ICD-11 Criteria for ICD-11 Classification of Disorders Due to the Use of MDMA or Related Drugs, Including MDA (6C4C)

Classification of Disorders Due to the Use of MDMA or Related Drugs, Including MDA (6C4C)

Parent: Disorders due to substance use

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Description

Disorders due to use of MDMA or related drugs, including MDA are characterised by the pattern and consequences of MDMA or related drug use. MDMA is methylene-dioxymethamphetamine and is a common drug of abuse in many countries especially among young people. It is predominantly available in tablet form known as ‘ecstasy’. Pharmacologically, MDMA has stimulant and empathogenic properties and these encourage its use among young people for social and other interactions. Considering its wide prevalence in many countries and among many sub-groups of young people, MDMA and Related Drug Dependence and MDMA and Related Drug Withdrawal are comparatively uncommon. Substance-Induced Mental Disorders may arise from its use. Several analogues of MDMA exist, including MDA (methylene-dioxyamphetamine).

Exclusions

Hazardous use of MDMA or related drugs (QE11.6)

Diagnostic Requirements

Disorders Due to Use of MDMA or Related Drugs, including MDA are characterized by the pattern and consequences of MDMA or related drug use. MDMA is methylene-dioxymethamphetamine and is a common drug of abuse in many countries especially among young people. It is predominantly available in tablet form known as ‘ecstasy’. Pharmacologically, MDMA has stimulant and empathogenic properties and these encourage its use among young people for social and other interactions. Considering its wide prevalence in many countries and among many sub-groups of young people, MDMA and Related Drug Dependence and MDMA and Related Drug Withdrawal are comparatively uncommon. Substance-Induced Mental Disorders may arise from its use and health sequelae are recognized, including liver disease and hyponatraemia, which may be fatal. Several analogues of MDMA exist, including MDA (methylene-dioxyamphetamine).

Diagnostic Categories that Apply to MDMA or Related Drugs, including MDA

Following is a list of specific diagnostic categories of that apply to MDMA or related Drugs, including MDA:

6C4C.0 Episode of Harmful Use of MDMA or Related Drugs, including MDA

6C4C.1 Harmful Pattern of Use of MDMA or Related Drugs, including MDA

6C4C.2 Synthetic Cannabinoid Dependence, including MDA

6C4C.3 MDMA or Related Drug Intoxication, including MDA

6C4C.4 MDMA or Related Drug Withdrawal, including MDA

6C4C.5 MDMA or Related Drug-Induced Delirium, including MDA

6C4C.6 MDMA or Related Drug-Induced Psychotic Disorder, including MDA

6C4C.70 MDMA or Related Drug-Induced Mood Disorder, including MDA

6C4C.71 MDMA or Related Drug-Induced Anxiety Disorder, including MDA

6C4C.Y Other Specified Disorder Due to Use of MDMA or Related Drugs, including MDA

6C4C.Z Disorder Due to Use of MDMA or Related Drugs, including MDA, Unspecified

An additional category of disorder induced by psychoactive substances is included in another part of the ICD-11 chapter on Mental, Behavioural, and Neurodevelopmental Disorders. This is cross-listed in the section below on Substance-induced Mental Disorders for reference:

6A41 Catatonia Induced by Substances or Medications

The first three diagnoses listed above (Episode of Harmful Use of MDMA or Related Drugs, including MDA, Harmful Pattern of Use of MDMA or Related Drugs, including MDA, and MDMA or Related Drug Dependence) describe the pattern of MDMA or related Drug use. One of these three diagnoses, or Disorder Due to Use of MDMA or Related Drugs, including MDA, Unspecified, for cases in which the use pattern in unknown at the time of evaluation, is considered to be the primary diagnosis. That is, one of these four diagnoses should be assigned when making a diagnosis of a Disorder Due to MDMA or Related Drug Use.

The remaining diagnoses reflect the impact of the pattern of MDMA or related Drug use and are thus considered to be associated with one of the primary use pattern diagnoses. These diagnoses should therefore be assigned together with the relevant primary diagnosis. For example, 6C4C.1/ 6C4C.5 is Harmful Pattern of Use of MDMA or Related Drugs, including MDA associated with MDMA or Related Drug-Induced Psychotic Disorder, 6C4C.2/6C4C.70 is MDMA or Related Drug Dependence associated with MDMA or Related Drug-Induced Mood Disorder, 6C4Z/6C4C.3 is Disorders Due to Substance Use, Unspecified associated with MDMA or Related Drug Intoxication (i.e., the pattern of use in this last case is unknown).

MDMA or Related Drug-induced Mental Disorders are characterized by psychological, cognitive, or behavioural symptoms that develop during or soon after MDMA or related drug intoxication or withdrawal or use. The duration or severity of the symptoms is substantially in excess of the characteristic syndrome of MDMA or Related Drug Intoxication or MDMA or Related Drug Withdrawal.

REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/

ICD-11 Criteria for Trance disorder (6B62)

Trance disorder is characterised by trance states in which there is a marked alteration in the individual’s state of consciousness or a loss of the individual’s customary sense of personal identity in which the individual experiences a narrowing of awareness of immediate surroundings or unusually narrow and selective focusing on environmental stimuli and restriction of movements, postures, and speech to repetition of a small repertoire that is experienced as being outside of one’s control. The trance state is not characterised by the experience of being replaced by an alternate identity. Trance episodes are recurrent or, if the diagnosis is based on a single episode, the episode has lasted for at least several days. The trance state is involuntary and unwanted and is not accepted as a part of a collective cultural or religious practice. The symptoms do not occur exclusively during another dissociative disorder and are not better explained by another mental, behavioural or neurodevelopmental disorder. The symptoms are not due to the direct effects of a substance or medication on the central nervous system, including withdrawal effects, exhaustion, or to hypnagogic or hypnopompic states, and are not due to a disease of the nervous system, head trauma, or a sleep-wake disorder. The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/

ICD-11 Criteria for Anxiety or Fear-Related Disorders (BlockL1‑6B0)

Anxiety and fear-related disorders are characterised by excessive fear and anxiety and related behavioural disturbances, with symptoms that are severe enough to result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. I closely related fear and anxiety phenomena; fear represents a reaction to perceived imminent threat in the present, whereas anxiety is more future-oriented, referring to perceived anticipated threat. A key differentiating feature among the Anxiety and fear-related disorders are disorder-specific foci of apprehension, that is, the stimulus or situation that triggers the fear or anxiety. The clinical presentation of Anxiety and fear-related disorders typically includes specific associated cognitions that can assist in differentiating among the disorders by clarifying the focus of apprehension.

Coded Elsewhere:  

• Substance-induced anxiety disorders
• Hypochondriasis (6B23)
• Secondary anxiety syndrome (6E63)

REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/