Randomized Controlled Trial

. 2019 May 14;17(1):93.

doi: 10.1186/s12916-019-1327-4.

The classification of feeding and eating disorders in the ICD-11: results of a field study comparing proposed ICD-11 guidelines with existing ICD-10 guidelines

Angélica M Claudino¹, Kathleen M Pike², Phillipa Hay³, Jared W Keeley⁴, Spencer C Evans⁵, Tahilia J Rebello⁶, Rachel Bryant-Waugh⁷, Yunfei Dai⁸, Min Zhao⁸, Chihiro Matsumoto⁹, Cecile Rausch Herscovici¹⁰, Blanca Mellor-Marsá¹¹, Anne-Claire Stona¹², Cary S Kogan¹³, Howard F Andrews¹⁴, Palmiero Monteleone^{15

16}, David Joseph Pilon¹⁷, Cornelia Thiels¹⁸, Pratap Sharan¹⁹, Samir Al-Adawi²⁰, Geoffrey M Reed^{21

22}

Affiliations

¹ Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Major Maragliano, 241, São Paulo, SP, 04017-030, Brazil. amclaudino@gmail.com.
² Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, Unit 9 Room 5808, 1051 Riverside Drive, New York, NY, 10032, USA. kmp2@cumc.columbia.edu.
³ Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, NSW Campbelltown, Australia.
⁴ Department of Psychology, Virginia Commonwealth University, 806 West Franklin St, Box 842018, Richmond, VA, 23284, USA.
⁵ Department of Psychology, Harvard University, 33 Kirkland St, 1040 William James Hall, Cambridge, MA, 02138, USA.
⁶ Global Mental Health Program, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, Mailman School of Public Health, 722 West 168th, Floor R2, R-233, New York, NY, 10032, USA.
⁷ Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH, UK.
⁸ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, People's Republic of China.
⁹ National Study Coordinator for ICD-11 Field Studies, ICD-11 Committee, Japanese Society of Psychiatry and Neurology, Hongo-Yumicho Building, 2-38-4, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
¹⁰ International Life Sciences Institute (ILSI, Argentina), J. Salguero 2745, Buenos Aires, 1425, CABA, Argentina.
¹¹ Department of Psychiatry, Faculty of Medicine, Universidad Autónoma de Madrid, Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental, 2ª Planta Norte, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain.
¹² Ministry for Solidarity and Health, Avenue Duquesne, 75350, Paris, France.
¹³ School of Psychology, Faculty of Social Sciences, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada.
¹⁴ Departments of Biostatistics and Psychiatry and New York State Psychiatric Institute, Columbia University, Vagelos College of Physicians and Surgeons, Unit 47, 1051 Riverside Drive, New York, NY, 10032, USA.
¹⁵ Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.
¹⁶ Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, via Allende, Baronissi, 84081, Salerno, Italy.
¹⁷ Nova Scotia Health Authority, Dalhousie University, LeMarchant Place, 2nd Floor, Rm 2121, 1246 LeMarchant Street, Halifax, NS, B3H 4R2, Canada.
¹⁸ Department of Social Studies, University of Applied Sciences Bielefeld, Kissinger Str. 14, D-12157, Berlin, Germany.
¹⁹ Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
²⁰ Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, P.C. 123, Al Khoud, Muscat, Sultanate of Oman.
²¹ Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
²² Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, Unit 9 Room 5816, 1051 Riverside Drive, New York, NY, 10032, USA.

PMID: 31084617
PMCID: PMC6515596
DOI: 10.1186/s12916-019-1327-4

Randomized Controlled Trial

The classification of feeding and eating disorders in the ICD-11: results of a field study comparing proposed ICD-11 guidelines with existing ICD-10 guidelines

Angélica M Claudino et al. BMC Med. 2019.

. 2019 May 14;17(1):93.

doi: 10.1186/s12916-019-1327-4.

Authors

Affiliations

¹ Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Major Maragliano, 241, São Paulo, SP, 04017-030, Brazil. amclaudino@gmail.com.
² Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, Unit 9 Room 5808, 1051 Riverside Drive, New York, NY, 10032, USA. kmp2@cumc.columbia.edu.
³ Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith South, 2751, NSW Campbelltown, Australia.
⁴ Department of Psychology, Virginia Commonwealth University, 806 West Franklin St, Box 842018, Richmond, VA, 23284, USA.
⁵ Department of Psychology, Harvard University, 33 Kirkland St, 1040 William James Hall, Cambridge, MA, 02138, USA.
⁶ Global Mental Health Program, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, Mailman School of Public Health, 722 West 168th, Floor R2, R-233, New York, NY, 10032, USA.
⁷ Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH, UK.
⁸ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, People's Republic of China.
⁹ National Study Coordinator for ICD-11 Field Studies, ICD-11 Committee, Japanese Society of Psychiatry and Neurology, Hongo-Yumicho Building, 2-38-4, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
¹⁰ International Life Sciences Institute (ILSI, Argentina), J. Salguero 2745, Buenos Aires, 1425, CABA, Argentina.
¹¹ Department of Psychiatry, Faculty of Medicine, Universidad Autónoma de Madrid, Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental, 2ª Planta Norte, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain.
¹² Ministry for Solidarity and Health, Avenue Duquesne, 75350, Paris, France.
¹³ School of Psychology, Faculty of Social Sciences, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada.
¹⁴ Departments of Biostatistics and Psychiatry and New York State Psychiatric Institute, Columbia University, Vagelos College of Physicians and Surgeons, Unit 47, 1051 Riverside Drive, New York, NY, 10032, USA.
¹⁵ Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.
¹⁶ Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, via Allende, Baronissi, 84081, Salerno, Italy.
¹⁷ Nova Scotia Health Authority, Dalhousie University, LeMarchant Place, 2nd Floor, Rm 2121, 1246 LeMarchant Street, Halifax, NS, B3H 4R2, Canada.
¹⁸ Department of Social Studies, University of Applied Sciences Bielefeld, Kissinger Str. 14, D-12157, Berlin, Germany.
¹⁹ Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
²⁰ Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, P.C. 123, Al Khoud, Muscat, Sultanate of Oman.
²¹ Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
²² Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, Unit 9 Room 5816, 1051 Riverside Drive, New York, NY, 10032, USA.

PMID: 31084617
PMCID: PMC6515596
DOI: 10.1186/s12916-019-1327-4

Abstract

Background: The World Health Organization (WHO) International Classification of Diseases and Related Health Problems (ICD) is used globally by 194 WHO member nations. It is used for assigning clinical diagnoses, providing the framework for reporting public health data, and to inform the organization and reimbursement of health services. Guided by overarching principles of increasing clinical utility and global applicability, the 11th revision of the ICD proposes major changes that incorporate empirical advances since the previous revision in 1992. To test recommended changes in the Mental, Behavioral, and Neurodevelopmental Disorders chapter, multiple vignette-based case-controlled field studies have been conducted which examine clinicians' ability to accurately and consistently use the new guidelines and assess their overall clinical utility. This manuscript reports on the results from the study of the proposed ICD-11 guidelines for feeding and eating disorders (FEDs).

Method: Participants were 2288 mental health professionals registered with WHO's Global Clinical Practice Network. The study was conducted in Chinese, English, French, Japanese, and Spanish. Clinicians were randomly assigned to apply either the ICD-11 or ICD-10 diagnostic guidelines for FEDs to a pair of case vignettes designed to test specific clinical questions. Clinicians selected the diagnosis they thought was correct for each vignette, evaluated the presence of each essential feature of the selected diagnosis, and the clinical utility of the diagnostic guidelines.

Results: The proposed ICD-11 diagnostic guidelines significantly improved accuracy for all FEDs tested relative to ICD-10 and attained higher clinical utility ratings; similar results were obtained across all five languages. The inclusion of binge eating disorder and avoidant-restrictive food intake disorder reduced the use of residual diagnoses. Areas needing further refinement were identified.

Conclusions: The proposed ICD-11 diagnostic guidelines consistently outperformed ICD-10 in distinguishing cases of eating disorders and showed global applicability and appropriate clinical utility. These results suggest that the proposed ICD-11 guidelines for FEDs will help increase accuracy of public health data, improve clinical diagnosis, and enhance health service organization and provision. This is the first time in the revision of the ICD that data from large-scale, empirical research examining proposed guidelines is completed in time to inform the final diagnostic guidelines.

Keywords: Anorexia nervosa; Avoidant-restrictive food intake disorder; Binge eating disorder; Bulimia nervosa; Clinical utility; Diagnosis and classification; Eating disorders; Feeding disorders; ICD-11; International classification of diseases.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

All study procedures were exempted from review by the World Health Organization Ethics Review Committee (Protocol ID RPC569) and by the Human Subjects Committee of the University of Kansas (HSCL #20804). University of Kansas servers hosted the survey system used in the study. All participants were presented with an online informed consent document describing the study and had to indicate their consent to participate in order to continue.

Consent for publication

Not applicable.

Competing interests

With the exception of Geoffrey M. Reed, the authors of this article were members of the ICD-11 Feeding and Eating Disorders Working Group, or members of or consultants to the ICD-11 Field Studies Coordination Group for Mental and Behavioral Disorders. Geoffrey M. Reed is a member of the Secretariat, WHO Department of Mental Health and Substance Abuse. The authors alone are responsible for the views expressed in this article, which do not necessarily represent the decisions, policy, or views of the World Health Organization.

Dr. Howard Andrews reports a grant from the WHO during the conduct of the study. Dr. Hay reports personal fees from Shire Pharmaceuticals, personal fees from Wesley Hospital Ashfield NSW, personal fees from NSW Health Education and Training, grants from CAPES Brazil, grants from NSW Health, personal fees from Australian Medical Council, other from BMC Publishing, outside the submitted work; and Member of the ICD-11 Working Group for eating disorders. Views in this paper are personal. Dr. Hay is author of some papers cited in this paper. Dr. Stona reports grants from the French Ministry of Health during the conduct of the study. Dr. Claudino reports grants from Janssen Cilag, Abbot, CAPES, and FAPESP during the conduct of the study. The other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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The classification of feeding and eating disorders in the ICD-11: results of a field study comparing proposed ICD-11 guidelines with existing ICD-10 guidelines

Affiliations

The classification of feeding and eating disorders in the ICD-11: results of a field study comparing proposed ICD-11 guidelines with existing ICD-10 guidelines

Authors

Affiliations

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical