ICD-11 Criteria for Autism Spectrum Disorder

ICD-11 Criteria for Autism Spectrum Disorder (6A02)

Autism spectrum disorder is characterised by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for the individual’s age and sociocultural context. The onset of the disorder occurs during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities. Deficits are sufficiently severe to cause impairment in personal, family, social, educational, occupational or other important areas of functioning and are usually a pervasive feature of the individual’s functioning observable in all settings, although they may vary according to social, educational, or other context. Individuals along the spectrum exhibit a full range of intellectual functioning and language abilities.

Inclusions:              

• Autistic disorder

Exclusions:             

• Rett syndrome (LD90.4)

6A02.0     Autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language

All definitional requirements for autism spectrum disorder are met, intellectual functioning and adaptive behaviour are found to be at least within the average range (approximately greater than the 2.3rd percentile), and there is only mild or no impairment in the individual's capacity to use functional language (spoken or signed) for instrumental purposes, such as to express personal needs and desires.

6A02.1      Autism spectrum disorder with disorder of intellectual development and with mild or no impairment of functional language

All definitional requirements for both autism spectrum disorder and disorder of intellectual development are met and there is only mild or no impairment in the individual's capacity to use functional language (spoken or signed) for instrumental purposes, such as to express personal needs and desires.

6A02.2       Autism spectrum disorder without disorder of intellectual development and with impaired functional language

All definitional requirements for autism spectrum disorder are met, intellectual functioning and adaptive behaviour are found to be at least within the average range (approximately greater than the 2.3rd percentile), and there is marked impairment in functional language (spoken or signed) relative to the individual’s age, with the individual not able to use more than single words or simple phrases for instrumental purposes, such as to express personal needs and desires.

6A02.3      Autism spectrum disorder with disorder of intellectual development and with impaired functional language

All definitional requirements for both autism spectrum disorder and disorder of intellectual development are met and there is marked impairment in functional language (spoken or signed) relative to the individual’s age, with the individual not able to use more than single words or simple phrases for instrumental purposes, such as to express personal needs and desires.

6A02.5      Autism spectrum disorder with disorder of intellectual development and with absence of functional language

All definitional requirements for both autism spectrum disorder and disorder of intellectual development are met and there is complete, or almost complete, absence of ability relative to the individual’s age to use functional language (spoken or signed) for instrumental purposes, such as to express personal needs and desires

6A02.Y        Other specified autism spectrum disorder

6A02.Z         Autism spectrum disorder, unspecified

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/

Foundation URI : http://id.who.int/icd/entity/822487798

ICD-11 Criteria For Seasonal Pattern Of Mood Episode Onset

6A80.4 

Description

In the context of recurrent depressive disorder, bipolar type I or bipolar type II disorder, there has been a regular seasonal pattern of onset and remission of at least one type of episode (i.e., depressive, manic, mixed, or hypomanic episodes), with a substantial majority of the relevant mood episodes corresponding to the seasonal pattern. (In bipolar type I and bipolar type II disorder, all types of mood episodes may not follow this pattern.) A seasonal pattern should be differentiated from an episode that is coincidental with a particular season but predominantly related to a psychological stressor that regularly occurs at that time of the year (e.g., seasonal unemployment).

Diagnostic Requirements

This specifier can be applied if:

• In the context of Bipolar Type I or Bipolar Type II Disorder there has been a regular seasonal pattern of onset and remission of at least one type of episode (i.e., Depressive, Manic, Mixed, or Hypomanic Episodes); the other types of Mood Episodes may not follow this pattern; or
• In the context of Recurrent Depressive Disorder there has been a regular seasonal pattern of onset and remission of Depressive Episodes.
• A substantial majority of the relevant Mood Episodes should correspond with the seasonal pattern.
• A seasonal pattern should be differentiated from an episode that is coincidental with a particular season but predominantly related to a psychological stressor that regularly occurs at that time of the year (e.g., seasonal unemployment).

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 Rapid Cycling in Mood Disorder

 6A80.5

Description

In the context of bipolar type I or bipolar type II disorder, there has been a high frequency of mood episodes (at least four) over the past 12 months. There may be a switch from one polarity of mood to the other, or the mood episodes may be demarcated by a period of remission. In individuals with a high frequency of mood episodes, some may have a shorter duration than those usually observed in bipolar type I or bipolar type II disorder. In particular, depressive periods may only last several days. If depressive and manic symptoms alternate very rapidly (i.e., from day to day or within the same day), a mixed episode should be diagnosed rather than rapid cycling.

Diagnostic Requirements

This specifier can be applied if the Bipolar Type I or Bipolar Type II Disorder is characterized by a high frequency of Mood Episodes (at least four) over the past 12 months. There may be a switch from one polarity of mood to the other, or the Mood Episodes may be demarcated by a period of remission.

In individuals with a high frequency of Mood Episodes, some may have a shorter duration than those usually observed in Bipolar Type I or Bipolar Type II Disorder. In particular, depressive periods may only last several days. However, if depressive and manic symptoms alternate very rapidly (i.e., from day to day or within the same day), a Mixed Episode should be diagnosed rather than rapid cycling.

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/

 Foundation URI : http://id.who.int/icd/entity/1906190365

ICD-11 Criteria for Current Depressive Episode Persistent

6A80.2

Description

The diagnostic requirements for a depressive episode are currently met and have been met continuously for at least the past 2 years.

Diagnostic Requirements

This specifier can be applied if the diagnostic requirements for Depressive Episode are currently met and have been met continuously (five or more characteristic symptoms occurring most of the day, nearly every day) for at least the past 2 years.

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 Current Depressive Episode With Melancholia

6A80.3

Description

In the context of a current Depressive Episode, several of the following symptoms have been present during the worst period of the current episode: loss of interest or pleasure in most activities that are normally enjoyable to the individual (i.e., pervasive anhedonia); lack of emotional reactivity to normally pleasurable stimuli or circumstances (i.e., mood does not lift even transiently with exposure); terminal insomnia (i.e., waking in the morning two hours or more before the usual time); depressive symptoms are worse in the morning; marked psychomotor retardation or agitation; marked loss of appetite or loss of weight.

Diagnostic Requirements

This specifier can be applied if, in the context of a current Depressive Episode, several of the following symptoms have been present during the worst period of the current episode:

• Loss of interest or pleasure in most activities that are normally enjoyable to the individual (i.e., pervasive anhedonia).
• Lack of emotional reactivity to normally pleasurable stimuli or circumstances (i.e., mood does not lift even transiently with exposure).
• Terminal insomnia (i.e., waking in the morning 2 hours or more before the usual time).
• Depressive symptoms are worse in the morning.
• Marked psychomotor retardation or agitation.
• Marked loss of appetite or loss of weight.

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/

Foundation URI : http://id.who.int/icd/entity/1383708356

ICD-11 Criteria For Panic Attacks in Mood Episodes

 6A80.1

Description

In the context of a current mood episode (manic, depressive, mixed, or hypomanic), there have been recurrent panic attacks (i.e., at least two) during the past month that occur specifically in response to anxiety-provoking cognitions that are features of the mood episode. If panic attacks occur exclusively in response to such thoughts, panic attacks should be recorded using this qualifier rather than assigning an additional co-occurring diagnosis of panic disorder. If some panic attacks over the course of the depressive or mixed episode have been unexpected and not exclusively in response to depressive or anxiety-provoking thoughts, a separate diagnosis of panic disorder should be assigned.

Exclusions

• Panic disorder (6B01)

Diagnostic Requirements

This specifier can be applied if, in the context of a current Episode, there have been panic attacks during the past month that occur specifically in response to depressive ruminations or other anxiety-provoking cognitions. If panic attacks occur exclusively in response to such thoughts, the ‘with panic attacks’ specifier should be applied rather than an additional co-occurring diagnosis of Panic Disorder. If some panic attacks over the course of the Depressive or Mixed Episode have been unexpected and not exclusively in response to depressive or anxiety-provoking thoughts and the full diagnostic requirements for Panic Disorder are met, a separate diagnosis of Panic Disorder should be assigned.

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 Prominent Anxiety Symptoms in Mood Episodes

Foundation URI : http://id.who.int/icd/entity/1119039346

Prominent Anxiety Symptoms in Mood Episodes

6A80.0

Description

In the context of a current depressive, manic, mixed, or hypomanic episode, prominent and clinically significant anxiety symptoms (e.g., feeling nervous, anxious or on edge, not being able to control worrying thoughts, fear that something awful will happen, having trouble relaxing, motor tension, autonomic symptoms) have been present for most of the time during the episode. If there have been panic attacks during a current depressive or mixed episode, these should be recorded separately. When the diagnostic requirements for both a mood disorder and an anxiety or fear-related disorder are met, the anxiety or fear-related disorder should also be diagnosed.

Diagnostic Requirements

This specifier can be applied if, in the context of a current Depressive, Manic, Mixed, or Hypomanic Episode, prominent and clinically significant anxiety symptoms (e.g., feeling nervous, anxious or on edge, not being able to control worrying thoughts, fear that something awful will happen, having trouble relaxing, muscle tension, autonomic symptoms) have been present for most of the time during the episode. If there have been panic attacks during the current Depressive or Mixed Episode, these should be recorded separately (see ‘with panic attacks’ specifier). This specifier may be used whether or not the diagnostic requirements for an Anxiety or Fear-Related Disorder are also met, in which case the Anxiety or Fear-Related Disorder should also be diagnosed.

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 Other Specified Depressive Disorders

6A7Y 

Essential (Required) Features:

• The presentation is characterized by mood symptoms that share primary clinical features with other Depressive Disorders (e.g., depressed mood, decreased engagement in pleasurable activities, decreased energy levels, disruptions in sleep or eating).
• The symptoms do not fulfil the diagnostic requirements for any other disorder in the Depressive Disorders grouping.
• The symptoms are not better accounted for by another Mental, Behavioural or Neurodevelopmental Disorder (e.g., Schizophrenia or Other Primary Psychotic Disorder, an Anxiety or Fear-Related Disorder, a Disorder Specifically Associated with Stress).
• The symptoms and behaviours are not a manifestation of another medical condition and are not due to the effects of a substance or medication (e.g., alcohol, benzodiazepine) on the central nervous system, including withdrawal effects (e.g., from cocaine).
• The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.

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 Factitious Disorder Imposed on Self

Factitious disorder imposed on self is characterised by feigning, falsifying, or inducing medical, psychological, or behavioural signs and symptoms or injury associated with identified deception. If a pre-existing disorder or disease is present, the individual intentionally aggravates existing symptoms or falsifies or induces additional symptoms. The individual seeks treatment or otherwise presents himself or herself as ill, injured, or impaired based on the feigned, falsified, or self-induced signs, symptoms, or injuries. The deceptive behaviour is not solely motivated by obvious external rewards or incentives (e.g., obtaining disability payments or evading criminal prosecution). This is in contrast to Malingering, in which obvious external rewards or incentives motivate the behaviour

Inclusions:              

• Münchhausen syndrome

Exclusions:             

• Excoriation disorder (6B25.1)

Malingering (QC30)

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 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/

ICD-11 Criteria for Disorders due to the Use of Non-Psychoactive Substances (6C4H)

Disorders due to use of non-psychoactive substances are characterised by the pattern and consequences of non-medical use of non-psychoactive substances. Non-psychoactive substances include laxatives, growth hormone, erythropoietin, and non-steroidal anti-inflammatory drugs. They may also include proprietary or over-the-counter medicines and folk remedies. Non-medical use of these substances may be associated with harm to the individual because of the direct or secondary toxic effects of the non-psychoactive substance on body organs and systems, or a harmful route of administration (e.g., infections due to intravenous self-administration). They are not associated with intoxication or with a dependence or withdrawal syndrome and are not recognized causes of substance-induced mental disorders.

6C4H.0          Episode of harmful use of non-psychoactive substances

An episode of use of a non-psychoactive substance that has caused damage to a person’s physical or mental health. Harm to health of the individual occurs due to direct or secondary toxic effects on body organs and systems or a harmful route of administration. This diagnosis should not be made if the harm is attributed to a known pattern of non-psychoactive substance use.

Exclusions:             

• Harmful pattern of use of non-psychoactive substances (6C4H.1)

 

6C4H.1           Harmful pattern of use of non-psychoactive substances

A pattern of use of non-psychoactive substances that has caused clinically significant harm to a person’s physical or mental health. The pattern of use is evident over a period of at least 12 months if use is episodic and at least one month if use is continuous (i.e., daily or almost daily). Harm may be caused by the direct or secondary toxic effects of the substance on body organs and systems, or a harmful route of administration.

Exclusions:             

• Harmful pattern of use of other specified psychoactive substance (6C4E.1)
• Episode of harmful use of non-psychoactive substances (6C4H.0)

6C4H.10               Harmful pattern of use of non-psychoactive substances, episodic

A pattern of episodic or intermittent use of a non-psychoactive substance that has caused damage to a person’s physical or mental health. The pattern of episodic or intermittent use of the non-psychoactive substance is evident over a period of at least 12 months. Harm may be caused by the direct or secondary toxic effects on body organs and systems, or a harmful route of administration.

6C4H.11               Harmful pattern of use of non-psychoactive substances, continuous

A pattern of continuous use of a non-psychoactive substance (daily or almost daily) that has caused damage to a person’s physical or mental health. The pattern of continuous use of the non-psychoactive substance is evident over a period of at least one month. Harm may be caused by the direct or secondary toxic effects on body organs and systems, or a harmful route of administration.

6C4H.1Z          Harmful pattern of use of non-psychoactive substances, unspecified
6C4H.Y            Other specified disorders due to use of non-psychoactive substances
6C4H.Z            Disorders due to use of non-psychoactive substances, unspecified
 6C4Y                   Other specified disorders due to substance use
  6C4Z                   Disorders due to substance use, unspecified

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 Generalised Anxiety Disorder (GAD)

Foundation URI:  http://id.who.int/icd/entity/1712535455

Description

Generalised anxiety disorder is characterised by marked symptoms of anxiety that persist for at least several months, for more days than not, manifested by either general apprehension (i.e. ‘free-floating anxiety’) or excessive worry focused on multiple everyday events, most often concerning family, health, finances, and school or work, together with additional symptoms such as muscular tension or motor restlessness, sympathetic autonomic over-activity, subjective experience of nervousness, difficulty maintaining concentration, irritability, or sleep disturbance. The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. The symptoms are not a manifestation of another health condition and are not due to the effects of a substance or medication on the central nervous system.

Diagnostic Requirements

Essential (Required) Features:

• Marked symptoms of anxiety manifested by either:
  • General apprehensiveness that is not restricted to any particular environmental circumstance (i.e., ‘free-floating anxiety’); or
  • Excessive worry (apprehensive expectation) about negative events occurring in several different aspects of everyday life (e.g., work, finances, health, family).
• Anxiety and general apprehensiveness or worry are accompanied by additional characteristic symptoms, such as:
  • Muscle tension or motor restlessness.
  • Sympathetic autonomic overactivity as evidenced by frequent gastrointestinal symptoms such as nausea and/or abdominal distress, heart palpitations, sweating, trembling, shaking, and/or dry mouth.
  • Subjective experience of nervousness, restlessness, or being ‘on edge’.
  • Difficulty concentrating.
  • Irritability.
  • Sleep disturbances (difficulty falling or staying asleep, or restless, unsatisfying sleep).
• The symptoms are not transient and persist for at least several months, for more days than not.
• The symptoms are not better accounted for by another mental disorder (e.g., a Depressive Disorder).
• The symptoms are not a manifestation of another medical condition (e.g., hyperthyroidism) and are not due to the effects of a substance or medication on the central nervous system (e.g., caffeine, cocaine), including withdrawal effects (e.g., alcohol, benzodiazepines).
• The symptoms result in significant distress about experiencing persistent anxiety symptoms or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.

Additional Clinical Features:

• Some individuals with Generalized Anxiety Disorder may only report general apprehensiveness accompanied by chronic somatic symptoms without being able to articulate specific worry content.
• Behavioural changes such as avoidance, frequent need for reassurance (especially in children), and procrastination may be seen. These behaviours typically represent an effort to reduce apprehension or prevent untoward events from occurring.

Boundary with Normality (Threshold):

• Anxiety and worry are normal emotional/cognitive states that commonly occur when people are under stress. At optimal levels, anxiety and worry may help to direct problem-solving efforts, focus attention adaptively, and increase alertness. Normal anxiety and worry are usually sufficiently self-regulated that they do not interfere with functioning or cause marked distress. In Generalized Anxiety Disorder, the anxiety or worry is excessive, persistent, and intense, and may have a significant negative impact on functioning. Individuals under extremely stressful circumstances (e.g., living in a war zone) may experience intense and impairing anxiety and worry that is appropriate to their environmental circumstances. These experiences should not be regarded as symptomatic of Generalized Anxiety Disorder if they occur only under such circumstances.

Course Features:

• Onset of Generalized Anxiety Disorder may occur at any age. However, the typical age of onset is during the early-to-mid 30s.
• Earlier onset of symptoms is associated with greater impairment of functioning and presence of co-occurring mental disorders.
• Severity of Generalized Anxiety Disorder symptoms often fluctuates between threshold and subthreshold forms of the disorder and full remission of symptoms is uncommon.
• Although the clinical features of Generalized Anxiety Disorder generally remain consistent across the lifespan, the content of the individual’s worry may vary over time and there are differences in worry content among different age groups. Children and adolescents tend to worry about the quality of academic and sports-related performance, whereas adults tend to worry more about their own well-being or that of their loved ones.

Developmental Presentations:

• Anxiety or Fear-Related Disorders are the most prevalent mental disorders of childhood and adolescence. Among these disorders, Generalized Anxiety Disorder is one of the most common in late childhood and adolescence.
• Occurrence of Generalized Anxiety Disorder increases across late childhood and adolescence with development of cognitive abilities that support the capacity for worry, which is a core feature of the disorder. As a result of their less developed cognitive abilities, Generalized Anxiety Disorder is uncommon in children younger than 5. Girls tend to have an earlier symptom onset than their same age male peers.
• While the essential features of Generalized Anxiety Disorder still apply to children and adolescents, specific manifestations of worry in children may include being overly concerned and compliant with rules as well as a strong desire to please others. Affected children may become upset when they perceive peers as acting out or being disobedient. Consequently, children and adolescents with Generalized Anxiety Disorder may be more likely to report excessively on their peers’ misbehaviour or to act as an authority figure around peers, condemning misbehaviour. This may have a negative effect on affected individuals’ interpersonal relationships.
• Children and adolescents with Generalized Anxiety Disorder may engage in excessive reassurance seeking from others, repeatedly asking questions, and may exhibit distress when faced with uncertainty. They may be overly perfectionistic, taking additional time to complete tasks, such as homework or classwork. Sensitivity to perceived criticism is common.
• When Generalized Anxiety Disorder does occur in children, somatic symptoms, particularly those related to sympathetic autonomic overactivity, may be prominent aspects of the clinical presentation. Common somatic symptoms in children with Generalized Anxiety Disorder include frequent headaches, abdominal pain, and gastrointestinal distress. Similar to adults, children and adolescents also experience sleep disturbances, including delayed sleep onset and night-time wakefulness.
• The number and content of worries typically manifests differently across childhood and adolescence. Younger children may endorse more concerns about their safety or their health or the health of others. Adolescents typically report a greater number of worries with content shifting to performance, perfectionism, and whether they will be able to meet the expectations of others.
• Adolescents with Generalized Anxiety Disorder may demonstrate excessive irritability and have an increased risk of co-occurring depressive symptoms.

Culture-Related Features:

• For many cultural groups, somatic complaints rather than excessive worry may predominate in the clinical presentation. These symptoms may involve a range of physical complaints not typically associated with Generalized Anxiety Disorder such as dizziness and heat in the head.
• Realistic worries may be misjudged as excessive without appropriate contextual information. For example, migrant workers may worry greatly about being deported, but this may be related to actual deportation threats by their employer. On the other hand, evidence of worries across several different aspects of everyday life may be difficult to establish when an individual places emphasis on a single overwhelming source of worry (e.g., financial concerns).
• Worry content may vary by cultural group, related to topics that are salient in the milieu. For example, in societies where relationships with deceased relatives are important, worry may focus on their spiritual status in the afterlife. Worry in more individualistic cultures may emphasize personal achievement, fulfilment of expectations, or self-confidence.

Sex- and/or Gender-Related Features:

• Lifetime prevalence of Generalized Anxiety Disorder is approximately twice as high among women.
• Although symptom presentation does not vary by gender including the common co-occurrence of Generalized Anxiety Disorder and Depressive Disorders, men are more likely to experience co-occurring Disorders due to Substance Use.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with Panic Disorder: Panic Disorder is characterized by recurrent, unexpected, self-limited episodes of intense fear or anxiety. Generalized Anxiety Disorder is differentiated by a more persistent and less circumscribed chronic feeling of apprehensiveness usually associated with worry about a variety of different everyday life events. Individuals with Generalized Anxiety Disorder may experience panic attacks that are triggered by specific worries. If an individual with Generalized Anxiety Disorder experiences panic attacks exclusively in the context of the worry about a variety of everyday life events or general apprehensiveness without the presence of unexpected panic attacks, an additional diagnosis of Panic Disorder is not warranted and the presence of panic attacks may be indicated using the ‘with panic attacks’ specifier. However, if unexpected panic attacks also occur, an additional diagnosis of Panic Disorder may be assigned.
• Boundary with Social Anxiety Disorder: In Social Anxiety Disorder, symptoms occur in response to feared social situations (e.g., speaking in public, initiating a conversation) and the primary focus of apprehension is being negatively evaluated by others. Individuals with Generalized Anxiety Disorder may worry about the implications of performing poorly or failing an examination but are not exclusively concerned about being negatively evaluated by others.
• Boundary with Separation Anxiety Disorder: Individuals with Generalized Anxiety Disorder may worry about the health and safety of attachment figures, as in Separation Anxiety Disorder, but their worry also extends to other aspects of everyday life.
• Boundary with Depressive Disorders: Generalized Anxiety Disorder and Depressive Disorders can share several features such as somatic symptoms of anxiety, difficulty with concentration, sleep disruption, and feelings of dread associated with pessimistic thoughts. Depressive Disorders are differentiated by the presence of low mood or loss of pleasure in previously enjoyable activities and other characteristic symptoms of Depressive Disorders (e.g., appetite changes, feelings of worthlessness, suicidal ideation). Generalized Anxiety Disorder may co-occur with Depressive Disorders, but should only be diagnosed if the diagnostic requirements for Generalized Anxiety Disorder were met prior to the onset of or following complete remission of a Depressive Episode.
• Boundary with Adjustment Disorder: Adjustment Disorder involves maladaptive reactions to an identifiable psychosocial stressor or multiple stressors characterized by preoccupation with the stressor or its consequences. Reactions may include excessive worry, recurrent and distressing thoughts about the stressor, or constant rumination about its implications. Adjustment Disorder centres on the identifiable stressor or its consequences, whereas in Generalized Anxiety Disorder, worry typically encompasses multiple areas of daily life and may include hypothetical concerns (e.g., that a negative life event may occur). Unlike individuals with Generalized Anxiety Disorder, those with Adjustment Disorder typically have normal functioning prior to the onset of the stressor(s). Symptoms of Adjustment Disorder generally resolve within 6 months.
• Boundary with Obsessive-Compulsive Disorder: In Obsessive-Compulsive Disorder, the focus of apprehension is on intrusive and unwanted thoughts, urges, or images (obsessions), whereas in Generalized Anxiety Disorder the focus is on everyday life events. In contrast to obsessions in Obsessive-Compulsive Disorder, which are usually experienced as unwanted and intrusive, individuals with Generalized Anxiety Disorder may experience their worry as a helpful strategy in averting negative outcomes.
• Boundary with Hypochondriasis (Health Anxiety Disorder) and Bodily Distress Disorder: In Hypochondriasis and Bodily Distress Disorder, individuals worry about real or perceived physical symptoms and their potential significance to their health status. Individuals with Generalized Anxiety Disorder experience somatic symptoms associated with anxiety and may worry about their health but their worry extends to other aspects of everyday life.
• Boundary with Post-Traumatic Stress Disorder: Individuals with Post-Traumatic Stress Disorder develop hypervigilance as a consequence of exposure to the traumatic stressor and may become apprehensive that they or others close to them may be under immediate threat either in specific situations or more generally. Individuals with Post-Traumatic Stress Disorder may also experience anxiety triggered by reminders of the traumatic event (e.g., fear and avoidance of a place where an individual was assaulted). In contrast, the anxiety and worry in individuals with Generalized Anxiety Disorder is directed toward the possibility of untoward events in a variety of life domains (e.g., health, finances, work).

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 Secondary Impulse Control Syndrome (6E66)

A syndrome characterised by the presence of prominent symptoms that are characteristic of Impulse Control Disorders or Disorders Due to Addictive Behaviours (e.g., stealing, fire-setting, aggressive outbursts, compulsive sexual behaviour, excessive gambling) that are judged to be a direct pathophysiological consequence of a health condition not classified under mental and behavioural disorders, based on evidence from the history, physical examination, or laboratory findings. The symptoms are not accounted for by delirium or by another mental and behavioural disorder, and are not a psychologically mediated response to a severe medical condition (e.g., as part of an adjustment disorder in response to a life-threatening diagnosis). This category should be used in addition to the diagnosis for the presumed underlying disorder or disease when the impulse control symptoms are sufficiently severe to warrant specific clinical attention.

Coding Note:     Code aslo the causing condition

Exclusions:  

• Delirium (6D70)

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 Secondary Neurocognitive Syndrome (6E67)

A syndrome that involves significant cognitive features that do not fulfill the diagnostic requirements of any of the specific neurocognitive disorders and are judged to be a direct pathophysiological consequence of a health condition or injury not classified under mental and behavioural disorders (e.g., cognitive changes due to a brain tumour), based on evidence from the history, physical examination, or laboratory findings. This category should be used in addition to the diagnosis for the presumed underlying disorder or disease when the cognitive symptoms are sufficiently severe to warrant specific clinical attention.

Coding Note:     Code also the causing condition

Exclusions:

• Disorders with neurocognitive impairment as a major feature (BlockL1‑8A2)

Coded Elsewhere:  

• Delirium (6D70)

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 Secondary Dissociative Syndrome

Description

A syndrome characterised by the presence of prominent dissociative symptoms (e.g., depersonalization, derealization) that is judged to be the direct pathophysiological consequence of a health condition not classified under mental and behavioural disorders, based on evidence from the history, physical examination, or laboratory findings. The symptoms are not accounted for by delirium or by another mental and behavioural disorder, and are not a psychologically mediated response to a severe medical condition (e.g., as part of an acute stress reaction in response to a life-threatening diagnosis). This category should be used in addition to the diagnosis for the presumed underlying disorder or disease when the dissociative symptoms are sufficiently severe to warrant specific clinical attention.

Exclusions

• Delirium (6D70)
• Acute stress reaction (QE84)

Diagnostic Requirements

Essential (Required) Features:

• The presence of prominent dissociative symptoms (e.g., depersonalization, derealization, dissociative amnesia, a marked alteration in the individual’s normal sense of personal identity).
• The symptoms are judged to be the direct pathophysiological consequence of a medical condition, based on evidence from the history, physical examination, or laboratory findings. This judgment depends on establishing that:
• The medical condition is known to be capable of producing the observed symptoms;
• The course of dissociative symptoms (e.g., onset, remission, response of the dissociative symptoms to treatment of the etiological medical condition) is consistent with causation by the medical condition; and
• The symptoms are not better accounted for by Delirium, Dementia, another mental disorder (e.g., Dissociative Disorders, Disorders Specifically Associated with Stress, Schizophrenia or Other Primary Psychotic Disorders) or the effects of a medication or substance, including withdrawal effects.
• The symptoms are sufficiently severe to be a specific focus of clinical attention.

Boundary with other disorders and normality:

Boundary with Dissociative Disorders: 

Determining whether dissociative symptoms are due to a medical condition as opposed to manifestations of a primary mental disorder is often difficult because the clinical presentations may be similar. Establishing the presence of a potentially explanatory medical condition that can cause dissociative symptoms and the temporal relationship between the medical condition and the dissociative symptoms is critical in diagnosing Secondary Dissociative Syndrome.

Boundary with dissociative symptoms caused by substances or medications, including withdrawal effects: 

When establishing a diagnosis of Secondary Dissociative Syndrome, it is important to rule out the possibility that a medication or substance is causing the dissociative symptoms. This involves first considering whether any of the medications being used to treat the medical condition are known to cause dissociative symptoms at the dose and duration at which it has been administered. Second, a temporal relationship between the medication use and the onset of the dissociative symptoms should be established (i.e., the dissociative symptoms began after administration of the medication and/or remitted once the medication was discontinued). The same reasoning applies to individuals with a medical condition and dissociative symptoms who are also using a psychoactive substance known to cause dissociative symptoms, either in the context of intoxication or withdrawal (e.g., amnesia due to ketamine or phencyclidine intoxication, depersonalization due to dextromethorphan intoxication).

Boundary with dissociative symptoms that are precipitated by the stress of being diagnosed with a medical condition: 

The stress of a medical diagnosis can precipitate dissociative symptoms (e.g., depersonalization, derealization). Depending on the nature of the medical condition (e.g., a life-threatening type of cancer, a potentially fatal infection) or its onset (e.g., a heart attack, a stroke, a severe injury), being diagnosed and/or having to cope with a severe medical condition can be experienced as a traumatic event, which may trigger dissociative symptoms. In the absence of evidence of a physiological link between the medical condition and the dissociative symptoms, a diagnosis of Secondary Dissociative Syndrome is not warranted. Instead, the appropriate mental disorder can be diagnosed (e.g., Adjustment Disorder, Depersonalization-Derealization Disorder).

Potentially Explanatory Medical Conditions (examples):

Brain disorders and general medical conditions that have been shown to be capable of producing dissociative syndromes include:

• Diseases of the Nervous System (e.g., encephalitis, migraine, seizures, stroke)
• Endocrine, Nutritional or Metabolic Diseases (e.g., hyperglycaemia)
• Injury, Poisoning or Certain Other Consequences of External Causes (e.g., intracranial injury)
• Neoplasms (e.g., neoplasms of brain)

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 Secondary Personality Change (6E68)

A syndrome characterised by a persistent personality disturbance that represents a change from the individual’s previous characteristic personality pattern that is judged to be a direct pathophysiological consequence of a health condition not classified under Mental and behavioural disorders, based on evidence from the history, physical examination, or laboratory findings. The symptoms are not accounted for by delirium or by another mental and behavioural disorder, and are not a psychologically mediated response to a severe medical condition (e.g., social withdrawal, avoidance, or dependence in response to a life-threatening diagnosis). This category should be used in addition to the diagnosis for the presumed underlying disorder or disease when the personality symptoms are sufficiently severe to warrant specific clinical attention.

Coding Note:     Code aslo the causing condition

Exclusions: 

• Personality difficulty (QE50.7)
• Personality disorder (6D10)
• Delirium (6D70)

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 Secondary Catatonia Syndrome (6E69)

Secondary catatonia syndrome is a syndrome of primarily psychomotor disturbances, characterized by the co-occurrence of several symptoms of decreased, increased, or abormal psychomotor activity, which occurs as a direct pathophysiological consequence of a medical condition not classified under Mental, Behavioural or Neurodevelopmental Disorders. Examples of medical conditions that may be associated with Catatonia include diabetic ketoacidosis, hypercalcemia, hepatic encephalopathy, homocystinuria, neoplasms head trauma, cerebrovascular disease, and encephalitis.

Coding Note:     Use additional code, if desired, for any underlying disorder if known.

  6E6Y          Other specified secondary mental or behavioural syndrome

Coding Note:     Code aslo the causing condition

  6E6Z          Secondary mental or behavioural syndrome, unspecified

Coding Note:     Code aslo the causing condition

  6E8Y            Other specified mental, behavioural or neurodevelopmental disorders
  6E8Z            Mental, behavioural or neurodevelopmental disorders, unspecified

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 Secondary Obsessive-Compulsive or Related Syndrome (6E64)

A syndrome characterised by the presence of prominent obsessions, compulsions, hoarding, skin picking, hair pulling, other body-focused repetitive behaviours, or other symptoms characteristic of obsessive-compulsive and related disorder that is judged to be the direct pathophysiological consequence of a disorder or disease not classified under Mental and behavioural disorders, based on evidence from the history, physical examination, or laboratory findings. The symptoms are not accounted for by Delirium or by another Mental and behavioural disorder, and are not a psychologically mediated response to a severe medical condition (e.g., repetitive ruminations in response to a life-threatening diagnosis). This category should be used in addition to the diagnosis for the presumed underlying disorder or disease when the obsessive-compulsive or related symptoms are sufficiently severe to warrant specific clinical attention.

Coding Note:     Code aslo the causing condition

Exclusions:

• Delirium (6D70)
• Obsessive-compulsive or related disorder induced by other specified psychoactive substance (6C4E.72)
• Tic disorders (8A05)

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/