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ICD-11 classification of personality disorders
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ICD-11 classification of personality disorders
The ICD-11 classification of personality disorders is a diagnostic framework for personality disorders (PD), introduced in the 11th revision of the International Classification of Diseases (ICD-11). This system of classification of personality disorders is an implementation of a dimensional model of personality disorders, meaning that individuals are assessed along continuous trait dimensions, with personality disorders reflecting extreme or maladaptive variants of traits that are continuous with normal personality functioning, and classified according to both severity of dysfunction and prominent trait domain specifiers. The ICD-11 classification of personality disorders differs substantially from the one in the previous edition, ICD-10; all distinct PDs have been merged into one: personality disorder, which can be coded as mild, moderate, severe, or severity unspecified.
Severity is determined by the level of distress experienced and degree of impairment in day to day activities as a result of difficulties in aspects of self-functioning, (e.g., identity, self-worth and agency) and interpersonal relationships (e.g., desire and ability for close relationships and ability to handle conflicts), as well as behavioral, cognitive, and emotional dysfunctions. There is also an additional category called personality difficulty, which can be used to describe personality traits that are problematic, but do not meet the diagnostic criteria for a PD. A personality disorder or difficulty can be specified by one or more of the following prominent personality traits or patterns: Negative affectivity, Detachment, Dissociality, Disinhibition, and Anankastia. In addition to the traits, a Borderline pattern – similar in nature to borderline personality disorder – may be specified.
Described as a clinical equivalent to the Big Five model, the five-trait system addresses several problems of the old category-based system. Of the ten PDs in the ICD-10, two were used with a disproportionate high frequency: emotionally unstable personality disorder, borderline type (F60.3) and dissocial (antisocial) personality disorder (F60.2). Many categories overlapped, and individuals with severe disorders often met the requirements for multiple PDs, which Reed et al. described as "artificial comorbidity". PD was therefore reconceptualized in terms of a general dimension of severity, focusing on five negative personality traits which a person can have to various degrees.
There was considerable debate regarding this new dimensional model, with many believing that categorical diagnosing should not be abandoned. In particular, there was disagreement about the status of borderline personality disorder. Geoffrey Reed wrote: "Some research suggests that borderline PD is not an independently valid category, but rather a heterogeneous marker for PD severity. Other researchers view borderline PD as a valid and distinct clinical entity, and claim that 50 years of research support the validity of the category. Many – though by no means all – clinicians appear to be aligned with the latter position. In the absence of more definitive data, there seemed to be little hope of accommodating these opposing views. However, the WHO took seriously the concerns being expressed that access to services for patients with borderline PD, which has increasingly been achieved in some countries based on arguments of treatment efficacy, might be seriously undermined." Thus, the WHO believed the inclusion of a borderline pattern category to be a "pragmatic compromise".
The Alternative DSM-5 Model for Personality Disorders (AMPD) included near the end of the DSM-5 is similar to the PD-system of the ICD-11. It was considered for inclusion in the ICD-11, but the WHO decided against it because it was considered "too complicated for implementation in most clinical settings around the world", since an explicit aim of the WHO was to develop a simple and efficient method that could also be used in low-resource settings. Research has found that the PD system of the ICD-11 aligns well with the AMPD, meaning that AMPD-related research findings are also possible to apply to the model used in the ICD-11. While there has been a limited amount of research conducted on the utility of the ICD-11 system for PD classification, studies have found favorable results.
After establishing the presence of Personality Disorder (6D10), a practitioner may determine whether the patient’s level of personality problems overall corresponds to a Mild Personality Disorder, a Moderate Personality Disorder, or a Severe Personality Disorder. Severity is determined by the degree and pervasiveness of disturbance in the person’s relationships and their sense of self; the intensity and breadth of the emotional, cognitive and behavioural manifestations of the person’s disturbance; the extent to which these patterns and problems cause distress or psychosocial impairment; and the level of risk of harm to self and others. For example, some patients’ sense of self may only be contradictory or inconsistent (Mild Personality Disorder), while other patients have a highly unstable or internally contradictory sense of self (Severe Personality Disorder).
Likewise, the patient’s situational and interpersonal appraisals may in certain cases involve some distortions but with intact reality testing (i.e., Mild Personality Disorder), while other patients experience extreme distortions under stress, often including dissociative states or psychotic-like perceptions and interpretations (i.e., Severe Personality Disorder). The ICD-11 classification of PD severity also incorporates harm to self and others, where patients with milder PD cause no significant harm while patients with severe PD often cause severe harm (e.g., repetitive self-injurious or aggressive behaviors).
The ICD-11 provides a list of essential features for each of the three categories of severity (i.e., mild, moderate, severe), which are accompanied by a list of examples that may guide practitioners in their decision-making. These features and examples are not supposed to be used as diagnostic “criteria”; they should only be used as guidelines for a more global evaluation.
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ICD-11 classification of personality disorders
The ICD-11 classification of personality disorders is a diagnostic framework for personality disorders (PD), introduced in the 11th revision of the International Classification of Diseases (ICD-11). This system of classification of personality disorders is an implementation of a dimensional model of personality disorders, meaning that individuals are assessed along continuous trait dimensions, with personality disorders reflecting extreme or maladaptive variants of traits that are continuous with normal personality functioning, and classified according to both severity of dysfunction and prominent trait domain specifiers. The ICD-11 classification of personality disorders differs substantially from the one in the previous edition, ICD-10; all distinct PDs have been merged into one: personality disorder, which can be coded as mild, moderate, severe, or severity unspecified.
Severity is determined by the level of distress experienced and degree of impairment in day to day activities as a result of difficulties in aspects of self-functioning, (e.g., identity, self-worth and agency) and interpersonal relationships (e.g., desire and ability for close relationships and ability to handle conflicts), as well as behavioral, cognitive, and emotional dysfunctions. There is also an additional category called personality difficulty, which can be used to describe personality traits that are problematic, but do not meet the diagnostic criteria for a PD. A personality disorder or difficulty can be specified by one or more of the following prominent personality traits or patterns: Negative affectivity, Detachment, Dissociality, Disinhibition, and Anankastia. In addition to the traits, a Borderline pattern – similar in nature to borderline personality disorder – may be specified.
Described as a clinical equivalent to the Big Five model, the five-trait system addresses several problems of the old category-based system. Of the ten PDs in the ICD-10, two were used with a disproportionate high frequency: emotionally unstable personality disorder, borderline type (F60.3) and dissocial (antisocial) personality disorder (F60.2). Many categories overlapped, and individuals with severe disorders often met the requirements for multiple PDs, which Reed et al. described as "artificial comorbidity". PD was therefore reconceptualized in terms of a general dimension of severity, focusing on five negative personality traits which a person can have to various degrees.
There was considerable debate regarding this new dimensional model, with many believing that categorical diagnosing should not be abandoned. In particular, there was disagreement about the status of borderline personality disorder. Geoffrey Reed wrote: "Some research suggests that borderline PD is not an independently valid category, but rather a heterogeneous marker for PD severity. Other researchers view borderline PD as a valid and distinct clinical entity, and claim that 50 years of research support the validity of the category. Many – though by no means all – clinicians appear to be aligned with the latter position. In the absence of more definitive data, there seemed to be little hope of accommodating these opposing views. However, the WHO took seriously the concerns being expressed that access to services for patients with borderline PD, which has increasingly been achieved in some countries based on arguments of treatment efficacy, might be seriously undermined." Thus, the WHO believed the inclusion of a borderline pattern category to be a "pragmatic compromise".
The Alternative DSM-5 Model for Personality Disorders (AMPD) included near the end of the DSM-5 is similar to the PD-system of the ICD-11. It was considered for inclusion in the ICD-11, but the WHO decided against it because it was considered "too complicated for implementation in most clinical settings around the world", since an explicit aim of the WHO was to develop a simple and efficient method that could also be used in low-resource settings. Research has found that the PD system of the ICD-11 aligns well with the AMPD, meaning that AMPD-related research findings are also possible to apply to the model used in the ICD-11. While there has been a limited amount of research conducted on the utility of the ICD-11 system for PD classification, studies have found favorable results.
After establishing the presence of Personality Disorder (6D10), a practitioner may determine whether the patient’s level of personality problems overall corresponds to a Mild Personality Disorder, a Moderate Personality Disorder, or a Severe Personality Disorder. Severity is determined by the degree and pervasiveness of disturbance in the person’s relationships and their sense of self; the intensity and breadth of the emotional, cognitive and behavioural manifestations of the person’s disturbance; the extent to which these patterns and problems cause distress or psychosocial impairment; and the level of risk of harm to self and others. For example, some patients’ sense of self may only be contradictory or inconsistent (Mild Personality Disorder), while other patients have a highly unstable or internally contradictory sense of self (Severe Personality Disorder).
Likewise, the patient’s situational and interpersonal appraisals may in certain cases involve some distortions but with intact reality testing (i.e., Mild Personality Disorder), while other patients experience extreme distortions under stress, often including dissociative states or psychotic-like perceptions and interpretations (i.e., Severe Personality Disorder). The ICD-11 classification of PD severity also incorporates harm to self and others, where patients with milder PD cause no significant harm while patients with severe PD often cause severe harm (e.g., repetitive self-injurious or aggressive behaviors).
The ICD-11 provides a list of essential features for each of the three categories of severity (i.e., mild, moderate, severe), which are accompanied by a list of examples that may guide practitioners in their decision-making. These features and examples are not supposed to be used as diagnostic “criteria”; they should only be used as guidelines for a more global evaluation.