Psykologfaglige vurderinger af overgangen fra ICD-10 til ICD-11

Psychologists Perspectives on the Transition from ICD-10 to ICD-11

Schmidt, Clara Høgh ; Vest, Pernille Sofie

4. semester

Psykologi, Kandidat

2026

Dette speciale undersøger, hvilke fordele og udfordringer psykologer i dansk psykiatri ser i overgangen fra diagnosesystemet ICD-10 til ICD-11, som forventes implementeret i de kommende år. Med afsæt i kritisk psykologi og videnskabs- og teknologistudier (STS) forstås ICD ikke blot som et neutralt, teknisk redskab, men som et klassifikationssystem, der hele tiden fortolkes og formes gennem psykologers konkrete brug i klinisk praksis. Specialet placerer sig i den bredere debat om formål og kritik af psykiatriske diagnosesystemer generelt, kritikken af ICD-10 specifikt samt de ændringer, der indføres i ICD-11’s kapitel om psykiske, adfærdsmæssige og neuroudviklingsforstyrrelser. Grundlaget er fire kvalitative, semistrukturerede interviews med psykologer, der arbejder i psykiatrien og til daglig anvender ICD-10. Gennem tematisk indholdsanalyse identificeres tre hovedområder af forandring: (a) skiftet fra en kategoriel til en dimensionel forståelse af psykiske lidelser, (b) diagnostisk omstrukturering og nye diagnoser samt (c) bredere gevinster og udfordringer ved selve overgangen. Analysen viser, at psykologerne både forventer væsentlige forbedringer og nye problemer. Den kategorielle model opleves som strukturgivende, men for rigid og dårligt egnet til at indfange kompleksitet og komorbiditet, hvilket blandt andet medfører hyppig brug af uspecificerede diagnoser. Den dimensionelle tilgang i ICD-11 anses for at kunne give mere nuancerede og mindre stigmatiserende beskrivelser, men samtidig for at stille større krav til detaljeringsgrad, ressourcer og organisering af behandling, og for potentielt at svække den diagnostiske klarhed. Omstruktureringen og de nye diagnoser vurderes overordnet positivt, bl.a. en mere sammenhængende klassifikation, styrket fokus på neuroudviklingsforstyrrelser, revideret forståelse af ADHD og autisme, en ny model for personlighedsforstyrrelser samt nye kategorier som kompliceret sorglidelse og kompleks PTSD, der opfattes som mere klinisk meningsfulde. Samtidig peges der på risici for udvanding af autismediagnosen, mindre behandlingsvejledning ved personlighedsforstyrrelser, mulig patologisering af sorg og uklar grænse mellem personlighedsforstyrrelser og kompleks PTSD. ICD-10 fungerer i dag som et fælles fagsprog, men bruges også til efterrationalisering af kliniske vurderinger; ICD-11 forventes både at kunne forbedre genkendelsen af patienters oplevede kompleksitet og at skabe nye udfordringer for kommunikation og selvforståelse, fx gennem mere nuanceret sprog om autisme, personlighed og intellektuelle funktionsnedsættelser, men med fortsat fokus på individet i diagnosticeringen.

This thesis explores the advantages and challenges that psychologists in Danish psychiatry associate with the transition from the diagnostic system ICD-10 to ICD-11, which is expected to be implemented in the coming years. Drawing on critical psychology and Science and Technology Studies (STS), the ICD system is conceptualised not as a neutral technical tool, but as a classification framework that is continuously interpreted and shaped through psychologists’ everyday use in clinical practice. The thesis is situated within broader debates about the purposes and critiques of psychiatric diagnostic systems in general, specific criticisms of ICD-10, and the revisions introduced in ICD-11’s chapter on mental, behavioural and neurodevelopmental disorders. The empirical basis consists of four qualitative, semi-structured interviews with psychologists working in psychiatry who currently use ICD-10 in their daily work. Using thematic content analysis, the study identifies three central domains of change: (a) the shift from a categorical to a dimensional understanding of mental disorders, (b) diagnostic restructuring and the introduction of new diagnoses, and (c) broader advantages and challenges related to the transition as such. The analysis indicates that psychologists expect both significant benefits and notable difficulties. The categorical model is experienced as offering structure and overview, but also as too rigid and poorly suited to capturing clinical complexity and comorbidity, contributing to frequent use of unspecified diagnoses with limited explanatory value. The dimensional approach in ICD-11 is expected to provide more nuanced and less stigmatising descriptions, while at the same time increasing demands for detail, clinical resources and organisational adjustments, and potentially reducing clarity in diagnostic assessment. The restructuring and new diagnoses are largely viewed as improvements, including a more coherent classification, a strengthened focus on neurodevelopmental disorders, revised conceptualisations of ADHD and autism, a new model for personality disorders, and new categories such as prolonged grief disorder and complex PTSD that are seen as more clinically meaningful. However, concerns are raised about a possible dilution of the autism category, reduced treatment guidance for personality disorders, potential pathologisation of grief, and blurred boundaries between personality disorders and complex PTSD. ICD-10 currently functions as a shared professional language but is also used to legitimise clinical judgements after the fact; ICD-11 is expected both to improve recognition of patient complexity and to create new challenges for professional communication and patient self-understanding, for example through more nuanced terminology for autism, personality and intellectual developmental disorders, while continuing to rely on individualising diagnostic language.

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