From the Guidelines
Personality disorders should be diagnosed and treated based on the ICD-11 classification, which characterizes them by problems in functioning of aspects of the self and/or interpersonal dysfunction, and differentiates them according to severity into mild, moderate, and severe. According to the ICD-11, the diagnosis of personality disorders has shifted from a categorical approach to a more dimensional approach, recognizing that psychopathology is continuously graded in severity 1. This change acknowledges that a large proportion of patients simultaneously fulfill the criteria for multiple personality disorders, and that the division of personality disorders into discrete categories is not empirically based.
The ICD-11 personality disorder diagnosis is further differentiated according to severity into mild, moderate, and severe, and may optionally be specified by the presence of one or multiple maladaptive personality traits, such as negative affectivity, detachment, dissociality, disinhibition, anankastia, and borderline pattern 1. Treatment for personality disorders typically involves psychotherapy, and may include medication to manage specific symptoms like anxiety or mood instability. Key considerations in treatment include:
- Improving interpersonal functioning
- Enhancing emotional regulation
- Reducing maladaptive behaviors
- Addressing underlying issues such as trauma and early life experiences
It is essential to note that the ICD-11 approach prioritizes clinical utility and simplicity, making it a more practical and effective framework for diagnosing and treating personality disorders in real-life clinical practice 1. By adopting this approach, healthcare professionals can provide more accurate diagnoses and develop more effective treatment plans, ultimately improving patient outcomes and quality of life.
From the Research
Classification of Personality Disorders
- Personality disorders are classified into clusters A, B, and C 2
- Cluster A includes schizoid, schizotypal, and paranoid personality disorders
- Cluster B includes borderline, histrionic, antisocial, and narcissistic personality disorders
- Cluster C disorders are more prevalent and include avoidant, dependent, and obsessive-compulsive personality disorders
Treatment of Personality Disorders
- Dialectical behavior therapy (DBT) is a structured outpatient treatment developed for the treatment of borderline personality disorder (BPD) 3
- DBT is based on cognitive-behavioral principles and is currently the only empirically supported treatment for BPD
- Psychotherapy, pharmacotherapy, and brief interventions can improve the health of patients with personality disorders 2
- Patients with borderline personality disorder may benefit from the use of omega-3 fatty acids, second-generation antipsychotics, and mood stabilizers 2
Efficacy of Dialectical Behavior Therapy
- Randomized controlled trials have shown the efficacy of DBT not only in BPD but also in other psychiatric disorders, such as substance use disorders, mood disorders, posttraumatic stress disorder, and eating disorders 3
- DBT has been found to be effective in reducing BPD symptoms in brief forms of treatment, such as 10-session interventions 4
- There is limited evidence that DBT, mentalization based therapy, and schema therapy are more effective than treatment as usual for personality disorders 5
Implementation of Dialectical Behavior Therapy
- Research has shifted focus to the evaluation of DBT implementation in routine clinical settings 6
- Coordinated implementation efforts have merit, but do not mitigate all implementation challenges 6
- Consideration of implementation facilitators and barriers in DBT can also be applied to other evidence-based interventions for BPD 6