Background The World Health Organization (WHO) International Classification of Diseases and Related Health Problems (ICD) is used globally by 194 WHO member nations. It is used for assigning clinical diagnoses, providing the framework for reporting public health data, and to inform the organization and reimbursement of health services. Guided by overarching principles of increasing clinical utility and global applicability, the 11th revision of the ICD proposes major changes that incorporate empirical advances since the previous revision in 1992. To test recommended changes in the Mental, Behavioral, and Neurodevelopmental Disorders chapter, multiple vignette-based case-controlled field studies have been conducted which examine clinicians’ ability to accurately and consistently use the new guidelines and assess their overall clinical utility. This manuscript reports on the results from the study of the proposed ICD-11 guidelines for feeding and eating disorders (FEDs). Method Participants were 2288 mental health professionals registered with WHO’s Global Clinical Practice Network. The study was conducted in Chinese, English, French, Japanese, and Spanish. Clinicians were randomly assigned to apply either the ICD-11 or ICD-10 diagnostic guidelines for FEDs to a pair of case vignettes designed to test specific clinical questions. Clinicians selected the diagnosis they thought was correct for each vignette, evaluated the presence of each essential feature of the selected diagnosis, and the clinical utility of the diagnostic guidelines. Results The proposed ICD-11 diagnostic guidelines significantly improved accuracy for all FEDs tested relative to ICD-10 and attained higher clinical utility ratings; similar results were obtained across all five languages. The inclusion of binge eating disorder and avoidant-restrictive food intake disorder reduced the use of residual diagnoses. Areas needing further refinement were identified. Conclusions The proposed ICD-11 diagnostic guidelines consistently outperformed ICD-10 in distinguishing cases of eating disorders and showed global applicability and appropriate clinical utility. These results suggest that the proposed ICD-11 guidelines for FEDs will help increase accuracy of public health data, improve clinical diagnosis, and enhance health service organization and provision. This is the first time in the revision of the ICD that data from large-scale, empirical research examining proposed guidelines is completed in time to inform the final diagnostic guidelines.

Guided self-change incorporating use of a self-care manual offers an approach that can be as effective as standard cognitive behavior therapy in the long term and can considerably reduce the amount of therapist contact required.

TheWorld Health Organization is currently revising the International Classification of Diseases\ud and Related Health Problems (ICD-10). A central goal for the revision of the ICD classification\ud of mental and behavioural disorders is to improve its clinical utility. Global representation and\ud cultural sensitivity and relevance are important across all mental disorders, but are especially\ud critical to advancing our understanding, diagnosis and treatment of feeding and eating\ud disorders (FED). This paper summarises the current status of the Eating Disorders\ud Consultation Group (EDCG) considerations regarding diagnostic categories for FEDs in\ud ICD-11 and represents work in progress. The recommendations of the EDCG are informed\ud by relevant research evidence, and the consultation group is striving to find a balance\ud between clinical utility and diagnostic purity. Provisional recommendations of the EDCG\ud include: (1) merger of previous FEDs categories in one group; (2) inclusion of six main\ud FED categories that include anorexia nervosa (AN), bulimia nervosa (BN), pica,\ud regurgitation disorder, binge-eating disorder (BED) and avoidant/restrictive food intake\ud disorder, the last two representing new categories; (3) broadening of categories with the aim\ud of reducing the use of the unspecified ED category (e.g. dropping the amenorrhea\ud requirement, increasing the body mass index cut-off for low weight and rewording the cognitive and behavioural features of AN to be more culturally-sensitive). In line with this last\ud recommendation, one point that require further analysis pertain to frequency and severity of the binge-eating and purging behaviours in BN and BED, as the EDCG is considering reducing or\ud eliminating the frequency criterion and broadening the binge-eating criterion to include\ud ‘subjective’ binge episodes

Gender is known to have an influence on medical treatment and the prescribing and outcome of drug treatment. This has also been suggested for selective serotonin reuptake inhibitors (SSRIs). To examine sex differences in the treatment with the SSRI sertraline in routine treatment of depression, data from a 6-month prospective drug utilization observation study on 3,858 women and 1,594 men were analysed for gender differences. Compared to men, women were more often treated by a general practitioner, were somewhat older, had a later onset of illness, were more likely to suffer from a recurrent rather than a first episode of depression, had been treated for depression before, and showed more anxious and less neurasthenic or retarded syndromes. There was no difference regarding duration of the present episode or severity of illness. The mean prescribed dose of sertraline was marginally lower for females compared to males (45.5 versus 46.5 mg/day) with no difference in the rate of psychoactive concomitant medication (6.76% versus 6.80%). There was no difference in side-effects, treatment termination or treatment response.

Evaluation is urgently needed for those uses of neuroleptic drugs that, from a pharmacoepidemiological perspective, must be seen as their primary indication.