A Forum About Interviewing and Diagnosis for Clinicians
By James Morrison, M. D.
Hey! There's some new stuff about ICD-11 below. Just scroll down.
Here's what I'm trying to do:
With the publication of DSM-5, there’s another thousand pages (nearly) of material loose in the land concerning mental health diagnosis. Much of it (most of it) is complicated; some of it is contradictory. And all of it is subject to the interpretation of readers, who come to the project with a variety of backgrounds and levels of education, training, experience, and understanding. I intend these pages to present a forum for discussion of not just DSM-5, but mental health evaluation and diagnosis in general. (I’m limiting myself here, inasmuch as my primary focus will not be on treatment but on evaluation and interpretation of diagnostic signs and symptoms.) And at that, I’ll stick mainly to the diagnosis of adults, though from time to time I will probably (inevitably) wander into the field of child and adolescent evaluation. I've even written a book (with Kathryn Flegel) that applies to kids.
You'll find a lot more on the "About DSM-5" page.
And below, you'll find a lot about ICD-11.
You can also email me with any questions or comments:
morrjame@ohsu.edu
Guilford has now released my newest book. It uses the stories of 26 new patients to explore further the material from several of my previous books.
ICD-11
For months, years now we have had access to the draft of ICD-11 codes for every imaginable physical and mental disorder. They are available at the link given below.
It isn’t clear to me just when ICD-11 will become the law of the land in the United States, though it might not happen until 2027. According to the Wikipedia article, a clinical modification will be needed first. However, what we have now is of considerable interest—at least to those who like to think about diagnosis and taxonomies—so I have posted a couple of PDFs that put what is already known into tables that allow, to an extent, an overview of the new format. You can see this material in the appended PDFs.
I. The first sheet displays both ICD-10 and ICD-11 coding and terminology for most mental health disorders.
II. Because of its complexity, the proposed ICD-11 coding for substance use disorders has its own separate space.
The tabular format is highly useful in that it allows us to see where some additional tweaking is sorely needed—principally in the substance use department. My principal complaints have to do with the logic (illogic) of the numbering system after the decimal point.
a. For example, the numbering for alcohol dependence progresses nicely (.20, .21, .22 …) from current use through episodic to early full remission, and so forth. But look what happens when we get to cannabis and every other substance to the right of alcohol on the spreadsheet: There is no “episodic” dependence, so the numbering for subsequent forms of dependence is different from that for alcohol. (This is confusing, as the spreadsheet makes instantly clear: For example, alcohol dependence early full remission is 6C40.22, whereas cannabis dependence early full remission is 6C41.21.)
b. Intoxication with alcohol (and most other substances) is 6C40.3. But caffeine, lacking dependence, hence having no use for the .2 that denotes dependence for other substance , repurposes it to use as caffeine intoxication—the only substance to do so. It is as though what’s really important is not consistency, not creating something that people can remember, but conserving numbers.
c. Then, the mystery deepens. In the text that accompanies the code for caffeine intoxication, severity is given as though the intoxication code were .3 and not .2. I hope someone will fix this before final publication.
d. And consider the codes for anxiety disorder associated with caffeine use, which is 6C48.40, whereas anxiety disorder associated with cocaine use is 6C45.71. I hope people who have the ability to make changes are paying attention to this stuff.
III. Substance use disorders aside, there are other issues that need fixing. For example, Take gambling disorder and the new category of gaming disorder. Here are their codes:
Predominately online
Predominately offline
Gambling disorder
6C50.0 Predominately online
6C50.1 Predominately offline
Gaming disorder
6C51.1 Predominately online
6C51.0 Predominately offline
Nope, that isn’t a misprint. At least, it isn’t my misprint.
IV. In the main table, I’ve included comparison codes for ICD-10. Comparing ICD-10 with ICD-11 for substance use is hard, in that their respective coding systems are set up to express different ideas. ICD-10 values concision and breadth of scope. For example, ICD-10 uses a single number to express dependence with psychosis; ICD-11 has no category to reflect a sleep disorder related to substance use. The categories are so differently constructed that I despair at ever getting them into a single table for comparison. (However, ICD-11 does make room for the category of synthetic cathinones.)
And here’s that link:
https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f334423054
For months, years now we have had access to the draft of ICD-11 codes for every imaginable physical and mental disorder. They are available at the link given below.
It isn’t clear to me just when ICD-11 will become the law of the land in the United States, though it might not happen until 2027. According to the Wikipedia article, a clinical modification will be needed first. However, what we have now is of considerable interest—at least to those who like to think about diagnosis and taxonomies—so I have posted a couple of PDFs that put what is already known into tables that allow, to an extent, an overview of the new format. You can see this material in the appended PDFs.
I. The first sheet displays both ICD-10 and ICD-11 coding and terminology for most mental health disorders.
II. Because of its complexity, the proposed ICD-11 coding for substance use disorders has its own separate space.
The tabular format is highly useful in that it allows us to see where some additional tweaking is sorely needed—principally in the substance use department. My principal complaints have to do with the logic (illogic) of the numbering system after the decimal point.
a. For example, the numbering for alcohol dependence progresses nicely (.20, .21, .22 …) from current use through episodic to early full remission, and so forth. But look what happens when we get to cannabis and every other substance to the right of alcohol on the spreadsheet: There is no “episodic” dependence, so the numbering for subsequent forms of dependence is different from that for alcohol. (This is confusing, as the spreadsheet makes instantly clear: For example, alcohol dependence early full remission is 6C40.22, whereas cannabis dependence early full remission is 6C41.21.)
b. Intoxication with alcohol (and most other substances) is 6C40.3. But caffeine, lacking dependence, hence having no use for the .2 that denotes dependence for other substance , repurposes it to use as caffeine intoxication—the only substance to do so. It is as though what’s really important is not consistency, not creating something that people can remember, but conserving numbers.
c. Then, the mystery deepens. In the text that accompanies the code for caffeine intoxication, severity is given as though the intoxication code were .3 and not .2. I hope someone will fix this before final publication.
d. And consider the codes for anxiety disorder associated with caffeine use, which is 6C48.40, whereas anxiety disorder associated with cocaine use is 6C45.71. I hope people who have the ability to make changes are paying attention to this stuff.
III. Substance use disorders aside, there are other issues that need fixing. For example, Take gambling disorder and the new category of gaming disorder. Here are their codes:
Predominately online
Predominately offline
Gambling disorder
6C50.0 Predominately online
6C50.1 Predominately offline
Gaming disorder
6C51.1 Predominately online
6C51.0 Predominately offline
Nope, that isn’t a misprint. At least, it isn’t my misprint.
IV. In the main table, I’ve included comparison codes for ICD-10. Comparing ICD-10 with ICD-11 for substance use is hard, in that their respective coding systems are set up to express different ideas. ICD-10 values concision and breadth of scope. For example, ICD-10 uses a single number to express dependence with psychosis; ICD-11 has no category to reflect a sleep disorder related to substance use. The categories are so differently constructed that I despair at ever getting them into a single table for comparison. (However, ICD-11 does make room for the category of synthetic cathinones.)
And here’s that link:
https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f334423054
| icd_crosswalk_main.pdf |
| icd_crosswalk_substance.pdf |