Disorders specifically associated with stress: A case-controlled field study for ICD-11 mental and behavioural disorders

Abstract

As part of the development of the Eleventh Revision of International Classification of Diseases and Related Health Problems (ICD-11), the World Health Organization Department of Mental Health and Substance Abuse is conducting a series of case-controlled field studies using a new and powerful method to test the application by clinicians of the proposed ICD-11 diagnostic guidelines for mental and behavioural disorders. This article describes the case-controlled field study for Disorders Specifically Associated with Stress. Using a vignette-based experimental methodology, 1,738 international mental health professionals diagnosed standardized cases designed to test key differences between the proposed diagnostic guidelines for ICD-11 and corresponding guidelines for ICD-10. Across eight comparisons, several proposed changes for ICD-11, including the addition of Complex PTSD and Prolonged Grief Disorder, produced significantly improved diagnostic decisions and clearer application of diagnostic guidelines compared to ICD-10. However, several key areas were also identified, such as the description of the diagnostic requirement of re-experiencing in PTSD, in which the guidelines were not consistently applied as intended. These results informed specific revisions to improve the clarity of the proposed ICD-11 diagnostic guidelines. The next step will be to further test these guidelines in clinic-based studies using real patients in relevant settings.

Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability

“…One of the first indications from the field of the clinical utility of the ICD-11 PGD was shown in the international ecological implementation field study organized by the WHO by means of the Global Clinical Practitioners Network (https://gcp.network/en/) (Keeley et al, 2016). In this study, 1738 clinicians representing 76 different countries were presented with a series of standardized case vignettes to test important differences in the proposed diagnostic criteria for ICD-11 compared with ICD-10.…”

“…This caveat, in part, originates from WHO’s above-mentioned vignette implementation field study (Keeley et al, 2016). In this field study, some clinicians diagnosed PGD in a vignette that was meant to represent a normal bereavement response at less than 6 months post-loss.…”

“…There are still significant questions concerning the application of this definition to different cultural groups and across the lifespan (Keeley et al, 2016; Reed et al, 2011; Robles et al, 2014; Schaal, Jacob, Dusingizemungu, & Elbert, 2010). To date, the WHO framework of clinical utility and international applicability has contributed to the development of applicable and culturally informed diagnostic criteria for PGD that, it is hoped, will improve clinical practice.…”

A psychometric assessment of Disturbances in Self-Organization symptom indicators for ICD-11 Complex PTSD using the International Trauma Questionnaire

“…Consistent with advances in the formulation of the ICD-11 PTSD assessment, our desire is to identify two well performing items for each DSO cluster. Additionally, our goal is that the AD cluster be represented using one symptom that reflects emotional hyper-activation, and one symptom that reflects emotional hypo-activation, as these were two important aspects of AD identified in an ICD-11 case-controlled field study (Keeley et al, 2016). …”

A socio-interpersonal approach to adjustment disorder: the example of involuntary job loss

“…Recent studies provided evidence for the proposed stress-response conceptualization for ICD-11 regarding its reliability and clinical utility (Bachem, Perkonigg, Stein, & Maercker, 2016; Glaesmer, Romppel, Brähler, Hinz, & Maercker, 2015; Keeley et al, 2016; Zelviene, Kazlauskas, Eimontas, & Maercker, 2017). However, little is known about predictive factors or models for the development of this disorder.…”