Update on the status of the classification of PVFS, ME and CFS for ICD-11: Part Three: WHO rejects Dr Dua’s proposal

Post #346 Shortlink: https://wp.me/pKrrB-4wZ

Related posts:

Update on the status of the classification of PVFS, ME and CFS for ICD-11: Part One

Update on the status of the classification of PVFS, ME and CFS for ICD-11: Part Two


Part Three (and it’s good news, for once)

As reported in Parts One and Two, three proposals for the ICD-10 G93.3 legacy categories, Postviral fatigue syndrome; Benign myalgic encephalomyelitis; and Chronic fatigue syndrome have sat unprocessed in the ICD-11 Proposal Mechanism for over a year:

the proposal by Dimmock & Chapman (submitted March 26, 2017);

the proposal by Dr Lily Chu on behalf of the IACFS/ME (submitted March 31, 2017);

the proposal by Dr Tarun Dua (submitted November 06, 2017).

If you are not registered for access to the ICD-11 Proposal platform, click to download the proposal submitted by Dimmock & Chapman in PDF format.


Dr Tarun Dua’s proposal to kick the G93.3 legacy categories out of the Neurology chapter

Dr Tarun Dua is a medical officer working on the Program for Neurological Diseases and Neuroscience, Management of Mental and Brain Disorders, WHO Department of Mental Health and Substance Abuse. This WHO department has responsibility for both mental disorders and neurological diseases and disorders. Its Director is Dr Shekhar Saxena.

Dr Dua had acted as lead WHO Secretariat and Managing Editor for ICD Revision’s Topic Advisory Group (TAG) for Neurology, which was chaired by Prof Raad Shakir.

When Dr Dua submitted a proposal, last year, recommending that “Myalgic encephalitis/Chronic Fatigue Syndrome (ME/CFS)” [sic] should be removed from the Diseases of the nervous system chapter and reclassified in the Symptoms, signs chapter as a child under Symptoms, signs or clinical findings of the musculoskeletal system, it was initially unstated whose position this controversial recommendation represented.

Read Dr Dua’s proposal in PDF format from Page 5 of this November 2017 commentary.

TAG Neurology had ceased operations in October 2016, leaving proposals for the G93.3 legacy categories hanging and the terms still unaccounted for in the public version of the ICD-11 Beta draft. The terms were eventually restored to the draft in March 2017.

Since early 2017, we had been advised several times by senior WHO officers that decisions regarding these categories were “on hold” while an in-house evidence review was being undertaken.

Moreover, WHO senior classification expert, Dr Robert Jakob, had assured me (via email in March 2017) that WHO had no intention of dumping these categories in the Symptoms, signs chapter — yet here was Dr Dua calling for precisely that.

The key question being: Did this recommendation represent the outcome of a now concluded evidence review or did it represented only the position of Dr Dua?

Dr Dua eventually stated that “…the proposal [had] been submitted on behalf of Topic Advisory Group (TAG) on Diseases of the Nervous System, and reiterates the TAG’s earlier conclusions.” But neither Dr Dua nor her line manager, Dr Saxena, were willing to provide us with responses to other queries raised in relation to this proposal, including, crucially: How does this proposal relate to the in-house evidence review?

We were subsequently advised by WHO’s Dr John Grove (Director, Department of Information, Evidence and Research) that the systematic evidence review would determine if the terms needed to be moved to any other specific chapter of ICD-11 and that the outcomes would be provided for review by the Medical Scientific Advisory Committee (MSAC).

A formal response by Dimmock & Chapman to Dr Dua’s proposal can be read in PDF format here Response by Dimmock & Chapman to Dr Tarun Dua proposal of November 6, 2017.


WHO rejects Dr Dua’s proposal 

On November 19, the proposal was marked as Rejected by ICD-11 Proposal Mechanism admins:

Screenshot: Accessed November 20, 2018:


This decision to reject Dr Dua’s recommendation that the terms should be relocated under the Symptoms, signs chapter is accompanied by a brief rationale from ICD-11 Proposal Platform admins “Team3 WHO”:

Screenshot: Accessed November 22, 2018:


Importantly, the decision to retain the terms in the Disorders of the nervous system chapter is supported by the WHO MSAC and CSAC committees.

(See Reference 10 for WHO/ICD-11’s guiding principles for consideration of legacy terms and potential chapter relocations — guidance with which Dr Dua is familiar and has cited, herself, when drafting other proposals, but which she evidently chose to disregard in the case of the G93.3 legacy categories.)


This means that these ICD-10 legacy terms continue to stand as per the “Implementation” version of the ICD-11 MMS that was published in June 2018:



But we are not done yet…

It’s not known when the remaining proposals submitted by myself and jointly with Mary Dimmock will be processed.

There remains a backlog of over 1000 unprocessed proposals, a number of which had met the March 30, 2017 proposal deadline and were expected to have been processed last year, in time for consideration for inclusion in the June 2018 “Implementation” release.

According to summary reports of the WHO-FIC Network Council’s April 26 and September 26, 2018 teleconferences:

  • Between June 2018 and the 2019 [World Health Assembly] resolution, WHO will work to improve user guidance around the classification and any final sorting of the extension codes, but there is not an intention to “reopen the package” of ICD-11 or to make major changes
  • The codes will not change after June 2018, and the URIs [Unique Reference Identifiers] will remain the constant, immoveable identifiers for each concept that underpin the classification
  • An update cycle was agreed by JTF [Joint Task Force] last week, including ongoing update of foundation entities (e.g. index terms, synonyms, extension codes, etc.) with
    • annual updates for entities below the shoreline,
    • a 5-year cycle for update of entities above the shoreline, and
    • a 10-year cycles for updates to the rules.

and from the September 26, 2018 teleconference:

  • WHO has updated the proposal platform to allow voting by CSAC* members and to align the process with the historical practices of the URC [ICD-10 Update and Revision Committee].
  • 90 proposals have been identified from the platform for consideration by the CSAC this year, though not all of them can be reviewed in detail face-to-face during the WHO-FIC Network Annual Meeting 2018. A call may be held in advance to discuss some specific priorities.
  • Given the huge volume of proposals, the meeting will go through the new procedures for the CSAC, review the voting process and tools, overview the proposal platform and how to use it, and determine timelines and workload for after the meeting.
  • CSAC governance will also be presented together with the content of ICD-11 prior to submission of the report on ICD-11 to the WHO Governing Bodies for review by the WHO Executive Board [in January 2019]

Source: WHO-FIC Council Google platform: WHO-FIC Council Teleconferences

*The Classifications and Statistics Advisory Committee (CSAC) takes over the role of the ICD-10 Update and Revision Committee (URC). The last update for ICD-10 will be 2019.


The ICD-11 MMS is expected to be frozen again in January 2019 in preparation for submission of the report to the Executive Board (EB):


Beyond World Health Assembly adoption, ICD-11 will be subject to an update and maintenance cycle:

(See Reference Guide Annex 3.7.1 – 3.7.6 for detailed information on ICD-11 Updating Cycles and Proposal Workflows.)

I’ve been unable to confirm whether the first update released after the June 2018 “Implementation” version would be a January 2019 release, or whether the June 2018 version is intended to remain more or less stable for a further year, until January 2020.

If WHO were to accept any of the proposals contained within my individual submissions and my joint submissions with Mary Dimmock, for example, approving our recommendations for deprecating the prefix “Benign”; deprecating Postviral fatigue syndrome as lead Concept Title; assigning separate Concept Title codes to Myalgic encephalomyelitis and to Chronic fatigue syndrome; or approving Exclusions under Bodily distress disorder (BDD), any approved recommendations would appear initially in the orange ICD-11 Maintenance Platform pending their eventual incorporation into an “Implementation” release.

I will keep you apprised of any significant developments.



1 G93.3 Postviral fatigue syndrome, ICD-10 Browser Version: 2016. Accessed November 22, 2018

World Health Organization finally releases next edition of the International Classification of Diseases (ICD-11) Dx Revision Watch, July 25, 2018

3 8E49 Postviral fatigue syndrome, ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) 2018 version for preparing implementation. Accessed November 22, 2018

4 8E49 Postviral fatigue syndrome, ICD-11 (Mortality and Morbidity Statistics) Maintenance Platform. Accessed November 22, 2018 The content made available on this platform is not a released version of the ICD-11. It is a work in progress in between released versions.

A proposal for the ICD-10 G93.3 legacy terms for ICD-11: Part Two. Dx Revision Watch, April 3, 2017

6 PDF: Proposal: Revision of G93.3 legacy terms for ICD-11, Dimmock & Chapman, March 27, 2017

7 Proposal: Revision of G93.3 legacy terms for ICD-11, Dr Tarun Dua, November 6, 2017

8 Response by Dimmock & Chapman to Dr Tarun Dua proposal of November 6, 2017, February 15, 2018

9 ICD-11 Reference Guide June 2018

10 Extract from Response to Dr Dua Proposal of November 6 2017: 4. Compliance with WHO standards and other considerations on relocation, Dimmock & Chapman, February 15, 2018


Update to addition of Disorder of nervous system parent for Chronic fatigue syndrome and terms under Synonyms in SNOMED CT

Post #345 Shortlink: https://wp.me/pKrrB-4uk

In Post #342 (August 1, 2018), I confirmed that the addition of parent: Disorder of nervous system to Chronic fatigue syndrome was implemented for the July 31, 2018 release of the SNOMED CT International Edition.

The SNOMED CT Concept term for Chronic fatigue syndrome is SCTID 52702003 Chronic fatigue syndrome (disorder). Benign myalgic encephalomyelitis; and Myalgic encephalomyelitis are included in a list of terms under Synonyms.

SCTID: 52702003 Chronic fatigue syndrome (disorder) and the terms listed under Synonyms are now located under supertype SCTID: 118940003 Disorder of nervous system (disorder). This change to the International Edition is being incorporated into the national editions, as they release their next updates. These are released on a staggered schedule.

The rationale for requesting this additional supertype for Chronic fatigue syndrome and the terms listed under Synonyms is set out in this August 2018 document:

PDF: Statement on SNOMED CT and Chronic fatigue syndrome

Note that prior to July 2015, Postviral fatigue syndrome had been listed under Children to SCTID: 52702003 Chronic fatigue syndrome.

But for the July 2015 release, Postviral fatigue syndrome was removed from under SCTID: 52702003 Chronic fatigue syndrome and relocated under supertype: Post-viral disorder under: Post-infectious disorder and assigned the Concept code: SCTID: 51771007.

(A change that had not been requested by the Countess of Mar during her 2014-2015 engagement with SNOMED CT terminology managers for the removal of the Mental disorder parent. Provision of the rationale for relocating Postviral fatigue syndrome was not pursued by Forward-ME.)

Incorporation of addition of supertype Disorder of nervous system into national editions

SNOMED CT U.S. Edition incorporated the change for its September 01, 2018 release:


SNOMED CT Belgium Edition incorporated the change for its September 15, 2018 release:


SNOMED CT Danish Edition incorporated the change for its September 30, 2018 release:


SNOMED CT Netherlands Edition incorporated the change for its September 30, 2018 release:

Note on inclusion of “neurasthenie” in the Netherlands Edition: SNOMED CT International Edition and national editions used to include a Concept term SCTID: 192439005 Neurasthenia. This Concept was retired (Inactivated) a number of years ago. However, the Netherlands Edition retained the term “neurasthenie” under the list of Synonym terms. “Neurasthenie” is designated as an “Acceptable” term in the Netherlands Dutch language reference set (open “Details” tab to view Netherlands reference sets).

Details tab:

A Netherlands advocate has contacted Pim Volkert (Terminology Co-ordinator, Nictiz, and lead for the Netherlands SNOMED CT National Release Centre) with a request and rationales for consideration of the removal of the “neurasthenie” term, for consistency with the SNOMED CT International Edition and with the WHO’s ICD-10, which has an exclusion for G93.3 under F48.0 Neurasthenia. This request has been considered and accepted. I am advised that removal of the “neurasthenie” term is anticipated to be implemented for the March 2019 release of the Netherlands Edition.


SNOMED CT UK Edition incorporated the change for its October 01, 2018 release:

(Public browser hosted by NHS Digital. Browser can also be accessed from the landing page of the SNOMED CT International browser platform.)

Note: the UK Edition has three severity specifier options listed under “Children” that are specific to the UK Edition.

These are assigned the discrete codes: SCTID: 377181000000104 Mild chronic fatigue syndrome; SCTID: 377171000000101 Moderate chronic fatigue syndrome; and SCTID: 377161000000108 Severe chronic fatigue syndrome.

It has yet to be established from NHS Digital in which year these severity specifier options were added to the UK Edition, to what extent they are used, and by what means clinicians would determine which of the severities to apply.

The UK Edition includes the terms Myalgic encephalitis and Myalgic encephalopathy.


Updated to add screenshot of Canadian Edition

SNOMED CT Canadian Edition incorporated the change for its October 30, 2018 release:


Updated to add screenshot of Swedish Edition

SNOMED CT Swedish Edition incorporated the change for its November 30, 2018 release:

Note: the Swedish Edition includes a separately coded for Concept term:

SCTID: 55941000052101 | kronisk trötthet | [Chronic fatigue (finding)].

This is marked with the Swedish flag symbol to denote that this SNOMED CT Concept term is exclusive to the Swedish Edition. It can be viewed here:


Updated to add screenshot of Argentinian Edition

SNOMED CT Argentinian Edition incorporated the change for its November 30, 2018 release:


Updated to add screenshot of Australian Edition

The January 31, 2019 release of the Australian Edition has incorporated the change:


If your country is a member of SNOMED International but does not have a publicly accessible browser hosted on the International Edition platform or hosted on its own platform, please refer to your country’s SNOMED CT National Release Centre website for the release schedule.


GP system updated to reflect M.E. as neurological, Action for M.E., August 01, 2018

NHS to update classification system to reflect that M.E. is neurological disease, ME Association, August 06, 2018

Chronic fatigue syndrome classified under Neurological disorder in SNOMED CT International Edition

Post #342 Shortlink: https://wp.me/pKrrB-4pK

SNOMED CT is a standardized electronic terminology system for recording and sharing symptoms, diagnoses, clinical findings, procedures etc. in primary and secondary care and across other health care settings.

Since April 2018, SNOMED CT UK Edition has been the mandatory terminology system for use in NHS primary care, replacing the Read Code (CTV3) terminology which is now retired. SNOMED CT UK Edition is scheduled for adoption across all NHS clinical settings by 2020.

In SNOMED CT terminology system, disease and disorder terms are not arranged in chapters, as they are in ICD-10 and ICD-11. Instead, terms are arranged within a hierarchical relationship of parent and children concepts (or supertypes and subtypes).

The SNOMED CT Concept term for Chronic fatigue syndrome is SCTID 52702003 Chronic fatigue syndrome (disorder). Benign myalgic encephalomyelitis; and Myalgic encephalomyelitis are included as Synonym terms.

Chronic fatigue syndrome has historically been located under the Parent Concept: Multisystem disorder.

Multisystem disorder Parent retired for January 2018 release

In 2017, SNOMED CT terminology managers decided that the Multisystem disorder concept term was not sufficiently specific for the purposes of their system and the term was inactivated (retired) for the January 2018 release.

There had been 90 Children terms under SCTID: 281867008 Multisystem disorder (disorder) and the retirement of this parent concept had implications for all of these 90 terms — not just for Chronic fatigue syndrome and its Synonym terms.

Many of these 90 Children terms were assigned under a more specific parent but a few, including Chronic fatigue syndrome, had no new parent assigned to them.

This presented an opportunity to request a more specific parent for Chronic fatigue syndrome.

In February 2018, a formal request and rationale for adding the supertype: Disorder of nervous system was submitted.

Chronic fatigue syndrome classified under Neurological disorder for July 2018 release

Following a peer review process, the addition of the parent: Disorder of nervous system for Chronic fatigue syndrome was provisionally approved for implementation in the next release, which has been finalized and published.

SCTID: 52702003 Chronic fatigue syndrome (disorder) is now classified under supertype SCTID: 118940003 Disorder of nervous system (disorder) in the July 2018 release of the SNOMED CT International Edition.

This change will be incorporated into the next update of the U.S. Edition (in September 2018), the UK Edition (in October 2018) and other National Editions, as they release their next updates.

Download a copy of the full report

PDF: Statement on SNOMED CT and Chronic fatigue syndrome


SNOMED CT International Edition Release for July 2018 (v20180731) was published on the public SNOMED CT browser on July 31, 2018


GP system updated to reflect M.E. as neurological, Action for M.E., August 01, 2018

NHS to update classification system to reflect that M.E. is neurological disease, ME Association, August 06, 2018

Update on SNOMED CT and Bodily distress disorder

Post #341 Shortlink: https://wp.me/pKrrB-4pG

Update on SNOMED CT terminology system and inclusion of Bodily distress disorder

The July 2017 Release for SNOMED CT International Edition included an undefined Bodily distress disorder term, assigned as a subtype under Parent: Functional disorder.

SNOMED CT does not regulate which concepts should or should not be used in clinical records, but makes concepts available within its system in response to submissions for potential inclusion.

It was possible that the World Health Organization (WHO) had requested the addition of the Bodily distress disorder term for alignment between SNOMED CT and new ICD-11 concept terms [1].

But given the concerns about Bodily distress disorder (BDD) and Bodily distress syndrome (BDS), it was important to establish what the SNOMED International terminology managers understood by the term “BDD” and to also establish who had submitted the request for its addition.

Download a copy of the full update

PDF: Statement on SNOMED CT and Bodily distress disorder

1 Bodily distress disorder, ICD-11 MMS Release June 2018

2 SNOMED CT International Edition Release for July 2018 was published on the public SNOMED CT browser on July 31, 2018

World Health Organization finally releases next edition of the International Classification of Diseases (ICD-11)

Post #339 Shortlink: https://wp.me/pKrrB-4nC

(Key links from this post are also available on the ICD-11 2018 tab page.)

After 11 years in development and four extensions to the timeline, the World Health Organization (WHO) finally released a version of ICD-11 on June 18th.

Advanced preview

The WHO is presenting this June release as an “advance preview” to enable countries to start planning for implementation, prepare national translations and begin training health professionals.

ICD-11 MMS is scheduled for presentation at the World Health Assembly (WHA) in May 2019 for adoption by member states, but WHA endorsement won’t come into effect until January 1, 2022. After that date, member states can begin using the new edition for data reporting — if they are ready.

The WHO has bought itself a further three and half years in which to complete the preparation of implementation and support materials and finalize companion publications and other derivatives.

Dr Christopher Chute, chair of ICD-11’s Medical and Scientific Advisory Committee (MSAC), predicts that early implementers may require around five years to prepare their countries’ health systems for transition. Member states using a “clinical modification” of ICD are likely to take longer to develop, test and roll out a country specific adaptation.

There is no mandatory implementation date — member states will migrate to ICD-11 at their own pace and according to their countries’ specific timelines, requirements and resources.

Global adoption will likely be a patchy and prolonged process and for a period of time, WHO will be accepting data recorded using both ICD-10 and the new ICD-11 code sets.

No countries have announced implementation schedules. NHS Digital says:

NHS Digital – ICD-11 Launch

“…No decision has been made for the implementation of ICD-11 in England, however NHS Digital plan to undertake further testing of the latest release and supporting products that will inform a future decision.”

In the meantime, the mandatory classification and terminology systems for use in the NHS are ICD-10* and SNOMED CT UK Edition**.

*NHS currently mandating ICD-10 Version: 2015.
**Read Codes (CTV-2 and CTV-3) are retired. SNOMED CT became the mandatory terminology system for use in NHS primary care in April 2018. Secondary Care, Acute Care, Mental Health, Community systems, Dentistry and other systems used in the direct management of care of an individual are scheduled to adopt SNOMED CT as the mandatory clinical terminology before 1 April 2020.

Key links

ICD-11 launch News Release

Launch information and short videos: ICD-11: Classifying disease to map the way we live and die

A dedicated website for ICD-11 information has been launched: https://icd.who.int

ICD-11 Beta Draft becomes ICD-11 Maintenance Platform

The orange ICD-11 Beta drafting platform is renamed to the “ICD-11 Maintenance Platform” and will remain in the public domain as a “work in progress” between stable releases.

The content on the orange platform will change as the substantial backlog of earlier proposals and new proposals submitted since the June 2018 release are processed.

An approved proposal for an addition or other change won’t immediately be reflected in the released version of the ICD-11 MMS but carried forward for eventual incorporation into a later release, according to the update cycle for that particular class of change.

There is a current backlog of over 1000 proposals waiting to be processed. New comments and proposals will continue to be accepted (see Annex 3.7 of the Reference Guide for maintenance and update schedules and guidance on submitting new proposals).

(If you were registered with the Beta drafting platform for access to the Comments function and Proposals Mechanism your account will work for the Maintenance Platform and you will be able to access historical comments and proposals.)

The maintenance and update of ICD-11 will be advised by the Classifications and Statistics Advisory Committee (CSAC); the Medical and Scientific Advisory Committee (MSAC); the Mortality Reference Group; the Morbidity Reference Group; and the Functioning and Disability Reference Group.

It is currently unclear in which year the first update cycle is anticipated to start, i.e., whether the next stable version would be released in January 2020, or in a later year.

The ICD Revision Topic Advisory Groups and sub working groups ceased operations in October 2016 and the Joint Task Force is expected to be stood down later this year.

The ICD-11 Maintenance Platform displays both the Foundation Component and the combined Mortality and Morbidity Statistics linearization:


The ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) 2018 version is on a new blue platform:


This platform currently displays only the MMS Linearization codes, not the Foundation Component which contains all the ICD entities. As released in June 2018, the content is planned to remain stable until January 2019, in preparation for presentation at the May 2019 World Health Assembly.

There is a coding tool here:

ICD-11 Coding Tool Mortality and Morbidity Statistics (MMS) 2018:


The ICD-11 Reference Guide (the equivalent of ICD-10’s Volume 2) is here:


(At the time of publication, there is no PDF version of the Reference Guide only an html version.)

What hasn’t been released yet?

Not all disorder “Descriptions” texts and other “Content Model” parameters have been populated and the full ICD-11 implementation package isn’t completed.

An updated ICD Revision information page states: “A suite of tools and functionality facilitate implementation and use of ICD-11.” But not all the tools and other materials listed under the Implementation Support tab are currently available.

The list also mentions “Specialty versions” but none of these are available; for example, the ICD-11 Clinical descriptions and diagnostic guidelines for Mental and Behavioural Disorders (the equivalent to ICD-10’s “Blue Book”) hasn’t been released yet.

This companion publication provides expanded clinical descriptions, differential diagnoses, diagnostic guidelines and codes for the categories in Chapter 06: Mental, behavioural and neurodevelopmental disorders including: “Essential (Required) Features, Boundaries with Other Disorders and Normality, and Additional Features sections. Additional sections (e.g., Culture-Related Features).”

Practitioners who have signed up to the Global Clinical Practice Network have had the opportunity to review and comment on drafts of the full clinical description and diagnostic guideline texts but drafts have not been available for public stakeholder review.

It’s not known whether this specialty mental disorder publication is planned to be released later this year or if the content cannot be finalized until after the ICD-11 MMS code sets have been ratified, in May 2019.

ICD-11 PHC: the revision of the 1996 publication: Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version (aka “ICD-10 PHC”) has not been released, either.

Drafts of the full texts for the disorder descriptions, as currently proposed for the 27 mental disorders for inclusion in ICD-11 PHC, are not available for public stakeholder scrutiny. There is no publicly available timeline for the finalization and release of ICD-11 PHC nor is it clear whether any additional field trials are in progress or have been recommended. NB: This publication will not be mandatory for use by WHO member states and it does not override the ICD-10 and ICD-11 code sets.

Additional materials

Brief Report from the Director-General: World Health Organization, EXECUTIVE BOARD EB143/13, 143rd session April 9, 2018, Provisional agenda item 5.2: International Statistical Classification of Diseases and Related Health Problems: update on the eleventh revision: http://apps.who.int/gb/ebwha/pdf_files/EB143/B143_13-en.pdf

Presentation Slides: ICD 11th revision, Member State Information Session Geneva, May 14, 2018, Dr John Grove, Director, Department of Information, Evidence, and Research, WHO and Dr Robert Jakob, Team Lead, Classifications, Terminologies and Standards, WHO https://dxrevisionwatch.files.wordpress.com/2018/05/icd11.pdf

Audio file from WHO Press Conference: June 14, 2018, Release of ICD-11 – the 11th revision of the International Classification of Disease, Dr Shekhar Saxena, Director, Department for Mental Health and Substance Abuse, WHO, Dr Robert Jakob, Team Lead, Classifications, Terminologies and Standards, WHO

Mp3 audio file [39:25 min]:


Presentation by Dr Michael First: Differences Between ICD-11 Classification of Mental & Behavioural Disorders and DSM-5. Nasjonal kompetansetjeneste ROP, Published July 20, 2018 [32:38 mins]


Comparison of SSD, BDD, BDS, BSS in classification systems

Post #338 Shortlink: https://wp.me/pKrrB-4ni

The World Health Organization (WHO) released the next edition of the International Classification of Diseases (ICD-11) on June 18.

WHO news release.

ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) version 2018 is an “advance preview” that will allow countries to plan for implementation, prepare translations and begin training health professionals.

No countries will be ready to transition from ICD-10 to ICD-11 for several years. The new edition is scheduled to be presented at the World Health Assembly (WHA) in May 2019 for adoption by Member States, but WHA endorsement won’t come into effect until January 1, 2022.

After that date, Member States can begin using the new edition for data reporting but there is no mandatory implementation date and for a period of time, the WHO will be collecting data recorded using both ICD-10 and the new ICD-11 code sets.

I’ll be posting key links and information on the release of this “advance preview” in future posts. In the meantime, here’s the current schedule:


Bodily distress disorder

For the main edition of ICD-11, most of ICD-10’s Somatoform disorders and Neurasthenia have been replaced with a single new diagnostic category called Bodily distress disorder [1].

The Bodily distress disorder term was added to the ICD-11 drafting platform in early 2012 and has been the only disorder construct under consideration for the main edition of ICD-11 [2][3].



We are still seeing a good deal of confusion between ICD-11’s defining of Bodily distress disorder (BDD) and Per Fink’s Bodily distress syndrome (BDS) disorder construct [4][5].

To assist stakeholders in navigating the complexities of nomenclature and classification, Dx Revision Watch and Mary Dimmock have prepared a document comparing the key features of:

DSM-5’s Somatic symptom disorder (SSD)

ICD-11’s Bodily distress disorder (BDD)

Fink et al. (2010) Bodily distress syndrome (BSD)

Bodily stress syndrome (BSS), as proposed for the ICD-11 PHC


You can download a copy of the comparison table and notes, here:

Comparison of SSD, BDD, BDS, BSS in classification systems

Version 1 | July 2018

Download PDF

Click to access comparison-of-ssd-bdd-bds-bss-in-classification-systems-v1.pdf



1 Creed F, Gureje O. Emerging themes in the revision of the classification of somatoform disorders. Int Rev Psychiatry. 2012 Dec;24(6):556-67. doi: 10.3109/09540261.2012.741063. [PMID: 23244611]

2 Gureje O, Reed GM. Bodily distress disorder in ICD-11: problems and prospects. World Psychiatry. 2016 Oct;15(3):291-292. doi: 10.1002/wps.20353. [PMID: 27717252]

3 ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) 2018 Release, Version for preparing implementation. Accessed July 20, 2018 https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f767044268

4 Fink P, Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res. 2010 May;68(5):415-26. [PMID: 20403500]

5 Syndromes of bodily distress or functional somatic syndromes – Where are we heading. Lecture on the occasion of receiving the Alison Creed award 2017, Fink, Per. Journal of Psychosomatic Research, Volume 97, 127 – 130
Lecture slides: http://www.eapm2017.com/images/site/abstracts/PLENARY_Prof_FINK.pdf

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