Evolution of diagnoses in ICD-11: the sample case of trauma- and stress-associated disorders

<h3>Biography</h3> Andreas Maercker, PhD, MD, completed his medical and psychological education in Halle/Saale and Berlin. He received his MD at Humboldt University and his PhD at Max Planck Institute for Human Development in Berlin. After academic positions in Dresden and Trier, he was appointed 2005 as chair and full professor of Psychopathology and Clinical Intervention at the University of Zurich. He is co-director of the Institute’s outpatient clinic services. Professor Maercker is or has been principal and co-investigator in numerous national and international studies in traumatic stress research, clinical geropsychology, and internet-assisted mental health and has published more than 200 peer review articles. From 2011–2018 he chaired a work group at WHO for revising the International Classification of Diseases in the area of trauma- and stress-related disorders. From 2017 he chairs the Historical Commission of the German Psychological Society on Stasi psychology in the former East Germany. He authored or edited 14 scientific or therapeutic books. Keywords characterizing the expertise: PTSD, stress-response syndromes, lifespan developmental psychopathology, treatment, e-mental health. In 2017, he was awarded the highest order in Germany, the Federal Cross of Merit, as well as the Wolter de Loos Award for Distinguished Contribution to Psychotraumatology in Europe from the European Society for Traumatic Stress Studies for his scientific work. Two new trauma- and stress-related diagnoses have been added to the ICD-11: complex PTSD and prolonged grief disorder (PGD) - in addition to the existing PTSD and the newly defined adjustment disorder (AjD). There are also many other disorders that can be the result of traumatic or stressful experiences. My contribution has three parts: (1) I describe how the World Health Organization developed the completely new and redefined disorders about 5 years ago. This took place in several processes, including involving you as clinicians and asking you about your needs when diagnosing. In validating these diagnoses and their new clinical assessment tools, machine learning algorithms were also used. (2) New psychopathological symptoms emerged, such as preoccupations for PGD or AjD, and yearning symptoms for PGD. These symptoms enrich the diagnostic possibilities. There are also cultural particularities for some of the new diagnoses, which were deliberately included as part of the development of ICD-11. This also makes the ICD-11 more applicable to patient groups from other regions of the world. (3) Based on which diagnostic algorithms should the old and new diagnoses be assigned? In this section, I will give a brief overview of findings with AI assistance in this area and try to summarize their possibilities and limitations. However, my focus in this part will be on the problems with applying pan-cultural diagnostic algorithms in the mental health field and that alternative concepts such as ‘cultural scripts of trauma sequelae disorders’ are an equally promising new development.