Triggers, Fears, and Irritants by Classification of ICD‐11 (English)

Triggers, Fears, and Irritants by Classification of Mental Disorders

ICD-11 (English)

Below are common triggers, fears, and irritants for each category in ICD-11 Chapter 06: Mental, Behavioural or Neurodevelopmental Disorders. All content is provided in English so it can be shared with international teams or clients.

ICD-11 Category	Triggers (what to avoid)	Fears (sensitive topics)	Other Irritants
Neurodevelopmental disorders (e.g., autism, ADHD)	- Sensory overload such as bright lights, loud noises, or crowded spaces can lead to overwhelming distress or emotional outbursts. - Abrupt changes to routine or new environments without preparation often spark anxiety or meltdowns. - Complex multi-step tasks delivered without clear, step-by-step instructions cause frustration and refusal to engage.	- Fear of social situations where they may be misunderstood or rejected (common for autistic people). - Fear of sudden changes that disrupt their sense of stability. - Fear of failing to meet academic or work expectations because of their traits (e.g., ADHD-related performance anxiety).	Dismissive attitudes toward their needs, talking over them, or unexpected touch can quickly drain their energy.
Schizophrenia or other primary psychotic disorders	- Severe stress or emotional shocks (conflicts, bereavement) can precipitate a psychotic relapse. - Alcohol or substance use intensifies psychotic symptoms and must be avoided. - Irregular use or sudden discontinuation of antipsychotics creates a high risk of symptom return.	- Fear of persecution or conspiracies against them, especially when delusions are active. - Fear of losing control over their thoughts or behaviour. - Fear that they will be seen as “crazy” and isolated if others recognize their illness.	Chaotic environments, sleep deprivation, and antagonistic confrontation can worsen agitation.
Catatonia (independent category)	- Extreme stress or physical exhaustion can trigger catatonic episodes. - Sudden changes in prescribed medication, especially antipsychotics, may provoke catatonia. - Forcing movement during stupor can increase muscle rigidity or escalate agitation.	- During stupor there may be a deep fear of being trapped or helpless. - After catatonic excitement, fear of having no memory of events or of harming others. - Families often fear the person will remain in that state indefinitely.	Loud commands, harsh handling, and crowded clinical spaces increase distress for both patient and caregivers.
Mood disorders (affective: bipolar and depressive disorders)	- Sleep disruption (jet lag, night shifts, chronic insomnia) destabilizes mood. - High psychosocial stress (conflicts, divorce, job loss) often precipitates depressive or manic episodes. - Alcohol, drugs, and even prescribed medications taken off-schedule (e.g., steroids, unsupervised antidepressants) can trigger mood swings.	- Fear of sliding back into severe depression after recovery. - In bipolar disorder, fear of the consequences of manic behaviour (debts, broken relationships) coexists with fear of losing the euphoric highs. - In depression, profound hopelessness and fear that improvement will never come.	Overscheduling, emotional invalidation, and pressure to “snap out of it” exacerbate symptoms.
Anxiety or fear-related disorders	- Stimulants such as caffeine, energy drinks, or decongestants elevate heart rate and can trigger panic. - Sudden exposure to feared situations (e.g., surprise parties for someone with social anxiety) provokes intense discomfort. - Loud conflicts or shouting in their environment heighten their sense of threat.	- Fear of losing control (fainting, suffocating, “going crazy”) during an anxiety attack. - Fear of negative social evaluation, humiliation, or ridicule. - Persistent worry about harm coming to themselves or loved ones (generalized anxiety).	Crowded waiting rooms, ticking clocks, and long uncertainty (e.g., delayed responses) can intensify anxiety.
Obsessive–compulsive or related disorders	- Deliberately provoking obsessions (touching dirty surfaces, creating chaos) causes severe distress. - Forcibly interrupting rituals without preparation can trigger panic. - High stress and fatigue intensify intrusive thoughts and compulsions.	- Fear of contamination or germs, leading to panic when exposed to perceived dirt. - Fear of forgetting something critical that could lead to disaster (e.g., leaving the stove on). - Fear of losing control and acting against their will (harming themselves or others).	Sarcasm about rituals, visible messiness, and pressure to “just stop” increase resistance and shame.
Disorders specifically associated with stress (e.g., PTSD)	- Sudden loud noises or unexpected touch can trigger flashbacks. - Direct, unprepared questions about traumatic events can retraumatize. - Anniversaries of traumatic events often spike distress even if life seems stable.	- Fear of reliving the trauma in reality. - Fear of losing control when intrusive memories arise (screaming, freezing, dissociating). - Deep mistrust and expectation that disaster can strike at any moment.	Graphic media depictions of trauma, crowds with limited exits, and isolation from supportive people increase vulnerability.
Dissociative disorders	- Rapid exposure to trauma reminders without grounding can provoke severe dissociation. - Emotional overload (arguments, threats to safety) often leads to shutdown or trance-like states. - Sudden, unfamiliar touch may trigger out-of-body sensations.	- Fear that they or their surroundings are unreal (depersonalization/derealization). - Fear of memory gaps and acting out of character without awareness. - Fear that others will think they are “crazy” or fabricate experiences.	Strong perfumes, flashing lights, and forced eye contact during overwhelm exacerbate dissociation.
Feeding or eating disorders	- Jokes or criticism about weight or body shape, even seemingly positive comments, can be extremely painful. - Public pressure to eat or scrutiny of their meals increases shame. - Obsessive discussion about diets, calories, or weight in their presence triggers setbacks.	- Intense fear of weight gain, even when underweight. - Fear of losing control during meals (e.g., binge eating). - Fear of judgment from others about their body or food choices.	Mirrors in dining areas, unsolicited body checks, and comparison culture on social media intensify distress.
Elimination disorders (enuresis, encopresis)	- Shaming or punishing accidents worsens frequency and anxiety. - Major life stressors (family conflict, relocation, parental divorce) often reignite symptoms. - Failing to remind gently about bathroom breaks before long trips or events raises the risk of accidents.	- Fear of humiliation in front of peers or relatives after an accident. - Fear of toilets or bathroom environments (e.g., automatic flush, darkness) for younger children. - Fear that something is “wrong” with them and that caregivers will withdraw affection.	Talking about accidents in front of others, restrictive fluids without explanation, and rigid schedules without support aggravate distress.
Disorders of bodily distress or bodily experience (somatic symptom disorders)	- Overexposure to medical details or symptom stories encourages symptom focus. - Dismissing concerns with phrases like “it’s all in your head” heightens anxiety and symptom persistence. - Unsupervised browsing of dubious medical websites fuels self-diagnosis spirals.	- Fear of having a serious undetected illness. - Fear that clinicians missed something and are not thorough enough. - Fear that family and doctors think they are faking, leading to abandonment when real danger occurs.	Long wait times for medical feedback, inconsistent messaging from providers, and sensational health news intensify worry.
Disorders due to substance use	- Spending time in environments linked to past substance use (old using companions, familiar bars) triggers cravings. - Emotional extremes (depression, stress, loneliness) increase relapse risk. - Exposure to substances during celebrations (e.g., “just one drink”) undermines sobriety.	- Fear of withdrawal agony and helplessness against cravings. - Fear of permanent loss of trust from loved ones. - Deep guilt and shame that paradoxically fuels desire to use again.	Glorifying past substance use, lack of structured daily activities, and easy access to cash or substances heighten risk.
Disorders due to addictive behaviours	- Easy access to the addictive behaviour (gambling websites, gaming consoles without limits) undermines recovery. - Emotional triggers such as boredom, stress, or helplessness drive relapse. - Chaotic schedules and sleep deprivation reduce self-control.	- Fear of missing out on pleasure or opportunities if they quit (e.g., gamblers fear losing a “big win”). - Fear of admitting loss of control. - Fear of social judgment or prohibition, even when they secretly want help.	Competitive talk that glorifies the behaviour, exposure to marketing, and unstructured downtime can reignite urges.
Impulse control disorders	- Provoking anger or temptation makes it nearly impossible to stop once impulses start. - Lack of clear structure is destabilizing, yet overly rigid rules also lead to rebellion—balance is essential. - Leaving tempting objects accessible (valuables with kleptomania, matches with pyromania) increases impulsive acts.	- Fear of being unable to control themselves and causing harm. - Fear of legal or social consequences once the impulse passes. - Fear of their “dark side,” such as an intense pull toward fire for someone with pyromania.	Crowded, overstimulating settings and goading comments (“prove you can control yourself”) heighten impulsivity.
Disruptive behaviour or dissocial disorders (conduct disorders, ODD)	- Direct confrontation and shouting from adults escalate disruptive acts. - Lack of supervision or constructive activities increases rule-breaking in peer groups. - Easy access to weapons or dangerous objects amplifies the risk of serious incidents.	- Fear of appearing weak or being dominated, leading to aggression as self-protection. - Underlying belief that the world is hostile (“attack first or be attacked”). - Youth with oppositional defiant disorder may fear being controlled, so they rebel pre-emptively.	Humiliating punishments, inconsistent boundaries, and public criticism provoke defiance.
Personality disorders and related traits	- Insults or mockery of personality traits are powerful triggers (e.g., shaming someone with narcissistic or borderline traits). - Unpredictable relationship dynamics (hot-and-cold behaviour) are destabilizing, especially for borderline personalities. - Harsh ultimatums or restrictive control anger those who value autonomy (obsessive-compulsive or paranoid personalities).	- Fear of abandonment and loneliness (borderline, dependent traits). - Fear of being insignificant or a failure, often hidden beneath confidence (narcissistic traits). - Paranoid fear of betrayal drives hypervigilance.	Silent treatment, invalidating emotions, and comparing them to “normal people” intensify symptoms.
Paraphilic disorders	- Leaving triggering objects or content visible can intensify fixation. - Excessive moralizing or shaming during therapy increases secrecy and avoidance of help. - Access to situations that align with the paraphilia (e.g., unsupervised access to minors for pedophilic disorder) must be strictly limited.	- Fear of exposure and public humiliation. - Fear of losing control and committing an offense despite knowing the consequences. - Fear of punishment or imprisonment, even when the drive momentarily overrides that fear.	Sensational media coverage, unmoderated online communities that reinforce fantasies, and isolation from supportive treatment networks worsen risk.
Factitious disorders (artificially induced illness)	- Lack of attention or support can intensify symptom fabrication. - Harsh confrontation (“we know you’re faking”) drives patients to escalate or seek new providers. - Performing unnecessary invasive procedures “just in case” unintentionally rewards symptom production.	- Fear of being invisible or unloved without the sick role. - Fear of public shame if deception is revealed. - Paradoxical fear that symptoms will stop, because attention and care might disappear.	Fragmented care teams, gossip among staff, and inconsistent boundaries increase manipulation and distress.
Neurocognitive disorders	- Frequent environmental changes without gradual orientation heighten confusion and agitation. - Sensory chaos (loud TV, multiple people talking at once) disorients and can provoke aggression. - Directly challenging every memory lapse leads to frustration and mood decline.	- Fear of remaining mentally aware while the body fails. - Fear of abandonment or institutionalization; feeling like a burden. - During lucid moments, fear and shame about their own helplessness.	Harsh corrections, infantilizing language, and ignoring their input increase agitation and despair.

Note: ICD-11 categories often parallel DSM-5-TR, so similar considerations apply. Always tailor these precautions to the individual. For example, Neurodevelopmental disorders (6A0) benefit from structured support and low sensory stimulation, while Stress-related disorders (6B4) require a sense of safety and avoidance of trauma reminders. The key across all categories is empathy and consistency. When unsure, gently ask the person what situations or topics upset them, and what helps them feel safe—this empowers them and helps avoid unnecessary triggers.