The field mental disorders specifically associated with stress is characterised by lively debates, including about the extent to which human suffering should be medicalised and the purportedly inflationary expansion of post-traumatic stress disorder (PTSD) diagnoses. The ICD-11 Working Group on this topic was asked to review scientific evidence and other information on use, clinical utility, and experience with relevant ICD-10 diagnoses in various health care settings; to review proposals for DSM-5 and consider how these may be suited for global applications; and to assemble proposals for ICD-11 with a focus on improving clinical utility. The Working Group has recommended a separate grouping of ‘Disorders Specifically Associated with Stress’ for ICD-11, rather than combining them with anxiety disorders as in ICD-10. Among potentially far-reaching changes are a narrow definition of (classic) PTSD, a new distinction between PTSD and Complex PTSD, the introduction of a prolonged grief disorder, and changes to the conceptualisation of acute stress reaction and adjustment disorder. First multicenter studies in five languages across the world with clinical practitioners support the new definitions.