropathological abnormalities shows that there is at least some organic basis for these disorders. The category of ‘organic mental syndromes and disorders’ was renamed as ‘delirium, dementia and amnestic and other cognitive disorders’ in the modern classifications.  2. Neurosis and Psychosis For many years it was customary to divide functional mental illnesses into neuroses and psychoses. Neuroses: The person with neurosis was believed to have insight into his illness, with only part of the personality involved in the disorder, and to have intact reality testing. Psychoses: The individual with psychosis, by contrast, was believed to lack insight, had the whole of his personality distorted by the illness and constructed a false environment out of his distorted subjective experience (disturbed reality testing). Such differences are an oversimplification, since many individuals with neurotic conditions have no insight, whereas people with schizophrenia may seek help willingly during or before episodes of relapse, they have insight.  Modern Classifications Two modern systems of classification are : The Diagnostic and Statistical Manual (DSM) is used mainly in the United States and is prepared by the American Psychiatric Association every few years. The International Classification of Diseases(ICD) is a World Health Organization document and covers all medical conditions; chapter 5 in ICD10 is devoted to mental and behavioral problems( in ICD11 changed to chapter 6). ICD is in use throughout the world, although the DSM is often used in research, including drug trials, because each disorder is operationally defined and these criteria can be applied when attempting to obtain homogenous populations, as is required in drug trials for the treatment of certain conditions. Dates of Publication of DSM and ICD DSM ICD DSM-I 1952 ICD-7 1955 DSM-II 1968 ICD-8 1965 DSM-III ICD-9 1978 1980 DSM-IV ICD-10 1992 1994 DSM-5 2013 ICD-11 2018/9  DSM-5 DSM-5 represents an opportunity to better integrate neuroscience and the wealth of findings from neuroimaging, genetics, cognitive research, that have emerged over the past several decades – all of which are vital to diagnosis and treatment development. DSM-5 will be more amenable to updates in psychiatry and neuroscience, making it a “living document” and less susceptible to becoming outdated than its predecessors. DSM5 text revision (DSM5 TR) was issued in March 2022. DSM-5 has moved to a nonaxial documentation of diagnosis (formerly axes I, II, and III), with separate notations for important psychosocial and contextual factors (formerly axis IV) and disability (formerly axis V)  DSM-5 chapters 1. Neurodevelopmental 2. Disorders schizophrenia spectrum and other psychotic disorders 3. Bipolar and related depressive disorders. 4. Anxiety Disorders 5. Obsessive-Compulsive and related disorders: (body dysmorphic, trichotillomania, excoriation disorders ….) 6. Trauma-and Stressor-related disorders ( PTSD, Adjustment disorder, Prolonged grief disorder and others ….) 7. Dissociative disorders 8. Somatic symptom disorders: DSM-5 Focuses in this group on a broader range of somatic symptom-related disorders, including those with intentional symptom production (factitious disorder) and those where symptoms are not intentionally produced like somatic symptom disorder, conversion and illness anxiety disorders. Illness anxiety disorder still named hypochondriasis in ICD11. Cont. DSM-5 chapters 9. Feeding and eating disorders 10.Elimination disorders (Enuresis & encopresis) 11. Sleep-wake disorders 12. Sexual dysfunctions 13. Gender dysphoria 14. Disruptive, impulse control and conduct disorders 15. Substance use and addictive disorders 16. Neurocognitive disorders 17. Personality disorders 18. Paraphilic disorders 19. Other disorders  ICD-11 for Mental Health The international classification of diseases (ICD-11) is the 11th edition of a global categorization system for physical and mental illnesses published by the world health organization (WHO). The ICD-11 is a revised version of the ICD-10. The new version of the ICD 11 was released on June 18, 2018, as a preliminary version. ICD11 is now officially in effect (2022 release) for the national and international recording and reporting mortality and morbidity statistics. Dimensional approach Another enhancement of the ICD-11 is that it's based on a dimensional approach that makes it better at capturing change over time, is consistent with research evidence and helps to reduce artificial comorbidity, which refers to a person being diagnosed with more than one illness when in fact their symptoms are all part of the same illness.  Chapter 6 of IC11 contains the following blocks of mental disorders : 1. Neurodevelopmental disorders 2. Schizophrenia or other primary psychotic disorders 3. Catatonia 4. Mood disorders 5. Anxiety or fear-related disorders 6. Obsessive-compulsive or related disorders: beside OCD this group comprise the following; bodily dysmorphic disorder, hypochondriasis, trichotillomania (hair-pulling) and excoriation (skin-picking) disorder and others… 7. Disorders specifically associated with stress: (complex post traumatic stress disorder, PTSD, prolonged grief disorder, adjustment disorder and others …) 8. Dissociative disorders 9. Feeding or eating disorders 10. Elimination disorders 11. Disorders of bodily distress or bodily experience: Persistent bodily symptoms that are distressing to the individual and excessive attention directed toward the symptoms which the equivalent of somatic symptoms disorders in DSM5. 12. Disorders due to substance use or addictive behaviors. 13. Impulse control disorders 14. Disruptive behavior or dissocial disorders 15. Personality disorders and related traits 16. Paraphilic disorders 17. Factitious disorders 18. Neurocognitive disorders 19. Mental or behavioral disorders associated with pregnancy, childbirth and the puerperium 20.Secondary mental or behavioral syndromes associated with disorders or diseases classified elsewhere.  ICD-11Newly Added diagnoses The following diagnoses are now included in the ICD-11. 1. Attention deficit disorder Attention-deficit hyperactivity disorder (ADHD) was finally added to the ICD-11 after not being included in the ICD-10. given that this diagnosis has primarily been made in the United States being included in the DSM-5, this is a significant change that may impact rates of ADHD diagnoses worldwide. 2. Complex PTSD in the group stress related disorders The definition of complex post-traumatic stress disorder (PTSD) in the ICD-11 involves the three symptoms of PTSD 1. re-experiencing. (intrusive thoughts/memories, nightmares or flashbacks) 2. avoiding reminders. 3. heightened sense of threat/arousal- Hypervigilance. along with broader problems in emotion regulation, shame, guilt, and interpersonal conflict, such that it affects the person's entire life. 3. Prolonged grief disorder(PGD)(stress related) :is defined in the ICD- 11 as grief that extends beyond what most people would consider a reasonable or expected amount of time. Also, PGD is a new addition to DSM5 (DSM5–TR) which was released in March 2022. 4. Compulsive sexual behavior disorder(impulsive disorders group) Compulsive sexual behavior disorder is defined in the ICD-11 as a disorder "characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior." It is classified as an impulse control disorder rather than an addictive disorder. 5. Gaming disorder (grouped under addictive behaviors) Gaming disorder is newly defined in the ICD-11 as “a pattern of persistent or recurrent gaming behavior (‘digital gaming’ or ‘video-gaming’).”  ICD-11 Deleted diagnoses The following disorders were removed in the new version. 1. Acute stress disorder is no longer included as a mental disorder and instead is now classified as a reaction to trauma (factor influencing health). This contrasts with the DSM-5. 2. Gender incongruence Gender incongruence (gender dysphoria in the DSM) is no longer listed as a mental disorder but rather a sexual health condition to avoid stigma about it being a psychological rather than medical condition. 3. Personality disorders The section on personality disorders has been completely overhauled. There is now one diagnosis of "personality disorder" as it was found that there was much overlap in clinical practice. This diagnosis is labeled as mild, moderate, or severe, and measured in terms of trait domain areas to retain some of the earlier specificity of the diagnosis. This is a significant departure from the original ICD personality disorder diagnosis ( categories).  The five trait domains that represent a set of dimensions that correspond to the underlying structure of personality traits are included: 1. Negative affectivity: the tendency to manifest distressing. 2. Dissociality: the tendency to disregard social conventions and the rights of others. 3. Disinhibition :the tendency to act impulsively. 4. Anankastia :the tendency to control one’s own and other’s behavior. 5. Detachment: tendency to maintain emotional and interpersonal distance. 6. Borderline pattern : applied to individuals whose pattern of personality disturbance is characterized by a pervasive pattern of instability of interpersonal relationships ,.  ICD-11 VS. DSM-5 The ICD-11 and the DSM-5 share many similarities. Both are authoritative guidebooks for medical professionals to use for the diagnosis and treatment of diseases and disorders. They share a great overlap of material on mental disorders, with the DSM solely focused on mental health concerns, while the ICD covers all parts of the body and mind. DSM was published on.May 18, 2013, by the American Psychiatric Association (APA).A text –revision of DSM5 ( DSM5- TR) published in March 2022. The ICD-11 is broader both in its scope and its authorship (WHO). Mental health professionals in the United States are more likely to rely on and be familiar with the DSM, rather than the ICD, mental health classifications as the DSM guidebook is specifically tailored to cover mental health disorders as they are experienced and treated in that country.  Cont. ICD-11 vs. DSM-5 While the DSM-5 is published by the APA and has a rather narrow scope and authoritativeness as it's focused on North America, the ICD-11 draws its authorship globally(WHO) and is open to the public for submissions. The ICD-11 also covers medical diseases in addition to mental disorders. Another big difference is that the DSM does not code its diagnoses. Mental health professionals in the united states primarily use the DSM for diagnosis but rely on the ICD codes for insurance billing purposes. This can cause confusion and conflict when a disorder is classified differently (or not at all) from one manual to the other. REF: 1. https://sadarpsych.com/illness-vs-disease/ 2. Https://omh.Ny.Gov/omhweb/resources/providers/dsm-5- overview.Pdf 3. Https://www.Verywellmind.Com/overview-of-the-icd-11-45893 92 4. Fish’s clinical psychopathology fourth edition 1. Which term refers to the subjective experience of feeling unwell? A) disease B) syndrome C) disorder D) illness 2. Which of the following is a new addition in ICD-11? A) Autism spectrum disorder B) Gaming disorder C) Obsessive-compulsive disorder D) Gender incongruity 3. Which is of the following disorders is now not considered as mental disorder by ICD 11? A. Catatonia B. Factitious disorder C. Paraphilic disorder D. Gender incongruence 4. ICD-11 introduced a new category of disorders related to which of the following? A) infectious diseases B) substance use C) eating disorders D) stress related disorders