ICD-11 Personality Disorders: Utility and Implications of the New Model.

Roger T Mulder

doi:10.3389/fpsyt.2021.655548

Abstract

The ICD-11 classification of personality disorders represents a paradigm shift in diagnosis. This was felt necessary because previous personality disorder classifications had major problems. These included unnecessary complexity, inconsistency with data on normal personality traits, and minimal consideration of severity despite this being shown to be the major predictor of outcome. The ICD-11 classification abolishes all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as “mild,” “moderate,” or “severe.” Patient behavior can be described using one or more of five personality trait domains; negative affectivity, dissociality, anankastia, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier. The ICD-11 shows considerable alignment with the DSM-5 Alternative Model for Personality Disorders. Early evidence around the reliability and validity of the new model appear promising, although at present there is still limited specific evidence due to the model being so recently finalized. However, for the model to be successful, it needs to be embraced by clinicians and used widely in normal clinical practice.

Highlights

When the ICD-11 working group for the revision of the classification of personality disorders was established in 2010 there was a great deal of dissatisfaction with the current ICD-10 [1] and DSM IV [2] classifications
Severity of Personality Disturbance it is not surprising that when the ICD-11 personality disorder classification committee met in 2010, they felt that a paradigm shift was necessary
Led by Peter Tyrer, the initial proposal for the ICD-11 classification set out to abolish all categories of personality disorder except for the general description of a personality disorder

Summary

INTRODUCTION

When the ICD-11 working group for the revision of the classification of personality disorders was established in 2010 there was a great deal of dissatisfaction with the current ICD-10 [1] and DSM IV [2] classifications. The descriptions appear to have evolved from historical precedents, clinical experience, and committee consensus Some categories had their origins in Galen’s temperaments described over 2,000 years ago, while others, such as Borderline Personality Disorder, appeared in 1980. The classification was inconsistent with what data was available, with most evidence suggesting personality abnormality was distributed along a dimension [4] These dimensional constructs were similar to dimensions of personality which have been reported in the general population. The total number of diagnosed personality disorders or the number of traits explains more variability in functioning than specific personality disorders alone [10] Those with more severe personality disturbance are more likely to self-harm [11], to have a greater degree of comorbidity and suicide risk [12], and to have a higher risk of treatment drop-out [13]. The argument can be made that prioritizing severity helps re-focus on the core management around self and interpersonal difficulties rather than emphasizing behavioral descriptions

DISCUSSION

Findings

Borderline pattern qualifier

CONCLUSION