Mental health professionals' use of the ICD-11 classification of impulse control disorders and behavioral addictions: An international field study

Abstract

Background and aimsThe ICD-11 chapter on mental, behavioral and neurodevelopmental disorders contains new controversial diagnoses including compulsive sexual behavior disorder (CSBD), intermittent explosive disorder (IED) and gaming disorder. Using a vignette-based methodology, this field study examined the ability of mental health professionals (MHPs) to apply the new ICD-11 diagnostic requirements for impulse control disorders, which include CSBD and IED, and disorders due to addictive behaviors, which include gaming disorder, compared to the previous ICD-10 guidelines.MethodsAcross eleven comparisons, members of the WHO's Global Clinical Practice Network (N = 1,090) evaluated standardized case descriptions that were designed to test key differences between the diagnostic guidelines of ICD-11 and ICD-10.ResultsThe ICD-11 outperformed the ICD-10 in the accuracy of diagnosing impulse control disorders and behavioral addictions in most comparisons, while the ICD-10 was not superior in any. The superiority of the ICD-11 was particularly clear where new diagnoses had been added to the classification system or major revisions had been made. However, the ICD-11 outperformed the ICD-10 only in a minority of comparisons in which mental health professionals were asked to evaluate cases with non-pathological high involvement in rewarding behaviors.Discussion and ConclusionsOverall, the present study indicates that the ICD-11 diagnostic requirements represent an improvement over the ICD-10 guidelines. However, additional efforts, such as training programs for MHPs and possible refinements of diagnostic guidance, are needed to avoid over-diagnosis of people who are highly engaged in a repetitive and rewarding behavior but below the threshold for a disorder.

Delay discounting of protected sex and compulsive sexual behavior in women with borderline personality disorder

“…CSB involves a lack of control over sexual behavior that has become central to one's life, leading to distress and negative consequences and potentially to Compulsive Sexual Behavior Disorder (CSBD; ICD-11, World Health Organization, 2022 ). CSBD is conceptualized as an Impulse Control Disorder and individuals with BPD also commonly exhibit difficulties in regulating impulsive behavior ( Fuss et al, 2024 ). Research on associations between CSB and BPD has produced inhomogeneous results so far, with some data showing relations of borderline symptoms with CSB ( Elmquist, Shorey, Anderson, & Stuart, 2016 ; Fuss, Briken, Stein, & Lochner, 2019 ; Jardin et al., 2017 ), while others did not find a strong relationship ( Lloyd, Raymond, Miner, & Coleman, 2007 ).…”