Imagine playing golf and not having words for birdie or bogey. Imagine preparing dinner without the guidance of cookbooks that describe what a soufflé is and what the ingredients for lasagna are. The ICD-11 is the organizing volume, the guidebook, that captures our current knowledge for all health conditions, including mental health and substance use disorders.
So, it is a real milestone that after almost 30 years, on May 25th, the World Health Assembly of the World Health Organization adopted the eleventh edition of the International Classification of Diseases (ICD-11). Our WHO Collaborating Centre for Global Mental Health at Columbia University had the opportunity to contribute to the section on mental health directed by Dr. Geoffrey Reed, WHO Senior Project Officer and now a Columbia faculty member. I am excited to share the following highlights.
1. What is the ICD-11? The ICD is the International Statistical Classification of Diseases and Related Health Problems. It is essentially the lexicon for health and illness, defining global standards for disease, disorders, and other related health conditions. The new version of the ICD, ICD-11, is important because it reflects current advances in science and medicine since the last version was endorsed in 1990. It is designed for 21st century technology, which means it can be accessed around the world. You can get a bit more history about the ICD-11 in a past Five on Friday and a lot more history on the WHO website.
2. Gaming disorder. Gaming disorder is new to the ICD and is characterized by a lack of control over gaming and continued use of digital or video games no matter the negative consequences. The decision to include gaming disorder as a formal disorder was based on reviews of available evidence, recommendations by experts from around the world, and reflections on emerging treatment options. If we consider that Nintendo, one of the biggest and first gaming companies, was founded in 1989, it is understandable that gaming disorder was nonexistent in 1990. In fact, gaming disorder is a good example of how mental health conditions reflect other changes in human experience, in this case, the arrival of technology.
But, this new diagnosis does not mean that you need to be afraid of your son or daughter’s love of video games just yet. Studies suggest that gaming disorder only affects a small number of digital and video-game users. However, it is important to monitor the amount of time spent on video games and changes in physical and mental health based on video game usage. The hope is that this disorder classification will increase the scientific research conducted on the impact of gaming as well as general technology usage on the brain.
3. Sexual and behavioral disorders moved to a new section. In this version of the ICD, sexual disorders were moved from the mental and behavioral disorders chapter of the diagnostic guidelines to a separate “Conditions Related to Sexual Health” chapter. This shift was the culmination of years’ worth of research and advocacy around scientific evidence, best clinical practice, and human rights of LGBTQ+ individuals. This shift follows the scientific consensus that gender dysmorphia and sexual orientation as well as other conditions related to sexual health are not in and of themselves mental disorders, and sets the international standard for clinicians around this topic.
4. Burnout as a mental disorder. One of the most widely recognized changes in the ICD-11 is the inclusion of burnout. Huffington Post, Good Morning America, and even People magazine published articles about how work-related stress is now included as a mental disorder. There has been some pushback to this new diagnosis, especially since a Gallup survey in 2018 found that almost one in four employees reported feeling burned out at work very often or always.
As a clinician, I believe it is important to recognize the impact that burnout has on employees as an official mental disorder. Exhaustion, feelings of negativity, and reduced professional performance are not to be ignored or normalized, even if these symptoms are experienced by a large percentage of the population.
Last week, I spoke about global mental health to a standing-room-only audience at HSBC in London, where CEO John Flint has pledged to pioneer a movement for mental health in their workplace and around the world. We are excited to support their team in working against burnout and providing strategies for employees in need of mental health support.
5. Does diagnosis really matter? The answer is emphatically, yes. On a practical level, the ICD-11 will impact all the estimates of health and illness around the globe; shape public health strategies; define what conditions get treated in health care settings; and inform research priorities. Everyone knows that such a system is not perfect. Some people are not happy with particular changes; other think more radical changes should have been implemented. There is much we do not know, so the system will continue to evolve. The ICD is our map. It provides the best representation of coordinates and details available to navigate the world of mental illness. As such, it will provide the foundation for advocacy, care, and research to further improve what we know and what we do to improve mental health globally.
This is the first major revision of the world’s largest classification system for mental disorders in almost 30 years. Implementation will be the priority across nations for the next few years, with a target of official implementation in 2022. In this regard, our WHO Collaborating Centre will be engaged in supporting clinician trainings on the ICD-11 mental health changes. As we say, onward and upward!