Delusion according to ICD-11
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Delusion According to ICD-11
Definition
ICD-11 defines a delusion as a fixed, false belief that is held with strong conviction and is resistant to change even when confronted with contradictory evidence. It is not consistent with cultural or religious norms and is not better explained by another mental, behavioural, or neurodevelopmental disorder.
Key features required:
- Fixed — not amenable to logical argument
- False — not based in reality
- Not culturally sanctioned — cannot be explained by the person's cultural or religious background
ICD-11 Classification Context
In ICD-11, delusions are listed as a core symptom under the broader category of psychotic symptoms and appear prominently in the following diagnostic blocks:
| ICD-11 Code | Disorder |
|---|---|
| 6A20 | Schizophrenia |
| 6A21 | Schizoaffective disorder |
| 6A22 | Schizotypal disorder |
| 6A23 | Acute and transient psychotic disorder |
| 6A24 | Delusional disorder |
| 6A25 | Other primary psychotic disorders |
| 6A60–6A8Z | Bipolar or depressive episodes with psychotic features |
Delusional Disorder (ICD-11 Code: 6A24)
This is the disorder where delusions are the defining and primary feature.
Diagnostic requirements:
- Presence of one or more delusions of at least 3 months' duration
- The delusions are not better explained by another mental disorder (e.g., schizophrenia, mood disorder)
- Hallucinations are absent or, if present, are not prominent and are related to the delusional theme (e.g., olfactory/tactile hallucinations in somatic type)
- Functioning may be relatively preserved outside the delusional system
Qualifiers by content (delusional type):
| Type | Content |
|---|---|
| Persecutory | Belief of being spied on, harassed, conspired against |
| Grandiose | Belief of having special powers, identity, or destiny |
| Erotomanic | Belief that another person (often of higher status) is in love with the individual |
| Nihilistic | Belief that oneself, others, or the world does not exist or is ending |
| Somatic | Belief regarding bodily function or appearance (e.g., infestation, foul odour) |
| Jealous (Othello syndrome) | Belief of a partner's infidelity without evidence |
| Mixed | Features of more than one type without predominance |
| Unspecified | Content cannot be clearly categorised |
Delusions as a Symptom Qualifier in ICD-11
In schizophrenia (6A20), delusions are listed among the Group 1 positive symptoms. ICD-11 specifically describes:
- Bizarre delusions — clearly implausible, not understandable in ordinary experience (e.g., thought insertion, thought withdrawal, thought broadcasting, delusions of control/passivity)
- Non-bizarre delusions — involve situations that could conceivably occur in real life (e.g., persecution, infidelity)
Schizophrenia diagnosis under ICD-11 requires at least two of the core symptom groups (positive, negative, disorganised, psychomotor), with at least one being a first-rank/positive symptom. A single bizarre delusion alone can be sufficient to meet one of the symptom criteria.
Distinction from Related Phenomena
| Phenomenon | Key Difference from Delusion |
|---|---|
| Overvalued idea | Strongly held but not absolutely fixed; some degree of doubt possible |
| Obsession | Recognized by the individual as irrational (ego-dystonic) |
| Hallucination | A perception without external stimulus (distinct from belief) |
| Culturally held belief | Shared by the individual's cultural/religious community |
Course Specifiers (ICD-11)
ICD-11 introduces course specifiers for psychotic disorders, which apply to delusional disorder:
- First episode, currently symptomatic
- First episode, in partial remission
- First episode, in full remission
- Multiple episodes, currently symptomatic
- Multiple episodes, in partial remission
- Multiple episodes, in full remission
- Continuous
- Unspecified
Clinical Note
ICD-11 represents a shift from ICD-10 in several ways relevant to delusions:
- Greater emphasis on dimensional assessment alongside categorical diagnosis
- Removal of strict Schneiderian first-rank symptoms as pathognomonic (they are still relevant but not exclusively defining)
- Better alignment with DSM-5 definitions for international research comparability
Mania according to ICD 11
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mania manic episode ICD-11 diagnostic criteria classification
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bipolar disorder mania symptoms features elevated mood grandiosity
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Drawing from retrieved content and comprehensive ICD-11 knowledge to provide a full answer.
Mania According to ICD-11
Definition
ICD-11 defines a manic episode as a period of abnormally elevated, expansive, or irritable mood, accompanied by increased energy or activity, that is distinctly different from the person's usual behaviour. The episode must be severe enough to cause marked impairment in personal, social, or occupational functioning, or to necessitate hospitalisation to prevent harm.
ICD-11 Classification
Mania is primarily housed under:
| ICD-11 Code | Disorder |
|---|---|
| 6A60 | Bipolar type I disorder |
| 6A61 | Bipolar type II disorder (hypomania only — not full mania) |
| 6A6Y / 6A6Z | Other specified / unspecified bipolar or related disorders |
A single manic episode is sufficient to diagnose Bipolar I disorder (6A60) — a prior depressive episode is not required.
Diagnostic Requirements for a Manic Episode (ICD-11)
Duration: Symptoms present for most of the day, nearly every day, for at least 1 week — or any duration if hospitalisation is required.
Core mood symptom (at least one):
- Abnormally elevated or expansive mood, OR
- Abnormally irritable mood
Plus increased energy or activity that is clearly observable and represents a change from baseline.
Associated symptoms — at least three of the following (four if mood is irritable only):
| Symptom | Description |
|---|---|
| Inflated self-esteem / grandiosity | May reach delusional intensity |
| Decreased need for sleep | Feels rested after 3 hours or less |
| Pressured / more talkative | Difficult to interrupt, rapid speech |
| Flight of ideas / racing thoughts | Ideas shift rapidly, sometimes incoherent |
| Distractibility | Attention easily drawn to irrelevant stimuli |
| Increased goal-directed activity / psychomotor agitation | Social, occupational, sexual, or purposeless physical activity |
| Reckless behaviour | Excessive spending, sexual indiscretions, risky investments |
Severity Specifiers
ICD-11 formally grades manic episodes by severity:
| Severity | Features |
|---|---|
| Mild | Some functional impairment; does not require hospitalisation |
| Moderate | Significant impairment in multiple domains |
| Severe without psychotic features | Marked impairment; self-care affected; hospitalisation often required |
| Severe with psychotic features | Delusions and/or hallucinations present (mood-congruent or mood-incongruent) |
Psychotic Features in Mania
When psychosis accompanies mania, ICD-11 distinguishes:
- Mood-congruent psychotic symptoms — content consistent with the manic theme (e.g., grandiose delusions of special powers, persecutory delusions linked to inflated importance)
- Mood-incongruent psychotic symptoms — content unrelated to the predominant mood (e.g., thought insertion, delusions of control)
The presence of psychotic features does not reclassify the episode as schizophrenia; the mood episode remains the primary diagnosis.
Mixed Features Specifier
ICD-11 introduces a "with mixed features" qualifier for manic episodes, applicable when depressive symptoms are concurrently present but do not meet full criteria for a depressive episode. This is a significant update from ICD-10, which required separate mixed episode criteria.
Course Specifiers
ICD-11 applies the following episode/course qualifiers to Bipolar I:
- Currently symptomatic — mild / moderate / severe without psychotic features / severe with psychotic features
- Currently in partial remission
- Currently in full remission
Hypomania vs. Mania (ICD-11 Distinction)
| Feature | Hypomania | Mania |
|---|---|---|
| Duration | ≥ 4 consecutive days | ≥ 7 days (or any if hospitalised) |
| Functional impairment | Mild to moderate; no marked impairment | Marked impairment or hospitalisation required |
| Psychotic features | Absent | May be present |
| Bipolar type | Bipolar II (6A61) | Bipolar I (6A60) |
Key ICD-11 Updates vs. ICD-10
| Aspect | ICD-10 | ICD-11 |
|---|---|---|
| Mixed episode | Separate category (F38.00) | Replaced by "mixed features" specifier on mood episodes |
| Psychotic subtype labelling | F30.2 — Mania with psychotic symptoms | Severity qualifier with psychotic features |
| Dimensional assessment | Not included | Added as supplementary dimension |
| Alignment with DSM-5 | Partial | Substantially improved convergence |
| Minimum duration for mania | ~1 week | ≥ 7 days (unchanged) |
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