Academic journal article International Journal of Clinical and Health Psychology

Disorders Specifically Associated with Stress: A Case-Controlled Field Study for ICD-11 Mental and Behavioural Disorders

Academic journal article International Journal of Clinical and Health Psychology

Disorders Specifically Associated with Stress: A Case-Controlled Field Study for ICD-11 Mental and Behavioural Disorders

Article excerpt

The World Health Organization (WHO) is currently revising the International Classification of Diseases, with its Eleventh Revision (ICD-11) expected to be approved by the World Health Assembly in 2018. Disorders Specifically Associated with Stress is a new grouping proposed for the ICD-11 chapter on Mental and Behavioural Disorders that is intended to capture disorders that in part reflect maladaptive reactions to stressful or traumatic events; that is, a history of a stressful or traumatic event is necessary, but not sufficient, to produce the psychopathology represented by the disorder (Maercker, Brewin, Bryant, Cloitre, & Reed et al., 2013; Maercker, Brewin, Bryant, Cloitre, & van Ommeren et al., 2013). The proposed ICD-11 grouping of Disorders Specifically Associated with Stress includes some diagnoses that exist in various disorder groupings in the ICD-10, including Post-Traumatic Stress Disorder (PTSD), Adjustment Disorder, and Acute Stress Reaction, as well as two new diagnoses: Complex PTSD and Prolonged Grief Disorder (see Maercker, Brewin, Bryant, Cloitre, & Reed et al., 2013; Maercker, Brewin, Bryant, Cloitre, & van Ommeren et al., 2013)*.

Mental disorders specifically associated with stress are relative newcomers to psychiatric classification. The ICD-8, approved by the World Health Assembly in 1965, introduced a category of ''Transient situational disturbance'', which included adjustment problems, severe stress reactions, and combat neurosis. The ICD-9, approved in 1975, specified two separate disorders: Acute stress reaction and Adjustment reaction. The ICD-10, approved in 1990, included two additional disorders as independent diagnoses: PTSD and Enduring Personality Change after Catastrophic Experience. The latter diagnosis was described as sometimes following long-term exposure to extreme stress (e.g., concentration camp imprisonment or torture) and as sometimes being preceded by PTSD.

The ICD-11 Working Group on Disorders Specifically Associated with Stress was established by the WHO Department of Mental Health and Substance Abuse in 2011 to: (a) review available scientific evidence, (b) assess clinical and policy information on the use of these disorders, including perspectives from specialist and primary health care settings throughout the world; (c) review proposals for DSM-5 and consider their suitability for global applications; (d) assemble and prepare specific proposals, including the placement and organization of relevant categories; and (e) develop drafts of the content (e.g., definitions, descriptions, diagnostic guidelines) with a particular focus on improving clinical utility of relevant diagnostic categories (see First, Reed, Hyman, & Saxena, 2015).

Previous WHO surveys conducted in collaboration with partnering international psychiatric and psychological organizations showed that Disorders Specifically Associated with Stress categories rank high in clinical use in daily practice. For example, PTSD was the 7th most commonly used category among psychiatrists (Reed, Correia, Esparza, Saxena, & Maj, 2011) and 8th among psychologists (Evans et al., 2013). These surveys also asked participants to suggest diagnostic categories they felt should be added to the classification. Complex PTSD was the most frequently recommended category to be added, and Prolonged Grief Disorder (or some other form of pathological bereavement) was the 11th most commonly recommended category (Robles et al., 2014). The Working Group took these results into consideration when reviewing available scientific evidence on the validity of eligible categories as well as clinical and policy information on their clinical utility.

Field trial process and rationale

WHO has emphasized the importance of clinical utility in the revision process, and has defined clinical utility in relation to a range of implementation characteristics related to a particular category (International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders, 2011; Reed, 2010). …

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