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

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.

Late life personality disorders: Problems in assessment and management

“…According to a study by Hansen et al (2019), mental health professionals perceived the ICD‐11 approach as more useful than the ICD‐10 model in terms of usefulness in creating effective management plans and satisfactorily describing patients' personality problems. The improved general utility of the ICD‐11 diagnosis can allow it to be used in all age groups (Mulder, 2021).…”

The alternative model of personality disorder is inadequate for capturing obsessive-compulsive personality disorder.

“…Furthermore, even those 37 traits were impoverished for accounting for OCPD due to the lack of inclusion of workaholism, which is a central criteria for OCPD and included in other major trait models (Simms et al, 2013). Of course, International Classification of Diseases, 11th Revision does include more of these traits through the separate domain of anankastia, which more or less mirrors compulsivity (Mulder, 2021). Although we do not agree with separating the opposite poles of a single dimension into two traits (e.g., Samuel, 2011), this arrangement does have the benefit of better emphasizing the content of compulsivity that is relevant to OCPD.…”

Evaluation der Wirksamkeit der klärungsorientierten Psychotherapie bei Personen mit einer narzisstischen Persönlichkeitsstörung nach DSM-IV – eine naturalistische Längsschnittstudie mit prä-post Design

“…Vor dem Hintergrund der modernen, sich zunehmend durchsetzenden dimensionalen Betrachtung der Persönlichkeitsstörung(en) (AMPD, ICD-11, s. Exkurs im Online-Zusatzmaterial ) 46 47 , muss die Bedeutung der vorliegenden Studie mit kategorialer Diagnostik auf den ersten Blick kritisch gesehen werden. Bei genauerer Betrachtung war die Funktionalität der beiden Hauptfaktoren (Selbst und Interaktion) der Persönlichkeitsstörung (nach AMPD oder ICD-11; s. Exkurs im Online-Zusatzmaterial ) gegen Ende der KOP signifikant positiv verändert.…”

“…Bei genauerer Betrachtung war die Funktionalität der beiden Hauptfaktoren (Selbst und Interaktion) der Persönlichkeitsstörung (nach AMPD oder ICD-11; s. Exkurs im Online-Zusatzmaterial ) gegen Ende der KOP signifikant positiv verändert. Darüber hinaus hatte KOP einen starken positiven Effekt auf die negative Affektivität der Persönlichkeitsstörung ( s. Exkurs im Online-Zusatzmaterial ) 46 47 .…”