Classifying mental disorders: DSM-5-TR and ICD-11

Concept

The two manuals that define mental disorders, how they differ, and what is needed before a diagnosis is made.

Updated Nov 13, 2026

Key points

ICD is the WHO global standard for recording and reporting diseases; ICD-11 has a clinical manual for mental, behavioural and neurodevelopmental disorders, published in 2024.
A diagnosis rests on a characteristic pattern of symptoms with clinically significant distress or impairment in functioning; DSM-5-TR criteria also set symptom thresholds and durations.
Categorical: a disorder is present or absent. Dimensional: symptoms are rated on a continuum of severity.
ICD-11 personality disorder is graded as mild, moderate or severe, with optional trait domain qualifiers and a borderline pattern qualifier.
ICD-11 removed all subtypes of schizophrenia and introduced a set of dimensional symptom descriptors.
New in ICD-11: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, compulsive sexual behaviour disorder and bipolar type II as a separate category.

What it is

Mental disorders are classified mainly with two systems. The DSM-5-TR is the American Psychiatric Association’s manual, published in 2022 as the first revision of the DSM-5 since its publication in 2013, with diagnostic criteria that include symptom thresholds and durations. The ICD-11 is the World Health Organization’s classification, adopted in 2019 and in effect since January 2022, a global standard for recording and reporting diseases; for mental, behavioural and neurodevelopmental disorders it generally avoids arbitrary cut-offs and symptom counts and relies on flexible clinical judgement. ICD-11 is explicitly categorical but adds dimensional approaches.

Key facts

ICD-11 raised the threshold for a depressive episode, which increases consistency with the DSM-5.
ICD-11 adds dimensional qualifiers and descriptors, such as severity and trait domains for personality disorder and symptom descriptors for schizophrenia.
Culture shapes how distress is expressed; ICD-11 gives culture-related guidance for each disorder, and the DSM-5-TR text has a section on culture-related diagnostic features.
Prolonged grief disorder is in both ICD-11 and DSM-5-TR.

DSM-5-TR and ICD-11 side by side

Feature	DSM-5-TR	ICD-11
Who publishes it	American Psychiatric Association	World Health Organization
Current version	Text revision (2022) of the DSM-5 (2013)	Adopted in 2019, in effect since 2022; clinical manual for mental disorders published in 2024
Scope	Mental disorders only	All diseases and health problems; one chapter for mental, behavioural and neurodevelopmental disorders
Style of criteria	Criteria with symptom thresholds and durations	Arbitrary cut-offs and symptom counts generally avoided; more clinical judgement
New in the latest edition	Prolonged grief disorder among the added diagnoses	Complex PTSD, prolonged grief disorder, gaming disorder, compulsive sexual behaviour disorder
Gender	Gender dysphoria, with updated terminology in the text revision	Gender incongruence moved out of the mental disorders chapter into a new sexual health chapter

Clinical notes

In Colombia, the Ministry of Health has published tools to help health providers adapt WHO’s ICD-API (the programming interface of ICD-11) in their software.

Test yourself

Think of the answer, then tap the question to see it.

Which classification is the global standard for recording and reporting diseases?

The WHO International Classification of Diseases (ICD); ICD-11 came into effect in January 2022.

What separates a mental disorder from a normal reaction in these classifications?

A characteristic pattern of symptoms with clinically significant distress or impairment in functioning; DSM-5-TR criteria also set symptom thresholds and durations.

How does ICD-11 classify personality disorder?

As one diagnosis graded by severity (mild, moderate, severe), with optional trait qualifiers and a borderline pattern qualifier.

What is the difference between a categorical and a dimensional approach?

Categorical decides whether a disorder is present or absent; dimensional rates symptoms or traits along a continuum of severity.

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Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders (World Psychiatry, PubMed Central, 2019); New manual released to support diagnosis of mental, behavioural and neurodevelopmental disorders added in ICD-11 (World Health Organization, 2024); DSM-5-TR: overview of what’s new and what’s changed (World Psychiatry, PubMed Central, 2022); Herramientas para facilitar la adaptación de la ICD-API de la OMS en el software de las IPS de Colombia (Ministerio de Salud y Protección Social (Colombia), 2024).

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