# 04 - QE51.0 Relationship distress with spouse or p

# QE51.0 Relationship distress with spouse or partner

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders
QE51.0 Relationship distress with spouse or partner
QE51.1 History of spouse or partner violence
QE51.10 History of spouse or partner violence, physical
QE51.12 History of spouse or partner violence, sexual
QE51.11 History of spouse or partner violence, psychological
QE51.13 History of spouse or partner violence, neglect.
Relationship distress with spouse or partner and different forms of intimate partner maltreatment 
can co-occur. As many of the categories in this section may be assigned together as necessary to 
describe the relevant clinical phenomena.
General cultural considerations for relationship distress and maltreatment by 
spouse or partner
• Presentations of relationship distress vary, depending on cultural constraints on their 
expression. In some cultures, women may be more attentive to relationship problems and 
therefore more likely report relationship distress.
• The prevalence of the different forms of spouse or partner maltreatment (e.g. physical, 
sexual, psychological) vary widely by country, based on the social acceptance, detection 
and consequences of abusive behaviours.
General sex- and/or gender-related features for relationship distress and 
maltreatment by spouse or partner
• Although men and women are both affected by relationship distress, women’s health may 
be more influenced by relationship distress, whereas men’s health may be more influenced 
by relationship status (i.e. being in an intimate partner relationship or not).
• Gender differences are country- and culture-specific. Overall, women are at much higher 
risk of victimization by maltreatment by their spouses or intimate partners.
Relationship distress with spouse or partner
Essential (required) features
• Substantial and sustained dissatisfaction with the intimate relationship (e.g. pervasive 
unhappiness with the relationship, significant thoughts of divorce/separation) is required 
for diagnosis.
• The dissatisfaction is associated with disturbance in at least one major area of functioning 
such as:
• behaviour (e.g. persistent and intense conflicts, pervasive withdrawal or neglect, lack of 
positive behaviours);
Relationship problems and maltreatment | Relationship distress and current or past maltreatment by spouse or partner
QE51.0

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Relationship problems and maltreatment
• cognition (e.g. pervasive negative attributions of partner’s intent);
• emotion (e.g. persistent and intense anger, sadness or apathy);
• physical health (e.g. pain and other physical symptoms not fully explained by a medical 
condition);
• interpersonal interaction (e.g. social isolation, decreased involvement in social activities);
• major life role activities (e.g. work, school, caregiving).
Note: this category is assigned to the individual being evaluated. In situations in which a couple 
is being evaluated, it may be assigned to both parties if applicable.
Additional clinical features
• Relationship distress with spouse or partner is associated with increased risk of various 
mental disorders (e.g. depressive disorders, anxiety and fear-related disorders, disorders 
due to substance use), and risk of exacerbation of existing medical conditions.
Boundary with normality (threshold)
• Occasional relationship dissatisfaction and disagreements occur in most relationships. 
Relationship distress with a spouse or partner should only be assigned when relationship 
dissatisfaction or conflict is a pervasive pattern affecting the individual’s functioning in at 
least one major area.
Boundaries with other disorders and conditions (differential diagnosis)
Boundary with spouse or partner maltreatment (physical, psychological, sexual, 
or neglect)
Relationship distress with spouse or partner is not considered a form of maltreatment. However, 
if all diagnostic requirements are met for both relationship distress with spouse or partner and a 
maltreatment category, both may be assigned.
Relationship problems and maltreatment | Relationship distress and current or past maltreatment by spouse or partner