#icd11

Sleep–Wake Disorders in ICD-11 are defined by persistent disturbances in sleep quantity, quality, timing, or regulation that cause clinically significant distress or functional impairment.

Importantly, ICD-11 classifies sleep–wake disorders in a separate chapter to reduce the artificial separation between “mental” and “physical” conditions. Sleep disturbance may occur as:

• A primary disorder (e.g., Insomnia Disorder)

• Secondary to another mental disorder (e.g., depression, bipolar disorder)

• Associated with medical or neurological conditions

Accurate diagnosis requires evaluating:

• Duration and persistence

• Adequate opportunity for sleep

• Daytime impairment

• Differential diagnosis

Sleep is a regulatory system — not just a behaviour.

Understanding classification improves assessment.

Assessment improves intervention.

Continuing the ICD-11 Sleep–Wake Series:

Next — Insomnia

I just wanted to try out talking about that experience. maybe someone will relate, or find it useful.

i don't really remember how my tics started. i have a tendency of not acknowledging my feelings and brushing things off. i have always been a little jumpy, so I just blamed my weird shrugs and other weird unwanted movements on being easily scared.

they got really bad after my 18th birthday. and soon i asked my parents to see a neurologist.

before that we had conversations about me seeing a specialist, but i didn't want to hear about it. i wanted to pretend that everything was normal.

i went to the neurologist privately. which means that i didn't have to wait too long for the visit but I had to pay for it. my school needed a confirmation that i do have that disorder for my final exams.

i was very stressed, but the doctor was super nice. i had prepared a whole document in which i described all my symptoms, with dates if i could remember them, what my tics feel like, what makes them worse, what makes them better, family history of tics, or similar conditions, etc.

she was really nice and understanding. i don't remember the specific questions that she asked, but something about what is distracting/difficult about them. stuff like that.

she asked me to close my eyes and touch my nose, or left ear, stuff like that. also she had a little stick (like the ones doctor use to look into someones throat) and she would lead it from my fingertips up to my shoulders. she also checked my knee jerk reaction.

over all it was more of a chat, than an actual physical test.

she gave me a prescription for a brain scan (magnetic resonance, which i couldn't do due to having braces, and we switched to an MRI with contrast) - nothing wrong with it, thank fuck. and she prescribed me medication. i fucking hated those meds. they were Awful.

I never got a diagnosis from her. She gave me meds, and reassurance that this is probably psychological, which was enough at the time. Even tho she was a really good neurologist, tics were not her speciality, so i tried another guy.

AND BOY O BOY

he was supposed to be the lead specialist on tic disorders in my country. and maybe he was.

i spend 4h traveling from my city to the capital, just so i could see him.

i knew that he would probably asked my father my childhood, so i was prepared that my dad would be present for a while during the visit. but no, the doctor ever asked him to go out of the room, after the conversation about my childhood ended (it was brief, i had no symptoms in childhood). the doctor would ask my dad about other stuff as well, stuff i could have easily have talked about myself.

and then he asked me about my self harm, and depression, and suicidal thoughts (with my father still present in the room). i answered truthfully, even tho I REALLY wanted to lie. i came out of that visit with my F95.9 diagnosis, and a bunch of other diagnosis like anxiety and stuff. and a prescription for anti-anxiety drugs that i never bought.

Well, part of that is because the diagnostic criteria's phrasing is pretty ableist. I can give you a quote from the most recent DSM (DSM-V TR, 2022) which is the book that professionals in the USA diagnose out of. I cannot give you the current criteria for ASPD outside of the US, because the ICD-11 has gotten rid of individual personality disorders in favor of a general "Personality Disorder" diagnosis with 3 severities but no clusters or individual disorders. I can give you the previous criteria from ICD-10, however.

(From DSM-V TR, 2022 - "Antisocial Personality Disorder, Diagnostic Criteria")

"A. A pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following: 1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest 2. Deceitulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. 3. Impulsivity or failure to plan ahead 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults. 5. Reckless disregard for safety of self or others 6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. 7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another B. The individual is at least age 18 years. C. There is evidence of conduct disorder with onset before age 15 years. D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder."

The important thing to remember is that the DSM specifically states it is not meant to be used like a cookbook, where a list of ingredients makes a final outcome. That is to say, having ASPD isn't as simple as having 3/7 of the numbered criteria and fitting the lettered criteria. There is nuance to understanding what ASPD looks like and feels like, the diagnostic and associated features sections, development criteria that must also make sense (aka what, as far as we currently know, are either genetics and/or environments that cause ASPD) within your life experience, as well as differential diagnosis to make sure the symptoms don't fit better elsewhere.

The associated features section of the DSM-V TR section on ASPD is fairly long, so I am unable to put all of that here.

The differential diagnosis section of the DSM specifically mentions a few types of disorders to look out for that may appear to be ASPD based on symptoms alone, which I can list here.

Substance Use Disorder: If someone would also qualify for a substance use disorder diagnosis, then ASPD is only diagnosed if ASPD symptoms were present from young childhood and to present day. Both can be diagnosed, even if both were present in childhood and adulthood, but it is not ASPD if no ASPD traits were shown in childhood prior to the use of substances.

Schizophrenia and Bipolar disorders: If ASPD symptoms are only present during episodes associated with Bipolar disorder (manic episodes) or Schizophrenia (psychosis), then that isn't considered ASPD.

Other Personality Disorders: ASPD *can* co-occur with other personality disorders, but you want to research all of them to be certain that it a different PD doesn't fit better than, rather than in addition to, ASPD.

(From ICD-10 Dissocial Personality Disorder)

"Personality disorder characterized by disregard for social obligations, and callous unconcern for the feelings of others. There is gross disparity between behaviour and the prevailing social norms. Behaviour is not readily modifiable by adverse experience, including punishment. There is a low tolerance to frustration and a low threshold for discharge of aggression, including violence; there is a tendency to blame others, or to offer plausible rationalizations for the behaviour bringing the patient into conflict with society."

(It is worth noting the word "gross" used in the phrase gross disparity is referring to a secondary definition of gross, meaning large/important/marked/prominent. They are not being bluntly ableist on main in the ICD).

In the ICD, they note exclusions, which I believe is similar to the differential diagnosis section in the DSM, for Emotionally Unstable Personality Disorder (BPD) and Conduct Disorders.

Overall, this criteria has its own serious issues for both versions, but it is the diagnosing criteria (current for the DSM and recent but not current for the ICD, as mentioned above) for Antisocial/Dissocial Personality Disorder and therefore needs to be a part of any research into self diagnosis.

I would highly recommend looking into the DSM entry itself for ASPD as it is lengthy but thorough (and yes, somewhat stigmatizing) in its explanation of how ASPD tends to present itself. Putting the term PDF after DSM-V TR definitely does (cough) not (cough) produce some results that would aid you in this, and idk why anyone would do that when there is a perfectly legal way to buy the DSM for over $100 for a PDF version.

I tried to put the ICD-11 diagnostic guidelines of PD in a checklist instead of a text

Note: in the ICD-11, the concept of multiple distinctly defined PDs has been abolished. There is one personality disorder that is diagnosed with a specifier of severity. A specifier noting what traits are associated with the PD can also be used

Personality Disorder

A. Problems in one or both of the following areas:

Functioning of aspects of the self

Interpersonal functioning

B. The disturbance has persisted for at least two years

C. The disturbance is manifest in patterns of cognition, emotional experience, emotional expression, and behaviour that are maladaptive (e.g., inflexible or poorly regulated)

D. The disturbance is present across a range of personal and social situations

E. The patterns of behaviour characterizing the disturbance cannot be explained by normal development or by social or cultural factors, including socio-political conflict

F. The disturbance is associated with substantial distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning

Personality Functioning:

1. Areas of functioning of aspects of the self include:

identity

self-worth

accuracy of self-view

self-direction

2. Areas of interpersonal functioning include:

ability to develop and maintain close and mutually satisfying relationships

ability to understand others’ perspectives and to manage conflict in relationships

Severity

Mild:

Disturbances affect some areas of personality functioning but not others and may not be apparent in some contexts

There are problems in many interpersonal relationships and/or in performance of expected occupational and social roles, but some relationships are maintained and/or some roles carried out

Not likely to be associated with substantial harm to self or others

Distress and functional impairment are either limited to circumscribed areas or present in more areas but milder

Moderate:

Disturbances affect multiple areas of personality functioning though some areas may be less affected than others

There are marked problems in most interpersonal relationships and the performance of most expected social and occupational roles are compromised to some degree. Relationships are likely to be characterized by conflict, avoidance, withdrawal, or extreme dependency

May or may not be associated with harm to self or others

Marked functional impairment in many areas of life

Severe:

Most, if not all areas of personality functioning are affected. There is severe impairment in both interpersonal functioning and functioning of aspects of the self

Problems in interpersonal functioning seriously affect virtually all relationships and the ability and willingness to perform expected social and occupational roles is absent or severely compromised

Likely to be associated with harm to self or others

Functional impairment is severe and present in all or nearly all areas of life

Traits

None of these traits are inherently maladaptive. They're only a disorder if they're diagnosed as a specifier to personality disorder. Most can also be part of a diagnosis of a personality difficulty.

Negative Affectivity:

The disturbance is characterized by a tendency to experience a broad range of negative emotions

Common manifestations include:

experiencing a broad range of negative emotions with a frequency and intensity out of proportion to the situation

emotional lability and poor emotion regulation

negativistic attitudes

low self-esteem and self-confidence

mistrustfulness

(Compare: Dependent PD, Avoidant PD)

 Detachment:

The disturbance is characterized by a tendency to maintain interpersonal and emotional distance

Common manifestations include:

avoidance of social interactions

lack of friendships

avoidance of intimacy

reserve

aloofness

limited emotional expression and experience

(Compare: Schizoid PD)

Dissociality:

Disturbance is characterized by a disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy

Common manifestations of include:

sense of entitlement

expectation of others’ admiration

positive or negative attention-seeking behaviours

concern with one's own needs, desires and comfort and not those of others

indifference to whether one’s actions inconvenience hurt others

being deceptive, manipulative, and exploitative of others, being mean and physically aggressive

callousness in response to others' suffering

ruthlessness in obtaining one’s goals

(Compare: Antisocial PD, Narcissistic PD)

Dininhibition:

Disturbance is characterized by a tendency to act rashly based on immediate external or internal stimuli, without consideration of potential negative consequences

Common manifestations include:

impulsivity, distractibility, irresponsibility, recklessness, lack of planning

Anankastia:

The disturbance is characterized by a narrow focus on one’s rigid standard of perfection and of right and wrong, and by controlling one’s own and others’ behaviour and controlling situations to ensure conformity to these standards

Common manifestations include:

concern with social rules, obligations, and norms of right and wrong, scrupulous attention to detail, rigid, systematic, day-to-day routines, hyper-scheduling and planfulness, emphasis on organization, orderliness, and neatness, rigid control over emotional expression, stubbornness and inflexibility, risk-avoidance, perseveration, and deliberativeness

(Compare: Obsessive-Compulsive PD)

Borderline Pattern:

Personality Disorder is characterized by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, as indicated by many of the following:

frantic efforts to avoid real or imagined abandonment, a pattern of unstable and intense interpersonal relationships, identity disturbance, manifested in markedly and persistently unstable self-image or sense of self, a tendency to act rashly in states of high negative affect, leading to potentially self-damaging behaviours, recurrent episodes of self-harm, emotional instability due to marked reactivity of mood, chronic feelings of emptiness, Inappropriate intense anger or difficulty controlling anger, transient dissociative symptoms or psychotic-like features in situations of high affective arousal

(Compare: Borderline PD)

Zu viele Vorurteile die widergekäut werden, wobei dann gleichzeitig die persönliche Aussage die diese Vorurteile widerlegen.

Persönlich finde ich es nicht gut, wenn audhs jetzt unter "Autismus mit ADHS" abgelegt wird. Ich bin nicht einfach eine Autistin die nebenbei auch ADHS hat.

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