The Classification of Anxiety and Fear-Related Disorders in the ICD-11

Abstract

Anxiety disorders are highly prevalent worldwide and engender substantial economic costs and disability. The World Health Organization is currently developing the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11), which represents the first opportunity to improve the validity, clinical utility, and global applicability of the classification in more than 25 years. This article describes changes in the organization and diagnostic guidelines for anxiety and fear-related disorders proposed by the ICD-11 Working Group on the Classification of Mood and Anxiety Disorders and the rationale and evidence base for the proposals. In ICD-11, anxiety and fear-related disorders that manifest across the lifespan are brought together under a new grouping, and are partly distinguished by their focus of apprehension. The focus of apprehension is the stimulus or situation that triggers the fear or anxiety and may be highly specific as in specific phobia or relate to a broader class of situations as in social anxiety disorder. The guidelines also clarify the relationship between panic disorder and agoraphobia and a qualifier is provided for panic attacks in the context of other disorders. A standardized format emphasizing essential features of anxiety disorders is intended to improve clinical utility. Guidelines will be further refined based on findings from two types of field studies: those using a case-controlled vignette methodology disseminated via the Internet to practitioners worldwide (http://gcp.network) and clinic-based field trials implemented globally at participating field study centers.

The ICD‐11 developmental field study of reliability of diagnoses of high‐burden mental disorders: results among adult patients in mental health settings of 13 countries

“…The conceptualization of generalized anxiety disorder has been broadened in ICD‐11 CDDG to include worry as an alternative essential feature to generalized apprehension and accompanying physiological symptoms, based in part on studies that show that worry is a central characteristic of the disorder. Agoraphobia is reconceptualized to include a broader array of feared stimuli (fear of situations, fear of specific negative outcomes) and behaviours manifested in response to these stimuli (avoidance or entering the situations under specific conditions or enduring the situation with intense fear/anxiety), partly to allow for situations that may be more representative of those reported in low‐ and middle‐income countries.…”

“…The ICD‐11 conceptualization of social anxiety disorder has broadened the concept of ways in which the person could fear being negatively evaluated by others to include cultural variants of the disorder (i.e., fears of humiliation, embarrassment, rejection, or being offensive) as well as the range of behaviours in response to social stimuli. It is possible that the greater attention to the cognitive and behavioural components of anxiety disorders and their contextual and cultural features in the ICD‐11 CDDG as compared to the ICD‐10 CDDG helped to improve the reliability of these diagnoses.…”

“…If some panic attacks over the course of the disorder have been unexpected and not exclusively in response to stimuli associated with the focus of apprehension related to the relevant disorder, a separate diagnosis of panic disorder should be assigned. In such cases, it is not necessary to apply the “with panic attacks” qualifier. The lower kappa value for the ICD‐11 CDDG as compared to the ICD‐10 CDDG for panic disorder suggests that clinicians may have found it difficult to differentiate between expected and unexpected panic attacks or have been unclear about when to use the “with panic attacks” qualifier and when instead apply an additional diagnosis of panic disorder.…”

A comparison of DSM ‐5 and DSM ‐IV agoraphobia in the World Mental Health Surveys

“…The decision to classify AG as a disorder that exists separately from PD was based on studies indicating that a substantial proportion of individuals with AG do not have PD Wittchen, Gloster, Beesdo-Baum, Fava, & Craske, 2010), and/or PD or panic attacks do not precede AG (as implied in DSM-IV; Wittchen et al, 2010Wittchen et al, , 2008Wittchen, Reed, & Kessler, 1998). This is in line with the ICD criteria, in which AG is understood to be the consequence of a broader range of fears (Kogan et al, 2016;Stein, 2012;Wittchen et al, 2010). Further, DSM-5 criterion A is broadened to a fear or avoidance of situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence ; American Psychiatric Association, 2013).…”

The Icd-11 Chapter on Mental Disorders: An Update for Wpa Components

“…Gerçekten de, iki projenin ana amaçları (yani; ICD için psikiyatrik tanının klinik yararlılığını geliştirmek, Araştırma Alanı Kriterleri (RDoC) projesi için ise psikopatolojinin etyopatogenetik temellerini yenilikçi bir şekilde araştırmak) birbirini tamamlayıcı olarak görülebilir ve psikiyatristlerin günlük çalışmalarında, özellikle psikoz alanında, karşılaştıkları klinik görüngüler ve RDoC yapılandırması arasındaki açığı kapatmak için bir çok şey yapılabilir (Frangou ve ark. 2016, Maj 2016, Sanislow 2016). …”