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Purposed Updates for the DSM-6 and ICD-12

The purposed changes for the DSM-6 and ICD-12:

  • 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 Disorder (ADHD)

  • Inattentive subtype (ADHD-I)
  • Hyperactivity subtype (ADHD-H)
  • Combined subtype (ADHD-C)
  • Bipolar Disorder, Childhood Mood Dysregulation Disorder, Insomnia, Sensory Integration Disorder, and Spoken Language Disorder Specifiers
  • 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 spoken language, intellectual, or adaptive functioning.
  • Inattentive, 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. They often—but not always—require different medical treatments as well. The diagnostic manuals should also remove the word "Predominately" for the Inattentive subtype.

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 the research considers it to be a neurodevelopmental disorder.
  • Figurative Language Disorder, Speech Sound (Phonological) Disorder, and Spoken (Oral) Language Disorder Specifier

Physical Coordination Disorder (PCD)

  • A disorder of physical discoordination, or 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 Disorder Specifier
  • There should be a number severity scale of 1, 2, and 3.

Sensory Integration Disorder (SID)

  • ASD 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, PCD, and SMD despite many mental health practitioners noting it to be a distinct disorder that needs a diagnostic label for funding purposes.
  • Speech Sound Disorder and Spoken Language Disorder Specifiers

Other Specified Neurodevelopmental Disorder (ND-OS)

Unspecified Neurodevelopmental Disorder (ND-US)

Communication Disorders:

Autism Spectrum Disorder (ASD)

  • A disorder of deficits in the pragmatics of 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 figurative language (i.e., nonliteral humor, sarcasm, etc.); nonverbal communication (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 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 language delays, 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 nonspeaking over the course of their lifespan" (Wikipedia, n.d.), 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, Intellectual Developmental Disorder, Irritability, Insomnia, Speech Sound Disorder, and Spoken Language Impairment (Expressive or Receptive) 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 a spoken language deficit) and Other Specified ASD (if there is absence in spoken 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 Criterion A to "Persistent deficits in the pragmatics of social communication, including social interaction and verbal and nonverbal communication"; incorporate an additional sub-domain for the difficulties in understanding figurative language; include "to minimal or the lack of 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 (pragmatic) communication domain of the mild form of the ASD severity table scale.
  • The DSM should even rewrite in Criterion E that it is an ADHD which frequently co-occurs with ASD and clarify 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 a "Spoken Language (Expressive or Receptive) Impairment 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 "Inattention 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 spoken language, adaptive, and often intellectual functioning as well.

Figurative Language Disorder (FLD)

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

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  • A disorder of deficits in pronouncing oral speech sounds (phonetics), such as acoustic (transmission), articulation (production), and auditory (perception). The broad diagnosis includes the following disorders: verbal apraxia (motor planning), dysarthria (slurred speech), and sensory impairments (blind or deafness).
  • Blind, Deaf, Dysarthria, Spoken Language Disorder, and Verbal Apraxia Specifiers
  • The DSM-5 classifies it as Speech Sound Disorder, but the ICD-11 is purposing to title it Developmental Speech Sound Disorder.

Spoken Language Disorder (SLD)

  • A disorder of impairment in spoken (oral) language, ranging from delay in speech acquisition to chronic failure to speak at all. When initially acquiring spoken language, they might still struggle with semantics (the various meanings of words) and syntax, such as finding the proper word(s) or putting together sentences when conversing with others. These symptoms manifest due to expressive and/or receptive language deficits.
  • Expressive subtype (SLD-E)
  • The expressive subtype refers to a more general failure in speaking.
  • Mixed Receptive-Expressive subtype (SLD-MRE)
  • The mixed receptive-expressive subtype refers to failure in speaking due to difficulty comprehending language, which is often caused by a language processing disability, including an ADHD, auditory processing disorder, or dyslexia. It can sometimes describe echolalia (meaningless repetition of words) or aphasia—resulting from neurological damage, such as traumatic brain injury or stroke—as well.
  • ADHDs, Aphasia, Written Language Deficit, Sign Language Deficit, and Speech Sound Disorder Specifiers
  • ASD and IDDs must be ruled out before diagnosing SOLD.
  • Instead of consolidating Expressive Language Disorder and Mixed Receptive-Expressive Language into the single diagnosis of Language Disorder (as language refers to other things as well, such as pragmatics (i.e., social communication, figurative language), speech disfluency (stuttering), speech sounds (phonetics), etc., and this disorder refers exclusively to different forms of spoken language deficits), the DSM-5 should've just classified it as Spoken Language Disorder.
  • The ICD-11 is purposing to classify it in a developmental language disorder domain of the neurodevelopmental disorders, which would include expressive, mixed receptive-expressive, and pragmatics (the figurative form) as subtypes, but they should just include expressive and mixed receptive-expressive as subtypes of a spoken (oral) language disorder diagnosis.

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).

Scholastic Learning Disorders (SLDs):

Dyscalculia (DCL)

A scholastic learning disorder of understanding arithmetic (mathematics).

Dysgraphia (DGP)

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

Dyslexia (DLX)

A scholastic learning disorder of difficulty in reading and spelling words.

Acquired Neurological Disorders (ANDs)

  • Instead of calling it the Neurocognitive Disorders (as cognitive is really a synonym for mental), they should've had two separate categories: Acquired Neurological Disorders and Neurodegenerative Disorders.

Acquired Neurological Disorder (AND)

  • Benign Brain Tumor, Cancerous (Malignant) Brain Tumor, Fetal Alcohol Syndrome, HIV Infection, Traumatic Brain Injury, Vascular Disease, Multiple Etiologies, and Other Substance/Medication-Induced Condition Specifiers
  • There should be a severity measurement of severe, moderate, and mild.

Other Specified Acquired Neurological Disorder (AND-OS)

Unspecified Acquired Neurological Disorder (AND-US)

Neuromotor Disorders

*This category should be added to describe neurological movement (motor) disorders.

Catatonic Disorder (CTD)

  • 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 Body Movement Disorder (SBMD)

  • 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.

Multiple Tic (Tourette’s) Disorder (MTD)

  • A tic disorder characterized by a combination, mix of, or multiple physical and vocal tics, which the DSM-5 calls Tourette Syndrome.
  • Coprolalia (vocal tics of uttering foul language), Self-Injurious, Aggressive, Obsessive-Compulsive Disorder, and Attention-Deficit Hyperactivity Disorders Specifiers
  • There should be a severity number scale of 1, 2, and 3.

Primary Tic Disorder (PTD)

  • A tic disorder of physical or vocal subtypes that is persistent and lasts longer than a year.
  • The client must be under the age of 18 to be diagnosed.
  • Coprolalia, 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-P)
  • 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.
  • Vocal subtype (PTD-V)
  • This subtype refers to vocal tics involving repetitive sounds or phrases, including throat clearing, belching, sniffing, or grunting.

Provisional Tic Disorder (PVTD)

  • A provisional tic disorder—whether vocal 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 vocal 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, including—but not limited to—lips.
  • Obsessive-Compulsive Disorder Specifier

Excoriation Disorder (ED)

  • A repetitive self-injurious disorder of compulsive skin picking, including—but not limited to—lips.
  • Obsessive-Compulsive Disorder Specifier

Onychotillomanic Disorder (OMD)

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

Trichotillomanic 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

Adjustment Disorder (AjD)

Disinhibited Attachment Disorder (DPAD)

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

Prolonged Grief Disorder (PGD)

Posttraumatic Stress Disorder (PTSD)

  • Prolonged subtype (PTSD-P)
  • Acute subtype (PTSD-A)
  • The DSM-5 classifies the prolonged type as PTSD with the acute subtype as Acute Stress Disorder.

Reactive Attachment Disorder (RAD)

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

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

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 (Immobile) Conversion Disorder (HKD)

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

Unspecified Psychotic Disorder (PD-US)

  • Catatonic, Impulsive, Insomnia, and Suicidal Specifiers

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
  • Childhood-Onset Specifier
  • Although symptoms do not usually manifest until adulthood, the diagnostic criteria should require the client be diagnosed over the age of 4 since symptoms sometimes begin in childhood or adolescence.
  • 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.
  • Apathetic, Catatonic, Impulsive, Insomnia, Social Withdrawal, and Suicidal Specifiers
  • Childhood-Onset Specifier
  • Although symptoms do not usually manifest until adulthood, the diagnostic criteria should require the client be diagnosed over the of 4 since symptoms sometimes begin in childhood or adolescence.
  • 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

Delusional Disorders (DDs):

  • 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

Grandiostic Delusional Disorder (GDD)

  • 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.

Paranoid Delusional Disorder (PNDD)

  • PPD, SD, SAD, HPD, BPD, and BMD must be ruled out before diagnosing this subtype of DD.

Other Specified Delusional Disorder (DD-OS)

Unspecified Delusional Disorder (DD-US)

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.

Selective Mutism (SMT)

  • An 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.

Separation Anxiety Disorder (SXD)

  • An 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 SAD.

Social Anxiety Disorder (SAXD)

  • An anxiety disorder of 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 SAXD.

Specific Phobia (SP)

  • A specific phobia is one or more fears (or phobias) that interfere with interpersonal functioning.

Obsessive-Compulsive Spectrum and Related 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

Hoarding Disorder (HGD)

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.

Obsessive-Compulsive Disorder (OCD)

  • Perseverative subtype (OCD-P)
  • The perseverative subtype refers to the individual having rumination (repeated thoughts) and perseverating over minor stressful events or irrational worries to the point where it disrupts their interpersonal functioning.
  • Ritualistic subtype (OCD-R)
  • This subtype refers to the ritualistic 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-C)
  • 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).

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.

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

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

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 Disorder (BD)

  • 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)
  • BD 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 Mood Dysregulation Disorder (CMDD)

  • 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 Mood Dysregulation Disorder instead.
  • The DSM-5 added it in the Depressive Disorders section but they should’ve included it into a Mood Dysregulation and Related Affective Disorders category instead.
  • CPD 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)

Paraphilic (Sexual Perversion) Disorders

  • Paraphilias (sexual perversions) refers to atypical sexual arousals for the interest of masturbation; it is only considered a paraphilic disorder if the individual either fails to resist masturbating over such urges in enclosed public restrooms, experience dissatisfaction over sadistic fantasies, or if the paraphilia pertains to children, corpses, feces, urine, or nonhuman animals.

Coprophilic Disorder (CPD)

  • A paraphilia to feces.
  • This disorder should be added for funding purposes.

Necrophilic Disorder (NPHD)

  • A paraphilia to corpses (dead bodies).

Pedophilic Disorder (PPD)

  • A paraphilia to children; the pedophile is required to be at least three years older than the minor (the latter refers to someone below the age of 18).
  • The client must be over the age of 16 to be diagnosed.

Sexual Mascochism Disorder (SMD)

  • A paraphilic disorder in which the client experiences distress over their sadistic fantasies.

Urolagnic Disorder (UD)

  • A paraphilic disorder to urine.
  • This disorder should be added for funding purposes.

Zoophilic Disorder (ZPD)

  • A paraphilic disorder to nonhuman animals.
  • This disorder should be added for funding purposes.

Other Specified Paraphilic Disorder (PD-OS)

Unspecified Paraphilic Disorder (PD-OS)

Disruptive, Conduct, and Other Impulse-Control Disorders

Homicidal Disorder (HCD)

  • Childhood-Onset Specifier
  • The disorder should be added for funding purposes.

Kleptomanic Disorder (KM)

  • An impulse-control disorder of stealing or robberies.
  • Childhood-Onset Specifier

Physical Assault Disorder (PAD)

Pyromanic Disorder (PYM)

  • An impulse-control disorder of starting fires (i.e., exploding buildings, etc.).
  • Childhood-Onset Specifier

Immoral Conduct Disorder (ICD)

  • 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 moralpathic (antisocial) personality disorder is used instead.

Intermittent Explosive Disorder (IED)

Oppositional Defiant Disorder (ODD)

Provisional Homicidal Disorder (PHD)

. Childhood-Onset Specifier

Other Specified Impulse-Control Disorder (ICD-OS)

Unspecified Impulse-Control Disorder (ICD-US)

Sexual Violence or Harassment Disorders:

Beastiality Disorder (BD)

  • Childhood-Onset Specifier

Child Predatory Disorder (CPD)

Exhibitionistic Disorder (ED)

  • Childhood-Onset Specifier

Frotteuristic Disorder (FD)

  • Childhood-Onset Specifier

Sexual Coercion Disorder (SCD)

  • Childhood-Onset Specifier

Sexual Sadism Disorder (SAMD)

  • Childhood-Onset Specifier

Voyeuristic Disorder (VD)

Provisional Child Predatory Disorder (CPD-P)

Provisional Sexual Coercion Disorder (SCD-P)

Other Specified Sexual Violence or Harassment Disorder (SVHD-OS)

Unspecified Sexual Violence or Harassment Disorder (SVHD-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.

Anankastic Personality Disorder (AKPD)

  • A personality disorder of rigidity and 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.

Querulent (Suspicious) Personality Disorder (QPD)

  • A personality disorder in which the client is querulent and whose suspiciousness 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 hostile and fanatic.
  • Insomnia Specifier
  • Instead of removing it as a predominate trait specifier of Personality Disorder from the ICD-11, it should be listed as a separate personality disorder.

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.
  • Instead of removing it as a predominate trait specifier of Personality Disorder from the ICD-11, it should be listed as a separate personality disorder.

Schizotypal Personality Disorder (STPD)

  • A personality disorder of social withdrawal and a flat affect because of cognitive distortions that their peers hold negative views toward them, as well as falsely believing 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.
  • Impulsive, Insomnia, and Suicidal Specifiers
  • The DSM considers it a personality disorder while the ICD classifies it as a schizophrenia spectrum disorder.

Egocentric Personality Disorders:

Hysteric (Emotionally Unstable) 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, suspiciousness of others when angry, 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 tend to only be 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). More severe forms overlap with a dual diagnosis of narcissistic personality disorder, which is when they have a total lack of empathy (despite experiencing subsequent guilt) and are haughty and arrogant as well. Common co-morbidities include bipolar disorder, generalized anxiety disorder, and persistent depressive disorder. Hysterics are referred to as being overly dramatic, emotionally unstable, selfish, and the center of attention. Some are also impulsive, flirtatious, and vivacious (or extremely lively).
  • 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.
  • Instead of clustering it as a predominate trait specifier of Personality Disorder in the upcoming ICD-11, Hysteria (instead of Negative Affectivity) should be listed as a predominate trait specifier of Egocentric Personality Disorder, along with keeping the other predominate trait specifiers of Disinhibitory, Moralpathy (the latter as opposed to Dissociality), as well as adding Narcissism, and Seductive. On the other hand, Anankastic, Paranoid (should be retitled to Querulant), and Schizoid should remain separate personality disorders.
  • HPD should have a number severity scale of 1, 2, and 3.

Moralpathic Personality Disorder (MPPD)

  • A physiological personality disorder marked by the presence of moralpathic, 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 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.). It comes in two distinct forms: sociopathy (when making their moralpathic behavior publicly obvious) and psychopathy (covert, or skillful at not revealing their moralpathy). Moralpaths are even described as being self-indulgent, manipulative, callous, and sadistic. Many (but not all of them) are also malignant—or, in other words, mass murderers (homiciders).
  • Impulsive (i.e., substance misuse, self-cutting skin, inappropriate seduction, exhibitionism, 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.
  • 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 Moralpathic Personality Disorder.
  • Instead of clustering Dissociality predominate trait specifier of Personality Disorder, the ICD-11 should be listing it as the Moralpathy predominate trait specifier of Egocentric Personality Disorder, along with keeping the other predominate trait specifier of Disinhibitory, Hysteria (instead of Negative Affectivity), as well as adding Seductive, and Narcissism (or Haughty). On the other hand, Anankastic, Paranoid (should be retitled Querulent or Suspicious), and Schizoid should remain separate personality disorders.
  • MPPD should 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 haughtiness or arrogance over one's own superior qualities, traits, and appearance, as well as persistent desires to achieve fame or high power status. Other common symptoms include exploitive behavior. Narcissists are supercilious, shallow, vain, selfish, contemptuous, scornful, and often manipulative as well.
  • Malignant narcissists engage in criminal behavior, but in sharp contrast to moralpaths, they will have remorse for such behavior.
  • Impulsive (i.e., substance misuse, self-cutting skin, inappropriate seduction, exhibitionism, reckless shopping sprees, chaotic driving, etc.), Kleptomania, Pyromania, Criminal, and Homicidal Specifiers
  • Instead of clustering it as a Personality Disorder, Severity Unspecified in the ICD-11, it should be listed as a predominate trait specifier of Egocentric Personality Disorder, along with keeping the other predominate trait specifiers of Disinhibitory, Hysteria (instead of Negative Affectivity), Moralpathy (the latter as opposed to Disociality), as well as adding Seductive. On the other hand, Anankastic, Paranoid (should be retitled Querulant), and Schizoid should remain separate personality disorders.
  • NPD should have a number severity scale of 1 and 2.

Neurodegenerative Disorders

  • Instead of calling it the Neurocognitive Disorders (as cognitive is really a synonym for mental), they should've had two separate categories: Acquired Neurological Disorders and Neurodegenerative Disorders.

Frontotemporal Neurodegenerative Disorder (FND)

  • There should be a severity measurement of severe, moderate, and mild.

Other Specified Neurodegenerative Disorder (NDD-OS)

  • Alzheimer's Disease (AD), Huntington's Disease (HTD), Lewy Bodies (LB), Parkinson's Disease (PD), and Prion Disease (PRD) Specifiers
  • There should be a severity measurement of severe, moderate, and mild.

Unspecified Neurodegenerative Disorder (NDD-US)

Delirium Disorders (DDs):

Delirium (DM)

Other Specified Delirium (DM-OS)

Unspecified Delirium (DM-US)

Citations

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

Wikimedia. (n.d.). Autism spectrum. Wikipedia, the free encyclopedia. Retrieved November 10, 2022, from https://en.wikipedia.org/wiki/Autism_spectrum

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.).

Other Resources

Child Mind Institute. (2019, December 4). Disruptive mood dysregulation disorder basics. Retrieved April 9, 2021, from https://childmind.org/guide/guide-to-disruptive-mood-dysregulation-disorder/

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

Niedtfeld, I. (2017). Experimental investigation of cognitive and affective empathy in borderline personality disorder: Effects of ambiguity in multimodal social information processing. Psychiatry Research, 253, 58-63.

Paul, R., Campbell, D., Gilbert, K., & Tsiouri, I. (2013). Comparing spoken language treatments for minimally verbal preschoolers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 418-431.

Sokolova, E., Oerlemans, A. M., Rommelse, N. N., Groot, P., Hartman, C. A., Glennon, J. C., ... Buitelaar, J. K. (2017). A causal and mediation analysis of the comorbidity between attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Journal of Autism and Developmental Disabillities.

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