Integrative Dimensional Personality Inventory for ICD-11: Development and Evaluation in the Peruvian Correctional Setting / Inventario Integrativo de la Personalidad Dimensional para la CIE-11: desarrollo y evaluación en el sistema penitenciario peruano

Abstract Background: Personality disorder (PD) is an important predictor of the commission of crimes; however, there is a lack of clinical instruments adjusted to the characteristics of Peruvian convicts. Objective: To develop a reliable and valid comprehensive personality measurement instrument, the Integrative Dimensional Personality Inventory, ICD-11 version (IDPI-11), according to the standards of the International Classification of Diseases (ICD-11). Method: A stratified simple of prisoners from the Huancayo Penitentiary (HP) was selected (n study 1 = 60; n study 2 = 1095). Results: High reliability indices(McDonald's _ _ .73) and adequate levels of content validity(CVI-S ≥ .87), construct validity, and criterion validity of the scales were found. This could explain the probability (a) of belonging to the group of inmates with instrumental or impulsive crimes (R2 N ≥ .52, OR ≥ 1.02, p ≤ .021), and (b) that recidivism, designated by the prison security level imposed, increases (R2≥ .53, β ≥ 1.16, p ≤ .008). Conclusions: The instrument is a valid and reliable measure that allows a dimensional and integrative assessment of the personality of convicts of the HP, according to ICD-11 standards

Resumen Antecedentes: el trastorno de la personalidad (TP) es un predictor importante en la comisión de delitos; sin embargo, existe una ausencia de instrumentos clínicos para las características del convicto peruano. Objetivo: desarrollar un instrumento de medición integral de la personalidad confiable y válido, el Inventario Integrativo de Personalidad Dimensional versión CIE-11 (IDPI-11), según los estándares de la Clasificación Internacional de Enfermedades (CIE-11). Método: se utilizó una muestra estratificada de reclusos del Establecimiento Penitenciario de Huancayo (EPH) (n estudio 1 = 60; n estudio 2 = 1095). Resultados: se encontraron altos índices de confiabilidad (ω de McDonald ≥ .73) y niveles adecuados de validez de contenido (CVI-S ≥ .87), constructo y criterio de sus escalas, pudiendo explicar la probabilidad de: (a) pertenecer al grupo de internos con delitos instrumentales o impulsivos (R2≥ .52, OR ≥ 1.02, p ≤ .021);y(b) que la tendencia a reincidir, designada por el grado de seguridad penitenciaria impuesto, aumente (R2 ≥ .53, β ≥ 1,16, p ≤ .008). Conclusiones: el instrumento construido es una medida válida y confiable que permite una evaluación dimensional e integrada de la personalidad del convicto de la EP de Huancayo, de acuerdo con los estándares de la CIE-11.

Similarities and differences in the diagnostic criteria of ICD-11 and DSM-5 for sexual dysfunction / 四川精神卫生

The purpose of this paper is to compare the similarities and differences between the diagnostic criteria of sexual dysfunction in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） and the International Classification of Diseases， eleventh edition （ICD-11）. Sexual dysfunction is the inability of adults to experience various forms of satisfactory sexual performance. In this paper， the main diagnostic points of sexual dysfunction in both manuals are summarized and compared with a view to assisting psychiatric and psychological workers to acquire a better understanding of the corresponding sections.

Similarities and differences between the diagnostic criteria of ICD-11 and DSM-5 for somatic symptoms and related disorders / 四川精神卫生

The purpose of this paper is to compare the similarities and differences between the diagnostic criteria for somatic symptoms and related disorders in the International Classification of Diseases， eleventh edition （ICD-11） and the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）. The clinical features of somatic symptoms and related disorders are prominent somatic symptoms that cause significant functional impairment and suffering. This paper discusses the similarities and differences between the two diagnostic systems in order to facilitate mastery of the corresponding content.

Similarities and differences between the diagnostic criteria of ICD-11 and DSM-5 for feeding and eating disorders / 四川精神卫生

The purpose of this paper is to discuss the similarities and differences between the diagnostic criteria of feeding and eating disorders in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） and International Classification of Diseases， eleventh edition （ICD-11）. Feeding and eating disorders are clinically characterized by persistent disturbances in feeding or food-related behaviors that result in altered food consumption or absorption and significant impairment in physical health or social function. This paper discusses the similarities and differences of feeding and eating disorders in the two diagnostic manuals， in order to improve psychiatric and psychological workers’ understanding of the corresponding sections.

Similarities and differences between the diagnostic criteria of ICD-11 and DSM-5 for elimination disorders / 四川精神卫生

The purpose of this paper is to discuss the similarities and differences between the diagnostic criteria of elimination disorders in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） and International Classification of Diseases， eleventh edition （ICD-11）. Elimination disorders are clinically characterized by inappropriate urination or defecation， resulting in pain or functional impairment. This paper discussed the main points of elimination disorders in the two diagnostic manuals， in order to improve psychiatric and psychological workers’ understanding of the corresponding sections.

Similarities and differences between the diagnostic criteria of ICD-11 and DSM-5 for sleep-wake disorders / 四川精神卫生

This paper aims to discuss the similarities and differences between the diagnostic criteria for sleep-wake disorders in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） and International Classification of Diseases， eleventh edition （ICD-11）. Sleep-wake disorders are characterized by the unsatisfactory quality， quantity and circadian rhythm of sleep， leading to daytime distress and impaired social functioning. Therefore， the main diagnostic points of sleep-wake disorders in both manuals are summarized and compared in this study， in order to assist psychiatric and psychological workers to acquire a better understanding of the corresponding sections.

Report on the 9th MHLW ICF Symposium"Looking to a New Stage of ICD-11 and ICF Utilization - Toward a Common Language in Various Fields" / 全日本鍼灸学会雑誌

The International Classification of Functioning, Disability and Health (ICF), adopted by WHO in 2001, is an evolution of the International Classification of Impairments, Disabilities and Handicaps (ICIDH). It is a model that integrates the levels of 1) body function and structures, 2) activity, and 3) participation, and uses a holistic approach by focusing on the health of the entire body with an emphasis on the positive aspects of being able to do things. In May 2019, the WHO General Assembly adopted ICD-11, revised after 30 years, and for the first time introduced the classification of diseases used in traditional medicine. A symposium organized by the Ministry of Health, Labour and Welfare of Japan (MHLW) was held online on February 20, 2021, and is reported here.

Caracterización del trastorno por videojuegos: ¿Una problemática emergente? / Characterization of Gaming Disorder: An Emerging Problem? / Caracterização do transtorno pelos videojogos: um problema emergente?

Resumen Objetivo. Sistematizar la literatura actual disponible en torno a la caracterización del trastorno por videojuegos (VDJ), aportando a la comprensión de este fenómeno en el contexto latinoamericano y su incidencia en la población infanto-juvenil. Método. Se utilizó una revisión sistemática de literatura, de corte analítico. Como eje de búsqueda se consideraron las categorías: (a) uso de las TIC, (b) videojuegos, (c) adicción y (d) trastorno por videojuegos, de acuerdo con estudios publicados en las bases de datos PubMed, ScienceDirect y Google Scholar, teniendo como referencia el DSM-V y CIE-11. Resultados. Las manifestaciones clínicas descritas para su uso adictivo son aún heterogéneas. También, se pudo observar que, cuanto más temprano se empieza, mayor será la frecuencia de su uso en edades posteriores, lo que aumenta las conductas de riesgo en el futuro y su incidencia en el tiempo de ocio y la recreación cotidiana. Conclusión. Los efectos que puede generar el uso problemático de dispositivos tecnológicos en el desarrollo de las personas, se contrapone al uso de los VDJ en el tratamiento de diversos trastornos como en el plano educativo. Adicionalmente, se reafirma el desafío de construir saberes e investigaciones multidisciplinares en torno al uso problemático de estos dispositivos.

Abstract Objective. Systematize the current literature available on the characterization of video game disorder, in order to contribute to the understanding of this phenomenon in the Latin American context and its incidence in the child/youth population. Method. A systematic review and analysis of the literature was used. The following categories were considered lines of inquiry: (a) use of ICT, (b) video games, (c) addiction and (d) video game disorder, according to studies published in the PubMed, ScienceDirect and Google Scholar databases, having the DSM-V and ICD-11as references. Results. The clinical manifestations of its addictive use are still heterogeneous. Also, it was observed that the earlier it starts, the greater the frequency of its use in later ages, which increases risk behaviors in the future and its incidence in leisure time and daily recreation. Conclusion. The effects that the problematic use of technological devices can generate in the development of individuals are contrasted to the use of video games in the treatment of various disorders, such as in the educational field. Additionally, the challenge of building knowledge and multidisciplinary research around the problematic use of these devices is reaffirmed.

Resumo Escopo. Sistematizar a literatura atual disponível sobre a caracterização do transtorno pelos videojogos (VDJ), aportando à compreensão de este fenômeno no contexto latino-americano e sua incidência na população infanto-juvenil. Metodologia. Foi empregada uma revisão sistemática de literatura, de corte analítico. Como eixo de procura foram consideradas as categorias: a) uso das TIC, b) Videojogos, c) Vício e d) transtorno pelos videojogos, de acordo com estudos publicados nas bases de dados PubMed, ScienceDirect e Google Scholar, tendo como referencia o DSM-V e C1E-11. Resultados. As manifestações clínicas descritas para o seu uso aditivo ainda são heterogéneas. Também, foi observado que, quanto mais cedo começar, maior será a frequência do seu uso em idades posteriores, o que aumenta as condutas de risco no futuro e sua incidência no tempo de ócio e a recreação cotidiana. Conclusão. Os efeitos que pode gerar o uso problemático de dispositivos tecnológicos no desenvolvimento das pessoas, está contraposto ao uso dos VDJ no tratamento dos diversos transtornos como no plano educativo. Além do mais, é reafirmado o desafio de construir saberes e pesquisas multidisciplinares sobre o uso problemático de estes dispositivos.

The first instrument for complex PTSD assessment: psychometric properties of the ICD-11 Trauma Questionnaire

Objective: The ICD-11 Trauma Questionnaire (ITQ) was developed as a joint effort by researchers from several countries to evaluate post-traumatic stress (PTSD) and complex-PTSD (C-PTSD) symptoms. This study is part of a multi-center international collaborative research project that aims to provide psychometric support for this initial instrument in different languages, considering the specific contexts related to complex traumatization. This study verified the psychometric characteristics of the Portuguese version of the ITQ, evaluating symptoms beyond those described the existing literature. Methods: We examined the results of a convenience sample totaling 268 Portuguese and Angolan participants. Two instruments were applied: the ITQ, which evaluates symptoms resulting from a traumatic life event, and the Life Events Checklist (LEC), which evaluates stressful life events. The general characteristics of the scales are described, and reliability analysis and validity studies were performed. Results: Cronbach's alpha varied between 0.84 and 0.88, and the exploratory factorial analysis results were consistent with the concept of C-PTSD, with five components explaining 61.58% of scale variance. Conclusion: The results suggest good psychometric characteristics for the Portuguese version of the ITQ, and thus it can be included in protocols intended evaluating complex traumatic symptoms.

A digital application for implementing the ICD-11 traditional medicine chapter / 中西医结合学报

On May 25, 2019, the World Health Assembly approved the eleventh revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), containing a chapter on traditional medicine. This means that the traditional East Asian medicine (TEAM) is now officially recognized as a part of mainstream medical practice. However, the patterns presented in the ICD-11 traditional medicine chapter are only the tip of the iceberg of TEAM clinical practice, and it will be necessary to supplement and upgrade the contents. In order to implement this, objectification and standardization of TEAM must be premised, and grafting with proper modern science and technology is imperative. Pattern Identification and Prescription Expert-11 (PIPE-11), which is a TEAM clinical decision support system, adopts vastly from clinical literature on pattern identification and the prescription. By adopting the rule-based reasoning method, the way of diagnosis and prescription by a TEAM practitioner in actual clinical practice is implemented as it is. PIPE-11 could support to improve both the accuracy of medical diagnosis and the reliability of the medical treatment of TEAM in clinical practices. In the field of research, it might facilitate the usage for reliable reference for symptoms and signs retrieval and patient simulation. In the field of education, it can provide a high level of training for learning pattern identification and prescription, and further be used to reinforce skills of diagnosis and prescription by providing self-simulation methods. Therefore, PIPE-11 as a digital application is expected to support the traditional medicine chapter of ICD-11 to successfully contribute to the improvement of human health.

Psychological distress among transgender people in Brazil: frequency, intensity and social causation - an ICD-11 field study

Objective: To describe self-reported experiences of gender incongruence related to discomfort and body changes to be more congruent to the desired gender, and to examine whether experiences of psychological distress related to gender identity were more strongly related to the experience of gender incongruence per se or to experiences of social rejection. Methods: This field study used a structured interview design in a purposive sample of transgender adults (aged >18 years or older) receiving health-care services in two main reference centers in Brazil. Results: A high proportion of participants (90.3%, n=93) reported experiencing psychological distress related to their gender identity and report having experienced social rejection related to their gender identity during the interview index period and that rejection by friends was the only significant predictor for psychological distress. Conclusions: Gender incongruence variables were not significant predictors of distress. This result supports the recent changes proposed by the Word Health Organization in ICD-11 to move transgender conditions from the Mental and Behavioral Disorders chapter to a new chapter on Sexual Disorders and Conditions Related to Sexual Health.

Notícias sobre a nova classificação das identidades trans: uma análise das fontes citadas em reportagens publicadas no Brasil / News about the recent classification of trans identities: an analysis of the sources cited in reports published in Brazil / Noticias sobre la nueva clasificación de las identidades trans: un análisis de las fuentes citadas en reportajes publicados en Brasil

A divulgação da décima primeira edição da Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde (CID-11), em junho de 2018, mereceu atenção da imprensa internacional e nacional. Nessa versão, as identidades trans deixaram de ser classificadas como doença mental e foram categorizadas como incongruência de gênero no novo capítulo relacionado à saúde sexual. Considerando que práticas discursivas conformam e são conformadas por práticas sociais e que o processo de despatologização é marcado pelos conceitos de medicalização e biomedicalização, este trabalho identifica e analisa as fontes citadas na cobertura jornalística produzida no Brasil. O objetivo é entender, a partir dos atores sociais que foram selecionados, entrevistados e citados como fontes, os sentidos construídos pelos principais jornais do país sobre o tema. Observa-se que fontes institucionais do campo da saúde concorrem com outras do campo jurídico, com representantes de movimentos sociais e pessoas trans, que falam por si.

The release of the eleventh edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) in June 2018 received international and national press coverage. In this version, transgender identities are no longer described as a mental health condition. Instead, they are classified as gender incongruence in the chapter on sexual health. Considering that discursive practices conform and are conformed by social practices and that the process of despatologization is marked by the concepts of medicalization and biomedicalization, this work identifies and analyzes the sources quoted in the journalistic coverage produced in Brazil. This study, focusing on social actors quoted as sources, aims to understand the meanings constructed by the main Brazilian newspaper about this subject. It concludes that institutional sources in the health field compete with others in the legal field, with members of social movements and trans people, who speak for themselves.

La divulgación de la undécima edición de la Clasificación Estadística Internacional de Enfermedades y Problemas relacionados con la Salud (CID-11), en junio de 2018, mereció atención de la prensa internacional y nacional. En esa revisión, las identidades trans dejaron de ser clasificadas como enfermedad mental y fueron categorizadas como incongruencia de género en el nuevo capítulo relacionado a la salud sexual. Considerando que las prácticas discursivas conforman y son conformadas por prácticas sociales y que el proceso de despatologización está marcado por los conceptos de medicalización y biomedicalización, este trabajo identifica y analiza las fuentes citadas en la cobertura periodística producida en Brasil. El objetivo es entender, a partir de los actores sociales que fueron seleccionados, oídos y citados como fuentes, los sentidos construidos por los principales diarios del país sobre el tema. Observa que fuentes institucionales del campo de la salud concurren con otras del campo jurídico, con representantes de movimientos sociales y personas trans, que hablan por sí.

Chapter 26 Traditional Medicine Included in ICD-11 has Been Released, Till Now and From Now On! / 日本東洋医学雑誌

According to the World Health Organization (WHO), mortality by age, sex, and cause of death is the foun­dation of public health both globally and domestically. Comparable mortality statistics over time and investi­gations of mortality were used to develop the International Statistical Classification of Diseases and Related Health Problems (ICD). In the ICD, the WHO states that morbidity statistics are also an essential foundation of public health, but they are much less widely applied. The 10th revision of the ICD (ICD-10) is now in use, but further revisions must be made in the development of the 11th revision (ICD-11) to capture advances in health science and medical practice, to make better use of the digital revolution, and to evaluate traditional medicine (TM). Revision of ICD-10 began in 2007, and an ICD-11 version for preparing implementation was released on July 18, 2018. ICD-11 features a new TM chapter on Japanese traditional medicine, known as Kampo medicine, traditional Chinese medicine, and Korean medicine. ICD-11 will be approved at the next World Health Assembly in May 2019 and will come into effect. This means that the WHO does not currently recognize the effects of TM, but that we as well as the WHO will have hard time to prepare and study the effects of TM on morbidity statistics. It is very important to the study of Kampo medicine that we will be able to properly evaluate the terms and classifications contained in ICD-11.

Una nueva propuesta de clasificación de los trastornos de personalidad: la clasificación internacional de enfermedades CIE-11 / A new proposal to classifying personality disorders: the international classification of diseases ICD-11

Resumen La clasificación formal de los trastornos de personalidad se remonta a los cuatro humores descritos por Hipócrates, pero el proceso iniciado por la OMS tiene como meta un cambio fundamental de conceptualización en el CIE-11. La clasificación categorial se reemplaza en su totalidad por una clasificación dimensional amplia. 1) Se entregan los criterios generales de un trastorno de personalidad; 2) se diferencian tres niveles de severidad; 3) a continuación se evalúan cinco dominios de rasgos: afectividad negativa, alejamiento, disociabilidad, desinhibición y anancasmo. Otros calificadores, como alteraciones del sí como también de relaciones interpersonales, se dejan para el futuro para probablemente ser usados por los especialistas. La propuesta de clasificación de trastornos de la personalidad del CIE-11 se muestra como capaz de ser efectuada por clínicos muy ocupados a través de diversos países y medios clínicos, y también se alinea con la sección III del DSM-5.

Formal classification of personality disorders are linked to the hippocratic four humors but the process initiated by the WHO aims at a fundamental change of conceptualizing in ICD-11. The categorial classification is completely replaced by a widely dimensional classification. 1. General criteria of a personality disorder are given; 2. three severity levels are differentiated; 3. five trait domains are evaluated: negative affectivity, detachment, dissociality, desinhibition and anankastia. Other qualifiers such as functional impairments of the self as well as of interpersonal relationships are probably only to be used in the future in the expert setting. The proposed ICD-11 personality disorder classification seem parsimonious and feasible for busy practitioners across countries and clinical settings and also alining with DSM-5 section III system.

Characteristics and progress of International Disease Classification on ICD-11 / 中华医院管理杂志

The authors described the purpose of the creation, the structure of the basic model, and the changes in the chapters of ICD-11, and analyzed its differences with ICD-10, as well as its unique advantages and current progress. The revision of ICD-11 is closely related to the development of modern medicine. It features more elaborate expression of diseases and informatization of classification tools, making it better fitting the development of medical and health information big data and facilitating the global collection and application of medical information data.

Chronic Unexplained Vomiting: A Case Report With Focus On Issues Relevant For International Classification Of Disease (LCD)-11

Current classificatory systems subsume the psychogenic vomiting as a form of eating disorder, in spite of several obvious differences. Given the clinical presentation, vomiting associated with psychological factors as a solitary symptom merits clinical and research attention. Methods: The paper discusses a case with psychogenic vomiting presenting to child and adolescent psychiatric clinic at a tertiary care hospital, All India Institute of Medical Sciences (AIIMS) New Delhi, India. Results: It adds to the scarce reports on vomiting of psychogenic origin, and adds a newer perspective on diagnostic issues. Conclusion: Psychogenic vomiting might warrant recognition as an entity independent from eating disorders. ASEAN Journal of Psychiatry, Vol. 18 (1): January – June 2017: XX XX.

Social Function in Patients with Personality Disorder Diagnosed by Single Dimensional Severity Using Korean Version of Social Functioning Questionnaire / 신경정신의학

OBJECTIVES: The aims of this study were to examine validity and reliability of the Korean version of the Social Function Questionnaire (SFQ) and evaluated social function with SFQ in patients with personality disorder. METHODS: The SFQ was administered to 186 psychiatric patients (155 patients with personality disorder and 31 patients without personality disorder), and 22 healthy men were recruited to examine the test-retest reliability of SFQ. The severity of personality disorders was determined using the proposed the International Classification of Diseases (ICD)-11th revision (ICD-11) personality disorders. All participants completed the NEO-Five Factor Inventory, Beck Depression Inventory, and Spielberger State and Trait Anxiety Inventory to examine the convergent validity of SFQ. RESULTS: The Korean version of the SFQ showed good internal consistency (Cronbach's alpha=0.811) and test-retest reliability (r=0.746). Patients with personality disorder had more social dysfunction than those without personality disorder. A graded increase in social dysfunction was observed with increasing severity of personality disorder. Social dysfunction showed a strong linear relationship with the 5 factor model. CONCLUSION: The Korean version of the SFQ has good psychometric properties. The results of our study support the severity classification of personality disorder integrated to upcoming ICD-11.

Stereotyped movement disorder in ICD-11

According to current proposals for ICD-11, stereotyped movement disorder will be classified in the grouping of neurodevelopmental disorders, with a qualifier to indicate whether self-injury is present, similar to the classification of stereotypic movement disorder in DSM-5. At the same time, the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders has proposed a grouping of body-focused repetitive behavior disorders within the obsessive-compulsive and related disorders (OCRD) cluster to include trichotillomania and skin-picking disorder. DSM-5 has taken a slightly different approach: trichotillomania and excoriation (skin picking) disorder are included in the OCRD grouping, while body-focused repetitive behavior disorder is listed under other specified forms of OCRD. DSM-5 also includes a separate category of nonsuicidal self-injury in the section on “conditions for further study.” There are a number of unresolved nosological questions regarding the relationships among stereotyped movement disorder, body-focused repetitive behavior disorders, and nonsuicidal self-injury. In this article, we attempt to provide preliminary answers to some of these questions as they relate to the ICD-11 classification of mental and behavioral disorders.

Obsessive-compulsive disorder for ICD-11: proposed changes to the diagnostic guidelines and specifiers

Since the approval of the ICD-10 by the World Health Organization (WHO) in 1990, global research on obsessive-compulsive disorder (OCD) has expanded dramatically. This article evaluates what changes may be needed to enhance the scientific validity, clinical utility, and global applicability of OCD diagnostic guidelines in preparation for ICD-11. Existing diagnostic guidelines for OCD were compared. Key issues pertaining to clinical description, differential diagnosis, and specifiers were identified and critically reviewed on the basis of the current literature. Specific modifications to ICD guidelines are recommended, including: clarifying the definition of obsessions (i.e., that obsessions can be thoughts, images, or impulses/urges) and compulsions (i.e., clarifying that these can be behaviors or mental acts and not calling these “stereotyped”); stating that compulsions are often associated with obsessions; and removing the ICD-10 duration requirement of at least 2 weeks. In addition, a diagnosis of OCD should no longer be excluded if comorbid with Tourette syndrome, schizophrenia, or depressive disorders. Moreover, the ICD-10 specifiers (i.e., predominantly obsessional thoughts, compulsive acts, or mixed) should be replaced with a specifier for insight. Based on new research, modifications to the ICD-10 diagnostic guidelines for OCD are recommended for ICD-11.

Hoarding disorder: a new diagnostic category in ICD-11?

Despite the long-held view that hoarding is a symptom of both obsessive-compulsive disorder and obsessive-compulsive personality disorder, increased evidence has emerged during the last 20 years suggesting that hoarding represents a distinct form of psychopathology. This study reflects the discussions on the nosological status of hoarding carried out by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. The distinctiveness of hoarding is based on its having core symptoms that differ from those of other disorders, as well as distinctive neurobiological correlates and treatment responses. Furthermore, data showing the clinical utility, global applicability, and appropriateness of the concept of hoarding disorder outside specialty mental health settings suggest that this condition should be included in ICD-11. Finally, given the focus of ICD-11 on primary care and public health, the Working Group suggests that poor insight and severe domestic squalor may be considered as specifiers for hoarding disorder in ICD-11.