NAME:

MUNEEBA
CLASS:
MSc (Pre)
ROLL NO:
19
ASSIGNMENT:
PSYSCHOPATHOLOGY
TOPIC:
ICD 11
SUBMITTED TO:
MAM SUMMER
………………………………………………………………………
Definition
ICD is a tool for reporting and grouping conditions and factors that influence health.
It contains categories for diseases, health-related conditions, and external causes of
illness or death.

Background
The ICD-11 classification of Personality Disorders focuses on core personality dysfunction,
while allowing the practitioner to classify three levels of severity (Mild Personality
Disorder, Moderate Personality Disorder, and Severe Personality Disorder) and the option
of specifying one or more prominent trait domain qualifiers (Negative Affectivity,
Detachment, Disinhibition, Dissociality, and Anankastia). Additionally, the practitioner is
also allowed to specify a Borderline Pattern qualifier. This article presents how the ICD-11
Personality Disorder classification may be applied in clinical practice using five brief cases.

History of ICD
The first international classification edition, known as the International List of Causes
of Death, was adopted by the International Statistical Institute in 1893.

WHO was entrusted with the ICD at its creation in 1948 and published the 6th
version, ICD-6, that incorporated morbidity for the first time. The WHO Nomenclature
Regulations, adopted in 1967, stipulated that Member States use the most current
ICD revision for mortality and morbidity statistics. The ICD has been revised and
published in a series of editions to reflect advances in health and medical science
over time.
CD-10 was endorsed in May 1990 by the Forty-third World Health Assembly. It is cited in
more than 20,000 scientific articles and used by more than 100 countries around the world.

A version of ICD-11 was released on 18 June 2018 to allow Member States to prepare for
implementation, including translating ICD into their national languages. ICD-11 will be
submitted to the 144th Executive Board Meeting in January 2019 and the Seventy-second
World Health Assembly in May 2019 and, following endorsement, Member States will start
reporting using ICD-11 on 1 January 2022.

The history of the ICD traces back to England in the 16th century. Every week, the
London Bills of Mortality would announce deaths from distinctly medieval causes:
scurvy, leprosy, and the big killer – plague.

It wasn’t until the late 19th century though, when Florence Nightingale, just returned
from the Crimean War, advocated for the need for gathering statistics on causes of
disease and death that data began to be collected more systematically.

Around the same time French statistician Jacques Bertillon introduced the Bertillon
 Classification of Causes of Death, which was adopted by several countries. In the
1940s, the World Health Organization took over Bertillon’s system and expanded it to
include statistics on causes of injury and disease, producing the first version of the
International Statistical Classification of Diseases, Injuries and Causes of Death (ICD).
This allowed for the first time the collection of both morbidity and mortality data to map
both disease trends and causes of death.

ICD purpose and uses

ICD is the foundation for the identification of health trends and statistics globally, and
the international standard for reporting diseases and health conditions. It is the
diagnostic classification standard for all clinical and research purposes. ICD defines the
universe of diseases, disorders, injuries and other related health conditions, listed in a
comprehensive, hierarchical fashion that allows for:

 easy storage, retrieval and analysis of health information for evidenced-based decision-
making;
 sharing and comparing health information between hospitals, regions, settings and countries;
and
 data comparisons in the same location across different time periods.
Uses include monitoring of the incidence and prevalence of diseases, observing
reimbursements and resource allocation trends, and keeping track of safety and
quality guidelines. They also include the counting of deaths as well as diseases,
injuries, symptoms, reasons for encounter, factors that influence health status, and
external causes of disease.

Primary users
Users include physicians, nurses, health workers, researchers, health information
managers, policy-makers, insurers and national health programme managers,
among others.

ICD-11 development underway

The 11th version, ICD-11, is now being developed through a continuous revision process.
ICD-11 will be finalized in 2018.
For the first time, through advances in information technology, public health users,
stakeholders and others interested can provide input to the beta version of ICD-11 using an
online revision process. Peer-reviewed comments and input will be added through the
revision period. When finalized, ICD-11 will be ready to use with electronic health records
and information systems.
WHO encourages broad participation in the 11th revision so that the final classification meets
the needs of health information users and is more comprehensive.
The problem of rare diseases
Rare diseases present two problems in ICD-11: (1) sometimes appearing only in the
Foundation and being below the shoreline of the MMS; and (2) raising questions as to which
primary parent is most sensible in the MMS monohierarchy. Some rare diseases such as
Lesch–Nyhan syndrome (5C35.01) illustrate that they keep their heads above the shoreline,
though just barely with a rare six-digit code. However, while Fanconi anemia appears in the
Foundation, it is relegated to a more general category: congenital aplastic anemia (3A70.0)
exemplifying the first issue. Fanconi anemia does have a URI in the Foundation
(http://id.who.int/icd/entity/1500851497), which is distinct from the base-34 code in the
MMS. Further, while OMIM contains 19 entries in the phenotypic series for Fanconi anemia,
the ICD-11 Foundation has only a single entry. In future, we expect expansion to the etiology
and genomic modifier elements, which would allow a compositional expression of these 19
genomic variants of Fanconi anemia.
Substantial debate has occurred among the developers as to whether some hematological rare
diseases belonged in the clinical hematology chapter or among the inborn errors of metabolism
as a rare disease. In the Foundation, of course, they can be and are in both sections. In general,
the legacy of ICD-10 would be determinative, though diseases that had no ICD-11 legacy tended
to favor a clinically friendly category.

Conclusion
ICD-11 (International Classification of Diseases, 11th Revision) is significantly more expressive
and comprehensive than historical versions. The introduction of post-coordination makes the
Mortality and Morbidity Statistics (MMS) linearization more compact, while allowing highly
expressive compositional descriptions. Phenotype features are enriched, though fall short of
purpose-specific systems such as HPO. Rare diseases existing in the Foundation are not always
assigned a linearization code in the MMS, though they do have an independent URI.
Development of the ICD-11 Foundation and linkages to more robust ontologies will continue in
the foreseeable future, which we expect will strengthen the use and application of the MMS The
ICD-11 classification of Personality Disorders focuses on core personality dysfunction, while
allowing the practitioner to classify three levels of severity (Mild Personality Disorder, Moderate
Personality Disorder, and Severe Personality Disorder) and the option of specifying one or more
prominent trait domain qualifiers (Negative Affectivity, Detachment, Disinhibition, Dissociality,
and Anankastia). Additionally, the practitioner is also allowed to specify a Borderline Pattern
qualifier. This article presents how the ICD-11 Personality Disorder classification may be
applied in clinical practice using five brief cases.The ICD-11 Personality Disorder classification
was applicable to five clinical cases, which were classified according to Personaity Disorder
severity and trait domain qualifiers. We propose that the classification of severity may help
inform clinical prognosis and intensity of treatment, whereas the coding of trait qualifiers may
help inform the focus and style of treatment. Empirical investigation of such important aspects of
clinical utility are warranted.