07 - PJ22 Psychological maltreatment, spouse or pa

PJ22 Psychological maltreatment, spouse or partner, or QE51.11 History of spouse or partner ...

717 Relationship problems and maltreatment Developmental presentations • In general, adolescents and young adults are at greater risk of being victims of intimate partner sexual abuse because the rate of sexually abusive acts among perpetrators tends to decrease across the lifespan. Boundaries with other disorders and conditions (differential diagnosis) Boundary with relationship distress with spouse or partner Intimate partner sexual abuse may be, but is not always, associated with relationship distress with spouse or partner. If all diagnostic requirements are met for both relationship distress with spouse or partner and maltreatment or history of spouse or partner violence, both may be assigned. Psychological maltreatment, spouse or partner, or history of spouse or partner violence, psychological Essential (required) features • Verbal or symbolic acts with the potential to cause psychological harm to the victim are required for diagnosis, such as: • berating, disparaging, degrading, humiliating the partner; • interrogating the partner; • restricting the partner’s ability to come and go freely; • obstructing the partner’s access to assistance (e.g. police aid, legal help, protective resources, medical resources, mental health resources); • threatening the partner; • harming, or threatening to harm, people/things that the partner cares about; • restricting the partner’s access to or use of economic resources; • isolating the partner from family, friends or social support resources; • stalking the partner; • trying to make people think that the partner is “crazy”, including for suggesting that they are a victim of psychological maltreatment. • The acts cause (or exacerbate) at least one of the following: • significant fear; • significant psychological distress; • somatic symptoms that interfere with normal functioning; Relationship problems and maltreatment | Relationship distress and current or past maltreatment by spouse or partner PJ22/ QE51.11

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders • significant self-imposed restrictions in engaging in one or more major life activities (e.g. work, education, religion, medical or mental services, contact with family members) to avoid recurrence of the acts. Note: these categories are assigned to the victim, not the perpetrator. If PJ22 Psychological maltreatment is diagnosed, the perpetrator should be specified as a spouse or partner using the extension code XE454 (PJ22&XE454). On the ICD-11 platform, the option to specify the perpetrator–victim relationship appears in the context of the assault field. Additional clinical features • Intimate partner psychological abuse typically represents a pattern of behaviours. However, it may be diagnosed based on a single episode if it is sufficiently impactful (e.g. harming a pet to punish the partner). • Intimate partner psychological abuse at a clinically significant level is associated with increased risk of seeking medical attention, as well as an increased risk of poor health and of development of a chronic disease. • Intimate partner psychological abuse is associated with higher rates of depressive disorders, post-traumatic stress disorder and disorders due to substance use, as well as suicidality. Boundary with normality (threshold) • Acts of psychological aggression (e.g. disparaging one’s partner) that do not cause significant distress are relatively common in intimate relationships. In contrast, the verbal and symbolic acts and their associated impacts that constitute intimate partner psychological abuse are not characteristic of healthy functioning relationships. Course features • Intimate partner psychological abuse commonly emerges in adolescence and early adulthood, but is prevalent across the lifespan. • The risk of intimate partner psychological abuse increases in the context of external stressors (e.g. job loss). Relationship problems and maltreatment | Relationship distress and current or past maltreatment by spouse or partner