Preliminary studies of the ICD-11 classification of personality disorder in practice

Tyrer, Peter; Crawford, Mike; Sanatinia, Rahil; Tyrer, Helen; Cooper, Sylvia; Muller-Pollard, Chris; Christodoulou, Polyxeni; Zauter-Tutt, Maria; Miloseska-Reid, Katerina; Loebenberg, Gemma; Guo, Boliang; Yang, Min; Wang, Duolao; Weich, Scott

doi:10.1002/pmh.1275

Cited by 60 publications

(52 citation statements)

References 38 publications

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“…It has been proposed that the upcoming ICD-11 diagnostic criteria would utilize a more dimensional approach to personality disorders and thus, enable clinicians to take better into account the dimensional nature of personality and reduce the problem associated with the overlap of the different disorder categories [8, 9, 20, 36] The currently suggested personality disorder levels are: mild personality disorder, moderate personality disorder, and severe personality disorder [1]. “Mild personality disorder” is suggested to be used as an additional entity to denote characteristics that significantly influence a person’s health status and the use of health services, which are in general classified as Z codes under the current ICD-10 [37].…”

Section: Discussionmentioning

confidence: 99%

Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders

et al. 2017

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BackgroundCurrent categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance.MethodsThe sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder).ResultsThe proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p < 0.05) from the other groups regarding the BDI, 15D, and MHI-5 scores as well as the number of Axis I diagnoses. Patients with complex/severe personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but the differences between these groups were mostly non-significant.ConclusionsAn elevated severity level of personality disturbance is associated with an increase in psychiatric morbidity and social dysfunction. Diagnostically sub-threshold personality difficulties are of clinical significance and the degree of impairment corresponds to actual personality disorders. Since these two groups did not significantly differ from each other, our findings also highlight the complexity related to the use of diagnostic thresholds for separate personality disorders.

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Section: Discussionmentioning

confidence: 99%

Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders

et al. 2017

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“…In contrast, there is a vast body of empirical literature supporting dimensional models of personality disorder that are closely aligned with the proposed model , in addition to the emerging body of work on the specific dimensions proposed for ICD‐11 . The ICD‐11 proposal has two elements.…”

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confidence: 99%

The time has come for dimensional personality disorder diagnosis

Hopwood

Kotov

Krueger

et al. 2017

Personality & Mental Health

267

194

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“…It remains to be seen if the new domain structure is more robust and likely to be superior. One study suggests it has better links than ICD‐10 did (Tyrer et al, ). Other studies are comparing the domain structure of ICD‐11 with the operational criteria for personality disorder in the DSM‐IV, and these will also inform.…”

Section: Discussionmentioning

confidence: 99%

Preliminary field trial of a putative research algorithm for diagnosing ICD-11 personality disorders in psychiatric patients: 2. Proposed trait domains

Kim

Tyrer

Lee

et al. 2015

Personality and Mental Health

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This field trial examines the discriminant validity of five trait domains of the originally proposed research algorithm for diagnosing International Classification of Diseases (ICD)-11 personality disorders. This trial was carried out in South Korea where a total of 124 patients with personality disorder participated in the study. Participants were assessed using originally proposed monothetic trait domains of asocial-schizoid, antisocial-dissocial, anxious-dependent, emotionally unstable and anankastic-obsessional groups of the research algorithm in ICD-11. Their assessments were compared to those from the Personality Assessment Schedule interview, and the five-factor model (FFM). A total of 48.4% of patients were found to have pathology in two or more domains. In the discriminant analysis, 64.2% of the grouped cases of the originally proposed ICD-11 domains were correctly classified by the five domain categories using the Personality Assessment Schedule, with the highest accuracy in the anankastic-obsessional domain and the lowest accuracy in the emotionally unstable domain. In comparison, the asocial-schizoid, anxious-dependent and the emotionally unstable domains were moderately correlated with the FFM, whereas the anankastic-obsessional or antisocial-dissocial domains were not significantly correlated with the FFM. In this field trial, we demonstrated the limited discriminant and the convergent validities of the originally proposed trait domains of the research algorithm for diagnosing ICD-11 personality disorder. The results suggest that the anankastic, asocial and dissocial domains show good discrimination, whereas the anxious-dependent and emotionally unstable ones overlap too much and have been subsequently revised.

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Preliminary studies of the ICD-11 classification of personality disorder in practice

Cited by 60 publications

References 38 publications

Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders

Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders

The time has come for dimensional personality disorder diagnosis

Preliminary field trial of a putative research algorithm for diagnosing ICD-11 personality disorders in psychiatric patients: 2. Proposed trait domains

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