Culture and religion may influence the concept of mental illness and subsequently the classification, diagnosis and management. This paper discusses the confounding factors in the diagnosis of psychiatric disorders in Islamic, Arabic societies and the Islamic codes for addiction and other disorders. Moslems constitute 1.57 billion of world populations i.e. one in four people of world population are Moslems. The majority of Moslems are in Asia and not as perceived Arabs in the Middle East. The positive and negative symptoms have different connotations in Islamic societies and may be socially acceptable which may hamper the diagnosis of psychiatric disorders. Personality disorders present in the current classification have other religious connotations in Islam e.g. social phobia as system which is an acceptable and desirable social trait, schizoid is a dedicated, pious religious man etc. While the diagnosis of anxiety and phobia, eating disorders and others do not reach the threshold level of ICD 10 and DSM IV and may be non caseness in Islamic societies. A dimensional approach may help in including the subthreshold diagnosis in Arab Islamic countries within the framework of ICD11 and DSMV.