June 18, 2018
3 min read

ICD-11 updates resistance codes, adds gaming as addictive disorder

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WHO previewed a new International Classification of Diseases, ICD-11, which includes updates to codes related to antimicrobial resistance, adds gaming as an addictive disorder and categorizes gender incongruence as a matter of sexual health, not a mental health condition.

The ICD serves as a foundation for identifying global health trends and statistics and contains approximately 55,000 unique codes for injuries, diseases and causes of death, offering a common language that enables health care providers to share health information around the world, according to WHO. It has not been revised in nearly 3 decades.

WHO said it will present ICD-11 for adoption by member states at the World Health Assembly in May 2019. It will take effect on Jan. 1, 2022. The preview gives member states time to plan how to use the updated version, formulate translations and train health professionals on its use. ICD-10, which was endorsed in 1990, is used in more than 120 countries.

Robert Jakob, MD, WHO team leader for classifications, terminologies and standards, said ICD-11 “will provide better data at a lower cost.”

“This means that, for example, research can finally regroup conditions in a way that is correspondent to current knowledge to improve treatment, which means patient safety events can be recorded better than ever before,” he said during a news briefing.

Image of doctor reviewing notes.
ICD-11 will update codes for antimicrobial resistance and add gaming as an addictive disorder.
Source: Shutterstock.com

ICD-11 has taken more than a decade to compile and significantly improve on earlier editions, WHO said. The new version is completely electronic, offers a more user-friendly format and is the result of unprecedented involvement by health care workers.

According to WHO, the ICD is a valuable resource for health insurers whose reimbursements are based on ICD coding, as well as national health program managers, data collection specialists and others who monitor and allocate health care funds. It reflects advances in medicine and scientific understanding. For example, codes pertaining to antimicrobial resistance are now more closely aligned with the Global Antimicrobial Resistance Surveillance System, WHO said. According to Jakob, the section on HIV also has been significantly updated.

“The HIV subdivisions in the old classification have pretty much been old knowledge 30 years ago,” he said. “Now we have corresponding stages, and the stages are so important for the treatment guidelines for individuals.”

ICD-11 features new chapters, including one on traditional medicine, which has never been classified in the system. A chapter on sexual health recategorizes certain conditions, such as gender incongruence, which was formerly listed as a mental health condition.

“In ICD-11, with a better understanding of the issues surrounding this condition, we know that this is not actually related to a mental health condition,” Lale Say, MD, WHO coordinator for adolescents and at-risk populations, said in the briefing. “Gender incongruence is now moved out of the mental health chapter and into the newly created sexual health chapter.”

Shekhar Saxena, MD, director of WHO’s Department of Mental Health and Substance Abuse, said significant changes have been made to the mental health section.

“There is a complete reordering of categories,” Saxena said in the briefing. “We have discarded the mind/body dualism by aggregating some of the disorders which have either functional or so-called organic pathologies. For example, sleep and sexual dysfunction.”

He said the classification of personality disorders has also been reorganized, and the classification of substance use disorders has been expanded. Notably, the section on addictive disorders will now include a listing for gaming disorder. Previously, only gambling disorder was included.

“What do we mean by gaming disorder? It’s a disorder which is characterized by impaired control over digital or video gaming, and increased priority given to other activities, to the extent that gaming takes precedence over other interests or daily activities,” Saxena said. – by Jennifer Byrne

Disclosures: Jakob, Saxena and Say report no relevant financial disclosures.


WHO. Classification of Diseases (ICD). 2018. http://www.who.int/classifications/icd/en/. Accessed June 18, 2018.