Updated date:

Purposed updates for the DSM-6 and ICD-11

Author:

The purposed changes for the DSM-6 and ICD-11:

  • To begin, the DSM-6 should do rid with the diagnosis Gender Dysphoria (formerly called Gender Identity Disorder) since it is really a sexual orientation—not a mental disorder.
  • In the context of this article, empathy refers to affective (emotional) empathy—as that is how the DSM defines it, while social cognition describes cognitive empathy (also known as Theory of Mind, perspective taking, or mentalization).

Neurodevelopmental Disorders

Attention Deficit-Hyperactivity Disorders (ADHDs):

  • Inattentiveness, hyperactivity/impulsivity, or combined are classified as different subtypes of ADHD—not separate sub-disorders—in the DSM-5 and ICD-11 because inattention and hyperactivity physiologically function on the same receptors and most with the condition have the combined type. However, they should be classified as separate sub-disorders (as some are inattentive without exhibiting hyperactivity and vice versa, and they often—but not always—require different medical treatments as well).
  • The DSM-5 uses a severity specifier of mild, moderate, and severe, but the ADHDs should just have a severity number scale of 1, 2, and 3 instead, so it does not conflict with the severity scale of Autism Spectrum Disorder (ASD) since a diagnosis of an ADHD—regardless of severity—does not necessarily impact oral language, intellectual, or adaptive functioning.

Attention Deficit Disorder (ADD)

  • Insomnia and Oral Language Disorder Specifiers

Hyperactive Impulsivity Disorder (HID)

  • Childhood Emotional Dysregulation Disorder, Bipolar Affective Disorder, Childhood-Onset Conduct Disorder, Insomnia, and Sensory Integration Deficits Specifiers

Mixed Attention Deficit Hyperactivity Disorder (ADHD-MX)

  • Childhood Emotional Dysregulation Disorder, Bipolar Affective Disorder, Childhood-Onset Conduct Disorder, Insomnia, Oral Language Disorder, and Sensory Integration Deficits Specifiers

Unspecified Attention Deficit-Hyperactivity Disorder (ADHD-US)

  • The “unspecified” disorder should only be used when a client (parent or legal guardian if the client is a minor) or general medical doctor (i.e., pediatrician, internist) suspects the individual has an ADHD but would need to refer them to a speciality medical doctor (i.e., psychiatrist, neurologist), as everyone is inattentive (and children are often hyper and disruptive in school) to an extent but do not need to be prescribed stimulant medication unless they actually have an ADHD (as well as narcolepsy), especially since they are often overprescribed by physicians who don’t even specialize in mental health.

Communication Disorders:

Autism Spectrum Disorder (ASD)

  • A disorder of deficits in the pragmatics of reciprocal social communication, or more specifically, difficulties in social interaction—ranging from lack of engaging and "responding to the interaction" (American Psychiatric Association, 2013) of others, as well as "reduced sharing of interests, [imaginative play], and affect" (American Psychiatric Association, 2013), to inappropriate social approaches (i.e., trembling, proximity), which leads to failure in forming and maintaining friendships with their peers—as well as in identifying the aspects of semantic language (i.e., nonliteral humor, sarcasm, etc.); nonverbal (social cues)—including establishing eye contact, greeting others (i.e., waving), and understanding gestures (such as facial expressions or body language) and social cognition (cognitively (or mentally) processing emotions and others' differing perspective)—and verbal communication (varying from initiating, maintaining, or properly finishing a conversation; to "taking turns [when conversing with others] and rephrasing if misunderstood" (American Psychiatric Association, 2013); to "sharing information [or speaking in a volume that is] appropriate for the social context [or setting]" (American Psychiatric Association, 2013); to discussing a favorite topic, interest, or hobby in an overly formal, lengthy, narrow-sided exchange; to echolalia and minimal or lack of oral (spoken) language). There is typically also repetitive behaviors, including stereotypic body movements, self-injury, or restricted, maladaptive patterns of activity with toys and objects (i.e., twirling or compulsively lining them up) that are usually caused by hypo- or hyper- sensory integration dysfunction; as well as perseverative questioning or worrying; "rigid routines (i.e., taking same route, eating same food every day, [etc.])" (American Psychiatric Association, 2013); and distress over minor changes to schedule.
  • Common co-morbidities include irritability and deficits in attention; for those who have receptive oral language deficits, the inattention is more profound than those who have ADD alone and it typically leads to other significant developmental impairments, such as gazing their eyes to the ceiling or floor and not responding to their name being called. Severely afflicted individuals usually also have profound intellectual impairments and remain uncommunicative over the course of their lifespan, while those who are moderate may show these developmental delays during early childhood or up until aged 10 (and become more high-functioning). Even when the child initially looses their diagnosis (especially as they become more verbal and begin to interact with others), some lingering social communication traits tend to persist. It is quite rare to fully overcome the social communication deficits associated with the condition, as well as to no longer require anymore specialized services, but has sometimes been reported in those who were more moderate or mild earlier on in their lives. However, there is no cure on the physiological level.
  • Attention Deficit-Hyperactivity Disorders (ADHDs), Catatonia, Irritability, Insomnia, Phonetic Deficit, Receptive or Expressive Language Deficits, and Intellectual Developmental Disorder Specifiers
  • For those who have social communication impairments without the restricted interests/repetitive behaviors, the DSM-5 added the new controversial disorder, Social (Pragmatic) Communication Disorder (SPCD), yet it is really a milder form of ASD. Therefore, SPCD should be removed, as it "led to families to be defunded services" (Tager-Flusberg, 2018), mental health practitioners "do not even find the diagnosis necessary or useful" (Tager-Flusberg, 2018), and it was too premature in the research literature to be augmented (studies have since not been able to conclude that it is a distinct disorder); in other words, restricted/repetitive behaviors are often part of but should not necessarily be required for a diagnosis of ASD. The ICD-11 will be calling it ASD, Unspecified (if without an oral language deficit) and Other Specified ASD (if there is absence in oral language), which is technically more accurate and the insurance won't deny coverage since it's in the ICD. However, the updated manual will not be available in the United States until 2027.
  • They should also rephrase the restricted interests by explaining how the "perseverative interests" affects their verbal and nonverbal communication skills, as everyone has favorite interests or hobbies but what makes it autistic is that it impacts their conversational skills, and describe in the end of that sentence how echolalia and idiosyncratic phrases often occurs when there is limited or absence of oral language (as well as discuss in the social communication domain, the social cognition deficits, an additional sub-domain for the difficulties in understanding semantic language, include "to minimal or the lack of oral (spoken) language" after discussing the failure of the typical back-and-forth conversation in that same broader domain; and mention the range of nonreciprocal conversational exchanges mentioned above in the social communication domain of the mild form of the ASD severity table scale).
  • The DSM should even rewrite in Criterion E that it is ADHD which frequently co-occurs with ASD and specify that a co-morbidity of intellectual disability is more common in severe cases of ASD, but can co-occur in moderate and mild forms as well. Further, they should add an "expressive or receptive language specifier" to indicate which form of early applied behavior analysis (ABA) intervention the child requires, as well as an "irritability specifier" to determine whether the individual needs an antipsychotic (i.e., risperidone (Risperdal), aripiprazole (Abilify), etc.) augmented to an SSRI antidepressant (i.e., sertraline (Zoloft), fluoxetine (Prozac), etc.) and an "inattentive specifier."
  • The ICD-11 is purposing to classify it solely in the broader Neurodevelopmental Disorders category, but it should further be subcategorized in the developmental speech or language disorders section.
  • In the DSM-5, ASD has a severity number scale of 1, 2, and 3, but it should use the terms mild, moderate, and severe instead since severity is based predominantly on oral language, adaptive, and often intellectual functioning as well.

Oral Language Disorder (OLD)

  • A disorder of verbal apraxia and oral (spoken) language deficits, ranging from delay in speech acquisition to chronic failure to speak at all. This manifests due to expressive or receptive language deficits. Echolalia is often common during a speech delay as well.
  • Expressive subtype (OLD-E)
  • Receptive subtype (OLD-R)
  • The receptive subtype refers to failure in speaking due to not understanding language. As the child grows older and develops oral language, this subtype often leads to a diagnosis of other specific learning disabilities, such as an ADHD, auditory processing disorder, or dyslexia. It can sometimes refer to aphasia—a speech disorder resulting from a brain injury—as well.
  • Written Language, Sign Language, and Phonetic Deficits Specifiers
  • ASD must be ruled out before diagnosing OLD.
  • Instead of consolidating Expressive Language Disorder and Mixed Receptive-Expressive Language into the single diagnosis of Language Disorder (since language refers to other things as well, such as pragmatics (i.e., social communication, semantics), speech fluency, speech sounds (phonetics), etc., and this disorder refers exclusively to different forms of oral language deficits), the DSM-5 should’ve just classified Expressive and Receptive as subtypes of Oral Language Disorder.
  • The ICD-11 is purposing to classify it in a developmental language disorder domain of the neurodevelopmental disorders, which would include expressive, receptive, and pragmatics (the linguistics and semantics form) as subtypes, but they should just include receptive and expressive in a developmental oral language disorder diagnosis.

Semantic Language Disorder (SLD)

  • A pragmatic language impairment of "understanding [the linguistics and semantics] of nonliteral or ambiguous meanings of language (i.e., idioms, humor, [sarcasm], metaphors" (American Psychiatric Association, 2013), etc.).
  • ASD must be ruled out before diagnosing SLD.
  • The ICD-11 is purposing to call it Developmental Language Disorder with Impairment of Mainly Pragmatic Language, but they should classify it as Semantic Language Disorder instead since pragmatics is a broader term for other social forms of language as well and list it in the broader developmental speech or language disorders section.

Speech Fluency Disorder (SFD)

  • A disorder of speech disfluency—also called stuttering (or dysphemia).
  • The DSM-5 refers to it as Childhood-Onset Fluency Disorder, while the ICD-11 will be calling it Developmental Speech Fluency Disorder, but they should be titled Speech Fluency Disorder.

Speech Sound Disorder (SSD)

  • A disorder of deficits in speech sounds (phonetics), including acoustic (transmission), articulatory (production), and auditive (perception). It is triggered by either verbal apraxia or dysarthria (execution).
  • ASD and ELD must be ruled out before diagnosing SSD.
  • The DSM-5 classifies it as Speech Sound Disorder (as should the ICD-11), but the ICD-11 is purposing to title it Developmental Speech Sound Disorder.

Intellectual Disabilities:

Intellectual Developmental Disorder (IDD)

  • IDD has a severity measurement of mild, moderate, severe, and profound.

Provisional Intellectual Developmental Disorder (IDD-P)

  • A diagnosis made when the child is under the age of 5 and there are signs of intellectual impairment but cannot be formally tested because of a mental or physical disability (i.e., blindness, prelingual deafness, locomotor ataxia, severe problem behaviors, or a co-occurring mental disorder).
  • The DSM-5 called it Global Developmental Delay, while the ICD-11 is purposing to classify it as Disorder of Intellectual Development, Provisional.

Unspecified Intellectual Developmental Disorder (IDD-US)

  • A diagnosis made when the child is over the age of 5 and there are signs of intellectual impairment but cannot be formally tested because of a mental or physical disability (i.e., blindness, prelingual deafness, locomotor ataxia, severe problem behaviors, or a co-occurring mental disorder).

Physical Disabillities:

Physical Coordination Disorder (PCD)

  • A disorder of dyspraxia which affects the development of the individual’s physical motor coordination across their lifespan.
  • The ICD-11 calls it Developmental Motor Coordination Disorder while the DSM-5 refers to it as Developmental Coordination Disorder, but coordination doesn’t always mean physical, and motor can include vocalizations as well (i.e., verbal apraxia, phonic tics, etc.), so the DSM-5 should've called it physical coordination disorder with the ICD-11 classifying it as developmental physical coordination disorder.
  • Sensory Integration Deficit Specifier
  • There should be a number severity scale of 1, 2, and 3.

Scholastic Learning Disorders (SLDs):

Dyscalculic Disorder (DLD)

A scholastic learning disorder of understanding mathematics.

Dysgraphic Disorder (DGD)

A scholastic learning disorder of writing properly, including finger sequencing and/or legible handwriting.

Dyslexic Disorder (DXD)

A scholastic learning disorder of reading and spelling words.

Other Neurodevelopmental Disorders:

Auditory Processing Disorder (APD)

  • The DSM-6 should add the disorder for funding purposes, and the ICD-11 is purposing to call it Other Specified Disorders with Hearing Impairment in the Disorders with Hearing Impairment of The Diseases of Ear and Mastoid Process category, but both manuals should classify it as APD in the Neurodevelopmental Disorders category since it is really a neurodevelopmental disorder.

Sensory Integration Disorder (SID)

  • HID, ASD, DCD, and SMD should be ruled out before diagnosing SID.
  • SID was considered to be included in the DSM-5, but not added because there has yet to be enough research to distinguish it from only being a comorbidity to ADHDs, ASD, DCD, and SMD despite many mental health practitioners noting it to be a distinct disorder that needs a diagnostic label for funding purposes.
  • Oral Language Disorder Specifier

Unspecified Neurodevelopmental Disorder (ND-US)

Neuromotor Disorders

Catatonic Syndrome (CS)

  • A disorder manifested by a range of neuromotor symptoms occurring simultaneously, such as waxy flexibility (immobility), tics, stereotypic body movements, self-injury, echolalia, and echopraxia (repetitive imitation of body movements).
  • DD, SD, SAD, SFD, SIDD, SIHD, STD, SIPD-MX, and SZPD must be ruled out before diagnosing CS.
  • Obsessive-Compulsive Disorder Specifier
  • It warrants its own diagnosis in a Neuromotor Disorders category because the symptoms occasionally occur without being associated with a psychotic or mood disorder.

Restless Legs Syndrome (RLS)

  • A neuromotor disorder marked by uncontrollable leg trembling, especially while resting or laying down in the afternoon or evening.
  • The DSM-5 lists RLS in the Sleep-Wake Disorders category but it should have been reclassified in a separate category called Neuromotor Disorders since it does not occur while they are sleeping and is really a neural motor disorder.

Stereotypic Movement Disorder (SMD)

  • A neuromotor disorder of stereotyped or repetitive whole body movements (i.e., hand-flapping, finger twirling, rocking back and forth, etc.). The signs usually first become apparent in early childhood.
  • Obsessive-Compulsive Disorder and Sensory Integration Deficit Specifier
  • The DSM-5 lists it in the Motor Disorders subsection of the Neurodevelopmental Disorders category but it should have been reclassified in a separate category called Neuromotor Disorders since it is not always associated with a learning or developmental disability and is really a neural motor disorder.
  • There should be a number severity scale of 1, 2, and 3.
  • ASD must be ruled out before diagnosing SMD.

Tic Disorders (TDs):

  • A wide array of neuromotor disorders characterized by tics—or repetitive spasm movements of the muscles and uncontrollable twitches. The symptoms typically begin in childhood.
  • The DSM-5 lists TDs in the Motor Disorders subsection of the Neurodevelopmental Disorders category but it should have been reclassified in a separate category called Neuromotor Disorders since it is not always associated with a learning or developmental disability, sometimes occurs after the age of 18, and is really a neural motor disorder.

Persistent Tic Disorder (PTD)

  • A tic disorder of physical, phonic, or combined (mixed) subtypes that is persistent and lasts longer than a year.
  • The client must be under the age of 18 to be diagnosed.
  • Coprolalia (phonic tics of uttering foul language), Self-Injurious, Aggressive, Obsessive-Compulsive Disorder, and Attention Deficit-Hyperactivity Disorders Specifiers
  • There should be a number severity scale of 1, 2, and 3.
  • Physical subtype (PTD-PY)
  • This subtype refers to physical tics, such as eye blinking; head jerking; shoulder shrugging; hand clapping; facial grimacing; mouth movements; and head, neck, arm, or leg jerking.
  • Phonic subtype (PTD-PC)
  • This subtype refers to phonic (or vocal) tics involving repetitive sounds or phrases, including throat clearing, belching, sniffing, or grunting.
  • Combined subtype (PTD-C)
  • A combination (or mix) of both physical and phonic tics, which the DSM-5 calls Tourette Syndrome.

Provisional Tic Disorder (PVTD)

  • A provisional tic disorder—whether phonic and/or physical—which is also transient in that it lasts for under 12 months.
  • The client must be under the age of 18 to be diagnosed.
  • Coprolalia, Self-Injurious, Aggressive, and Obsessive-Compulsive Disorder Specifiers
  • There should be a number severity scale of 1, 2, and 3.

Other Specified Tic Disorder (TD-OS)

  • A diagnosis made when phonic and/or physical tics do not become apparent until after the age of 18.
  • Coprolalia, Self-Injurious, Aggressive, and Obsessive-Compulsive Disorder Specifiers
  • There should be a number severity scale of 1, 2, and 3.

Unspecified Tic Disorder (TD-US)

  • Coprolalia, Self-Injurious, Aggressive, and Obsessive-Compulsive Disorder Specifiers

Self-Injurious Disorders:

Dermatophagia Disorder (DPGD)

  • A repetitive self-injurious disorder of compulsive skin biting.
  • Obsessive-Compulsive Disorder Specifier

Excoriation Disorder (ED)

  • A repetitive self-injurious disorder of compulsive skin picking.
  • Obsessive-Compulsive Disorder Specifier

Morsicatio Disorder (MD)

  • A repetitive self-injurious disorder of compulsive lip, cheek, or tongue biting.
  • Obsessive-Compulsive Disorder Specifier

Onychopagy Disorder (OD)

  • A repetitive self-injurious disorder of compulsive nail biting.
  • Obsessive-Compulsive Disorder Specifier

Onychotillomanic Disorder (OMD)

  • A repetitive self-injurious disorder of compulsive nail picking.
  • Obsessive-Compulsive Disorder Specifier

Trichotillomanic (Hair Pulling) Disorder (TMD)

  • A repetitive self-injurious disorder of compulsive hair pulling.
  • The DSM-5 calls it Trichotillomania (Hair Pulling) Disorder.
  • Obsessive-Compulsive Disorder Specifier

Attachment, Trauma, and Other Stressor-Related Disorders

Posttraumatic Stress Disorder (PTSD)

  • Prolonged subtype (PTSD-PL)
  • Acute subtype (PTSD-AC)
  • The DSM-5 classifies the prolonged type as PTSD while the acute subtype as Acute Stress Disorder.

Adjustment Disorders (AjD)

Other Specified Trauma and Stressor-Related Disorder (TSRD-OS)

Unspecified Trauma and Stressor-Related Disorder (TSRD-US)

Childhood-Onset Attachment Disorders:

Reactive Attachment Disorder (RAD)

Disinhibited Attachment Disorder (DIAD)

  • The DSM-5 calls it disinhibited social engagement disorder (DISED).

Dissociative Disorders

Depersonalization-Derealization Disorder (DPDR)

  • Depersonalization subtype (DPDR-DP)
  • Derealization subtype (DPDR-DR)
  • Mixed subtype (DPDR-MX)

Dissociative Identity Disorder (DID)

  • A disorder of multiple identities in which there is a dissociation from self and shift into more than two personality states without any memory or recall of such transitions, but the individual may be aware of the other existing personalities or identities.
  • Impulsive (i.e., substance misuse, self-cutting skin, reckless shopping sprees, chaotic driving, dressing abnormally, etc.), Post-Traumatic Stress, Suicidal Thoughts, and Sociopathic (i.e., aggressive or violence toward others, illicit drug dealing, acts of robbery or stealing, vandalism (spray-painting with graffiti, breaking others' personal items, exploding buildings on fire), murderer, etc.) Specifiers
  • DID should have a severity number level of 1, 2, and 3.

Unspecified Dissociative Disorder (DD-US)

Conversion Disorders:

Hypokinetic Conversion Disorder (HCD)

Blindness Conversion Disorder (BCD)

Deafness Conversion Disorder (DCD)

Other Specified Dissociative Conversion Disorder (DCD-OS)

Psychogenic Disorders:

Psychogenic Amensia Disorder (PAD)

  • Generalized subtype (PAD-G)
  • Fugue subtype (PAD-F)
  • Localized subtype (PAD-L)

Psychogenic Seizure Disorder (PSD)

Other Specified Dissociative Psychogenic Disorder (DPD-OS)

Schizophrenia Spectrum and Related Psychotic Disorders

Brief Psychotic Disorder (BPD)

  • A disorder of a brief psychotic breakdown that only lasts between one day to a month.
  • Catatonic, Impulsive, Insomnia, and Suicidal Specifiers

Delusional Disorder (DD)

  • A disorder of chronic delusions (false beliefs), but the individual can not rationalize that their delusions never really took place.
  • Catatonic, Impulsive, Insomnia, and Suicidal Specifiers
  • Paranoid subtype (DD-P)
  • PPD, SD, SAD, HPD, BPD, and BMD must be ruled out before diagnosing this subtype of DD.
  • Grandiostic subtype (DD-G)
  • A delusion of believing one is of high-power status, or is rich and famous.
  • SD, SAD, BPD, HPD, and BMD must be ruled out before diagnosing this subtype of DD.
  • Other specific subtype (DD-S)

Schizoaffective Disorder (SAD)

  • A diagnosis made when the symptoms of schizophrenia overlap with bipolar affective disorder or persistent depressive disorder (in other words, when depressive or manic-depressive states briefly fade, the client still feels that their psychotic delusions and hallucinations actually occurred).
  • Catatonic, Impulsive, Insomnia, and Suicidal Specifiers
  • SAD should have a severity number scale of 1, 2, and 3.

Schizophrenic Disorder (SD)

  • A physiological disorder of chronic split from reality and symptoms of psychosis, particularly hallucinations (seeing or hearing things not present in the environment) and delusions (i.e., paranoia), but the person is not able to rationalize that their delusions and hallucinations did not actually occur.
  • Social Withdrawal, Apathetic, Catatonic, Impulsive, Insomnia, and Suicidal Specifiers
  • Diagnostic criteria should require the client be aged 4 and over (but signs usually don't manifest until adulthood)
  • SD should have a severity number scale of 1, 2, and 3.

Schizophreniform Disorder (SFD)

  • A psychotic disorder where the core signs of schizophrenia are present but only manifest for 1-6 months.
  • Catatonic, Impulsive, Insomnia, and Suicidal Specifiers

Schizotypal Disorder (STD)

  • A psychotic disorder of social withdrawal and a flat affect because of delusions that their peers hold negative views toward them, as well as auditory hallucinations in which they falsely believe that they could hear what others are thinking. Other common symptoms often associated with the condition include experiencing derealization, depersonalization, ideas of reference, or magical thinking, having paranormal and superstitious beliefs, and dressing abnormally.
  • Catatonic, Impulsive, Insomnia, and Suicidal Specifiers
  • The DSM considers it a personality disorder while the ICD classifies it as a psychotic disorder.

Unspecified Psychotic Disorder (PD-US)

  • Catatonic, Impulsive, Insomnia, and Suicidal Specifiers

Substance-Induced Psychotic Disorders:

Substance-Induced Delusional Disorder (SIDD)

  • Grandiostic subtype (SIDD-G)
  • Paranoid subtype (SIDD-P)
  • Other specified subtype (SIDD-OS)
  • Catatonic, Impulsive, Insomnia, and Suicidal Specifiers

Substance-Induced Hallucination Disorder (SIHD)

  • Auditory subtype (SIHD-AU)
  • Visual subtype (SIHD-VS)
  • Combined subtype (SIHD-CO)
  • Catatonic, Impulsive, Insomnia, and Suicidal Specifiers

Mixed Substance-Induced Psychotic Disorder (SIPD-MX)

  • Catatonic, Impulsive, Insomnia, and Suicidal Specifiers

Anxiety Disorders

Generalized Anxiety Disorder (GAD)

  • A disorder of general excessive worry and distress that disrupt interpersonal functioning.

Panic Disorder (PAD)

  • A disorder of frequent panic attacks.

Phobic Disorder (PHD)

  • A disorder of one or more fears (or phobias) that interfere with interpersonal functioning.
  • Agoraphobia (PHD-A)
  • Other specific subtype (PHD-S)
  • Multiple subtype (PHD-M)

Social Anxiety Disorders:

Separation Anxiety Disorder (SAXD)

  • A social anxiety disorder of having excessive anxiety over separation from home or those with which he or she is close.
  • The client must be over the age of 18 to meet the diagnostic criteria for the disorder.
  • AVPD, DPD and HPD must be ruled out before diagnosing SAXD.

Selective Mutism Disorder (SMD)

  • A social anxiety disorder in which the client is so nervous that they become silent and do not speak for a long period of time.
  • ASD must be ruled out before diagnosing SMD.

Social Apprehensive Disorder (SAPD)

  • A social anxiety disorder of apprehension and withdrawing from social situations (i.e., avoiding public speaking because of feared embarrassment, preventing oneself from initiating or maintaining friendships due to worrying that it may not work out).
  • ASD must be ruled out before diagnosing SAPD.
  • The DSM-5 and ICD-11 call it Social Anxiety Disorder.

Obsessive-Compulsive Spectrum and Related Disorders

Hoarding Disorder (HGD)

Obsessive-Compulsive Disorder (OCD)

  • Obsessive subtype (OCD-O)
  • This subtype refers to the ruminative obsessive form of OCD in which the individual perseverates over minor stressful events or irrational worries to the point where it disrupts their interpersonal functioning.
  • Compulsive subtype (OCD-C)
  • This subtype refers to the ritualistic compulsive form of OCD (i.e., consistent hand-washing, repetitively checking the door knob, constantly rearranging items, etc.) to the point where it disrupts their interpersonal functioning.
  • Combined subtype (OCD-CD)
  • ASD must be ruled out before diagnosing OCD.
  • The DSM-5 and ICD-11 should have added these subtypes of OCD to specify whether it is the ruminative obsessive, ritualistic compulsive, or combined form, as the ICD-10 does, especially since they require different psychotherapeutic interventions as well (i.e., the compulsive and combined subtypes would often require exposure and response prevention (ERP) while the obsessive subtype would require other psychotherapeutic and drug treatments).

Other Specified Obsessive-Compulsive Spectrum or Related Disorder (OCSRD-OS)

Substance/Medication-Induced Obsessive Compulsive Spectrum or Related Disorder (OCSRD-SMI)

Illness or Body-Focused Disorders:

Body Dysmorphic Disorder (BDD)

  • An obsessive-compulsive spectrum disorder of viewing "some aspect of one's own body part or appearance to be severely flawed" (Cororve & Gleaves, 2001) and fixates on it to the point of "warrant(ing) exceptional measures to hide or fix it" (Cororve & Gleaves, 2001).
  • Impulsive (i.e., self-cutting skin, substance misuse, poor nutrition, etc.), Social Withdrawal, Apathetic, Suicidal Thoughts and Insomnia Specifiers

Hypochondriasis Disorder (HHD)

  • An obsessive-compulsive spectrum disorder manifested by hypochondria in which one obsesses over an irrational perception that one has or might have a medical illness despite it being disproven.
  • The ICD-11 is purposing to classify it as Hypochondriasis With Poor to Absent Insight in the Obsessive-Compulsive or Related Disorders category, whereas the DSM-5 refers to it as Illness Anxiety Disorder in the Obsessive-Compulsive Spectrum and Related Disorders category.

Olfactory Reference Disorder (ORD)

  • An obsessive-compulsive spectrum disorder characterized by a perception that they have foul breath or body odor and that others are offended by it.
  • It is a new diagnosis purposed to be added in the Obsessive-Compulsive or Related Disorders category in ICD-11.

Somatic Illness Anxiety Disorder (SIAD)

  • An obsessive-compulsive spectrum disorder characterized by persistent focus and perseveration over the pain and symptoms of minor surgery or a confirmed medical diagnosis.
  • While the DSM-5 calls it Somatic Symptom Disorder in the Somatoform Disorder category, the ICD-11 is purposing to call it Hypochondriasis With Fair to Good Insight in the Obsessive-Compulsive or Related Disorders category.

Eating and Feeding Disorders

Eating Disorders:

Anorexia Nervosa Disorder (AND)

Binge Eating Disorder (BED)

Bulimia Nervosa Disorder (BND)

Pica Disorder (PCD)

Purge Eating Disorder (PED)

Selective Eating Disorder (SED)

  • The DSM-5 retitled it avoidant/restrictive food intake disorder (ARFID).

Feeding Disorders:

Pediatric Feeding Disorder (PFD)

Pediatric Feeding Disorder Due to a Medical Condition (PFD-MC)

Geriatric Feeding Disorder (GFD)

Geriatric Feeding Disorder Due to a Medical Condition (GFD-MC)

Mood and Related Affective Disorders

Bipolar Affective Disorder (BAD)

  • A physiological affective disorder marked by an unstable mood and a chronic pattern of manic (high mood)-depressive (low mood) symptoms. The mood swings go from (hypo)mania one week (i.e., high levels of anxiety, anger, laughing, impulsive, and/or psychosis) to depression a week later (i.e., social withdrawal, lack of interest in any pleasure or personal hobbies, flat affect, low self-esteem, crying, excessive tiredness, barely sleeping or sleeping too frequently, and/or suicidal thoughts).
  • Impulsive (i.e., aggression, substance misuse, unhealthy nutrition through starvation and/or binge eating, self-cutting skin, reckless shopping sprees, chaotic driving, etc.), Suicidal Thoughts, Catatonic, Social Withdrawal, Apathetic, Insomnia, and Psychotic Specifiers
  • Diagnostic criteria requires the client to be over the age of 18 (see CEDD below)
  • BMD has a severity number scale of unspecified (-US), 1 and 2, but should go up to 3 as well.
  • The ICD calls it Bipolar Affective Disorder while the DSM-5 refers to it as Bipolar Disorder.

Childhood Emotional Dysregulation Disorder (CEDD)

  • An affective disorder of emotional dysregulation—or rapid outbursts of irritability, anger, and sadness that constantly occur throughout each day in childhood and adolescence.
  • Impulsive (i.e., aggression, substance misuse, unhealthy nutrition through starvation and/or binge eating, self-cutting skin, reckless shopping sprees, chaotic driving, etc.), Suicidal Thoughts, Catatonic, Social Withdrawal, Apathetic, Insomnia, and Psychotic Specifiers
  • Diagnostic criteria for children under the age of 18 as behavior can be outgrown by adulthood; those with the condition are more likely to develop an anxiety and/or depressive disorder as they grow older.
  • While the DSM-5 calls it Disruptive Mood Dysregulation Disorder, the ICD-11 will be referring to it as Oppositional Defiant Disorder With Chronic Irritability-Anger, but should call it Childhood Emotional Dysregulation Disorder instead since it is really a dysregulated emotional disorder.
  • The DSM-5 added it in the Depressive Disorders section but they should’ve combined the Bipolar Spectrum and the Depressive Disorders categories into a broader Mood and Related Affective Disorders category, and added it in that category.
  • CMDD should have a severity number scale of 1, 2, and 3.

Cyclothymic Disorder (CD)

  • An affective disorder that consists of rapid outbursts of crying, anger, high anxiety, or laughing that is disproportionate to the actual event and is rather mild in symptoms. Emotional outbursts include a wide array of emotions that constantly switch from high to low throughout the day and only lasts for a couple of hours to a few days (at most).
  • Impulsive (i.e., aggression, substance misuse, unhealthy nutrition through starvation and/or binge eating, reckless shopping sprees, chaotic driving, etc.), Insomnia, and Apathetic Specifiers
  • BMD and HPD must be ruled out before diagnosing CD.
  • CD should have a severity number scale of 1 and 2.

Depressive Disorders:

Persistent Depressive Disorder (PDD)

  • A physiological disorder of persistent depressive symptoms (low moods), which lasts for at least 2 months or longer.
  • Impulsive (i.e., substance misuse, unhealthy nutrition through starvation and/or binge eating, self-cutting skin, chaotic driving, etc.), Suicidal Thoughts, Psychotic, Catatonic, Social Withdrawal, and Apathetic Specifiers
  • PDD should have a severity number scale of 1, 2, and 3.

Postpartum Depressive Disorder (PPDD)

Premenstrual Dysphoric Disorder (PMDD)

Seasonal Affective Disorder (SAFD)

Substance/Medication-Induced Depressive Disorder (DD-SMI)

Other Specified Depressive Disorder (DD-OS)

Disruptive, Conduct, and Other Childhood-Onset Impulse-Control Disorders

Childhood-Onset Conduct Disorder (CD-CO)

  • Kleptomanic, Pyromanic, and Homicidal (Murderer) Specifiers
  • The DSM-5 calls it Conduct Disorder, while the ICD-11 is purposing to classify it as Dysocial-Conduct Disorder, with Childhood-Onset and Adolescent-Onset as its subtypes.
  • When the individual is over the age of 18, the diagnosis of sociopathic (antisocial) personality disorder is used instead.

Childhood-Onset Kleptomanic Disorder (KMD-CO)

  • A childhood impulse-control disorder of stealing or robberies.

Childhood-Onset Pyromanic Disorder (PYMD-CO)

  • A childhood impulse-control disorder of starting fires (i.e., exploding buildings, etc.).

Intermittent Explosive Disorder (IED)

Oppositional Defiant Disorder (ODD)

Violent Ideation Disorder (VID)

  • Kleptomanic, Pyromanic, and Homicidal Thoughts Specifiers
  • The DSM and ICD should use this term to describe children who are emotionally disturbed and have persistent fantasies over engaging in violent behavior, such as exploding objects or buildings and even harming others, so that these children are able to receive services and mental health professionals can prevent a potential incident from occurring.

Other Specified Childhood Impulse-Control Disorder (CICD-OS)

Unspecified Childhood Impulse-Control Disorder (CICD-US)

Personality Disorders

  • Personality Disorders are chronic mental illnesses where the client manifests intransigent patterns of maladaptive thinking and behavior—which causes ongoing conflicting relationships with the people closest to them—that is ego-syntonic, as it is part of their personality and are therefore treatment-resistant to any sort of treatment (but behavior therapies and psychotropic medications can still be used to treat the co-morbid symptoms). The client must be aged 18 or over to meet the diagnostic criteria for a personality disorder.

Cluster A—Psychotic and Eccentric (or Odd) Personality Disorders:

Paranoid Personality Disorder (PPD)

  • A personality disorder in which the client’s paranoid delusions are correlated with a "general mistrust of others" (American Psychiatric Association, 2013) by denying how they are constantly searching for clues in the environment to validate their false-believed suspicions, but also exhibit "sensitivity to [other peoples'] setbacks [or] rebuffs" (World Health Organization, 2019). Those with the condition are also considered to be very querulant, hostile and fanatic.
  • Insomnia Specifier

Schizoid Personality Disorder (SZPD)

  • A personality disorder manifested by emotional coldness, secretiveness, odd fantasies, apathy (flat affect), and a preference for engaging in a solitary lifestyle, including social detachment and lack of sexual activity or any other sort of pleasure. Schizoids are also described as being very contempt (or disdainful) toward others as well.
  • Impulsive, Elevated Mood, Suicidal Thoughts, and Catatonic Specifiers
  • The diagnosis is often given to police officers.

Cluster B—Egocentric, Dramatic, and Erratic Personality Disorders:

Hysteric Personality Disorder (HPD)

  • A personality disorder of hysteria—or emotional instability and affective lability (rapid outbursts of crying, anger, high anxiety, or laughing that are disproportionate to the actual event) correlated with variations in empathy, which alters from compassion and concern for others to egocentrism before having contrition for their self-centered actions or remarks. Other symptoms typically include "constant shifts between idealization and devaluation of others" (American Psychiatric Association, 2013), low self-esteem, an "[excessive impressionistic] style of speech" (American Psychiatric Association, 2013), "sensitivity to minor rejection or criticism" (American Psychiatric Association, 2013), frantic attempts to avoid feared abandonment, paranoid delusions under stress, disturbed identity shifts, dissociative amnesia, planned accidents, chaotic driving, reckless shopping sprees, exhibitionism (dressing that exposes genitals or other private body parts in public), substance misuse, and poor nutrition (i.e., starvation, binge eating, etc.).
  • Yet, many afflicted have quite mild forms of the condition in which the person may show no signs if adjusted to lifestyles where they feel more stable; they are only egocentric during their emotionally reactive states, particularly when faced with challenging circumstances, rejection, or feeling as though others are abandoning them. Those who have suicidal thoughts and self-harm behaviors are typically hospitalized (but such individuals are often successfully treated with dialectical behavioral therapy or DBT). Common co-morbidities include bipolar affective disorder, generalized anxiety disorder, and persistent depressive disorder. Hysterics are referred to as being overly dramatic and vivacious (or extremely lively), emotionally unstable, selfish, and the center of attention. Some are also impulsive, flirtatious, and manipulative.
  • Impulsive (i.e., real or fictitious threats of suicide, self-cutting skin, aggression, inappropriate seduction, etc.), Insomnia, and Psychotic Specifiers
  • The DSM-5 currently lists Emotionally Unstable/Hysteroid (Borderline) and Hysterical (Histrionic) to be separate diagnoses in the cluster B personality disorders. However, both disorders are, at its core, correlated with egocentrism and unstable emotions, so they should be consolidated into a broader diagnosis of Hysteric Personality Disorder, and hysteria and emotionally unstable should be considered exact synonyms, as some are just more dramatic and attention-seeking than others.
  • HPD should also have a number severity scale of 1, 2, and 3.

Narcissistic Personality Disorder (NPD)

  • A disorder of narcissistic personality traits characterized by egocentrism (which is followed by feelings of guilt) and superior grandiosity ("[exaggerated] sense of [entitlement and] self-importance" (American Psychiatric Association, 2013)) due to viewing others as inferior to them and persistent desires to achieve fame or high power status, as well as arrogance or haughtiness over one's own superior qualities, traits, and appearance. Additional signs associated with the condition are being contemptuous, disdainful, or scornful toward other people. Other common symptoms include anger when experiencing rejection or criticism and exploitive behavior. Narcissists are supercilious, shallow, vain, selfish, and often manipulative as well.
  • Impulsive (i.e., substance misuse, self-cutting skin, inappropriate seduction, reckless shopping sprees, chaotic driving, etc.) Specifier
  • NPD should have a number severity scale of 1 and 2.

Sociopathic Personality Disorder (SPPD)

  • A physiological personality disorder marked by the presence of sociopathic, antisocial, or otherwise deviant behavior—particularly, egocentrism and lack of remorse for one's uncivil and immoral conduct, along with "deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure" (American Psychiatric Association, 2013). Other symptoms often include threatening to physically harm other people, as well as exhibiting aggression or violence towards them; acts of robbery or stealing; illicit drug dealing; and vandalism (such as spray-painting with graffiti, breaking others' personal items, exploding buildings on fire, etc.). Sociopaths are even described as being selfish, psychopathic, self-indulgent, and sadistic (or receives pleasure from causing someone else pain, suffering, and humiliation). Many (but not all of them) are also mass murderers (homiciders).
  • Impulsive (i.e., substance misuse, self-cutting skin, inappropriate seduction, reckless shopping sprees, chaotic driving, etc.), Suicidal Thoughts, Kleptomania, Pyromania, and Homicidal Specifiers
  • For those under the age of 18 who meet the diagnostic criteria for the personality disorder are instead diagnosed with conduct disorder as the behavior can be outgrown by adulthood, but it should be retitled to childhood-onset conduct disorder (CD-CO).
  • The DSM-5 calls it Antisocial Personality Disorder while the ICD-10 classifies it as Dissocial Personality Disorder, but the disorder should be retitled to Sociopathic Personality Disorder.
  • SPPD should have a number severity scale of 1, 2, and 3.

Cluster C—Anxious and Fearful Personality Disorders:

Anankastic Personality Disorder (AKPD)

  • A personality disorder of engaging in obsessive-compulsive behavior to the point of inflexibility and exclusion of other hobbies and social relationships. In sharp contrast to OCD in which obsessions and ritualistic compulsions are performed to relieve stress or anxiety, anankastics believe their distressing thoughts and compulsions are correct. Those with the condition are also considered to be perfectionists who are rather controlling to work with in the labor force and tend to be hoarders and misers as well.
  • Insomnia Specifier
  • The ICD-10 calls it anankastic (which means “compulsive” in English) personality disorder whereas the DSM refers to it as obsessive-compulsive personality disorder.

Avoidant Personality Disorder (AVPD)

  • A personality disorder characterized by severe social inhibition (or apprehension) and disengagement with others to avoid embarrassment, as well as potential abandonment, which leads to "restrictions in lifestyle" (World Health Organization, 2019), as they lack any involvement in employment opportunities and constantly feel the "need for [more] physical security" (World Health Organization, 2019), but also exhibit hostility when faced with criticism for their avoidant behavior.
  • Impulsive (i.e., substance misuse, self-cutting skin, etc.), Suicidal Thoughts, and Insomnia Specifiers
  • PPD and SZPD must be ruled out before diagnosing AVPD.
  • The DSM-5 refers to it as avoidant personality disorder while the ICD-10 calls it anxious personality disorder.

Dependent Personality Disorder (DPD)

  • A personality disorder in which there is an exaggerated "preoccupation with fear of being abandoned" (World Health Organization, 2019) and a persistent dependency on "others [by requiring them] to make most of [their daily] life decisions" (World Health Organization, 2019), constantly put others' needs before their own, "feel completely helpless when [left] alone" (World Health Organization, 2019), and immediately "seek another relationship [after the other one] ends" (American Psychiatric Association, 2013), but come across with hostility when faced with minor rejection or critiqued for their deference behavior, as they feel subordinate to everyone else and "lack confidence in [their own] judgement or abilities" (American Psychiatric Association, 2013). Dependents even allow others to take advantage of them and are more vulnerable to being in abusive relationships. Those with the condition are also described as being completely passive-aggressive (or submissive) and extremely asthenic as well.
  • Insomnia Specifier
  • HPD and NPD must be ruled out before diagnosing DPD.

Citations

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) (5th ed.).

Cororve, M. B., & Gleaves, D. H. (2001). Body dysmorphic disorder: A review of conceptualizations, assessment, and treatment strategies. Clinical Psychology Review, 21(6), 949-970.

Tager-Flusberg H., and Simons Foundation. (2018, April 17). Why no one needs a diagnosis of 'social communication disorder'. Spectrum. Retrieved from https://www.spectrumnews.org/opinion/viewpoint/no-one-needs-diagnosis-social-communication-disorder/

World Health Organization. (2019). V. Mental and behavioral disorders. In International Classification of Diseases (ICD-10) (10th ed.).

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May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. The Mental Health Clinic, 6(2), 62-67.

Dziobek, I., Preibler, S., Grozdanovic, Z., Heuser, I., Heekeren, H. R., & Roepk, S. (2011). Neuronal correlates of altered empathy and social cognition in borderline personality disorder. NeuroImage, 57(2), 539-548.

Fein, D. A., Barton, M., Eigsti, I. M., Kelley, E., Naigles, L., Sschultz, R. T., ... Tyson, K. (2013). Optimal outcome in individuals with a history of autism. Journal of Child Psychology and Psychiatry, (54)2, 195-205.

Grande, T. (2021, March 11). Histrionic personality disorder deep dive | What is hysteria? Retrieved from YouTube at https://www.youtube.com/watch?v=WECpW3FlyKk

Leitner, Y. (2014). The co-occurrence of autism and attention deficit hyperactivity disorder in children - What do we know? Frontiers in Human Neuroscience, 8, 268.

MedCircle. (2018). Narcissism vs Borderline Personality Disorder (BPD vs NPD). Retrieved from YouTube at https://www.youtube.com/watch?fbclid=IwAR2V3a7sQdHXHhUNsBP1uObToHn7IXuez7Ta8M74PuKtZqc4rUQL5ng3U8w&v=TxrSPlL5s7cfbclid=IwAR2V3a7sQdHXHhUNsBP1uObToHn7IXuez7Ta8M74PuKtZqc4rUQL5ng3

American Academy of Child & Adolescent Psychiatry. (2019, May). Disruptive mood dysregulation disorder (DMDD). Retrieved April 9, 2021, from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Disruptive-Mood-Dysregulation-Disorder-_DMDD_-110.aspx

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