From the Guidelines
Personality disorders are now categorized into a single diagnosis in ICD-11, characterized by problems in functioning of aspects of the self and/or interpersonal dysfunction, and can be further differentiated according to severity and the presence of specific maladaptive personality traits. The ICD-11 approach to personality disorders represents a significant shift from the previous categorical approach, acknowledging the complexity and dimensionality of these conditions 1. This change is based on the understanding that personality disorders exist on a spectrum, and that individuals may exhibit a range of traits and symptoms that do not fit neatly into discrete categories. The new classification system includes six specific maladaptive personality traits: Negative affectivity, detachment, dissociality, disinhibition, anankastia, and Borderline pattern, which can be used to specify the diagnosis and guide treatment 1. Key aspects of the new classification system include:
- A single personality disorder diagnosis that encompasses a range of symptoms and traits
- Differentiation according to severity, with mild, moderate, and severe categories
- Optional specification of one or multiple maladaptive personality traits
- A focus on clinical utility and simplicity, while still acknowledging the complexity of personality disorders. In contrast to the DSM-5, which retains a categorical approach to personality disorders, the ICD-11 system provides a more nuanced and dimensional understanding of these conditions 1. Overall, the ICD-11 classification system for personality disorders represents a significant advancement in the field, and has the potential to improve diagnosis, treatment, and outcomes for individuals with these conditions.
From the Research
Classification of Personality Disorders
- Personality disorders are classified into three clusters: A, B, and C 2
- Cluster A includes schizoid, schizotypal, and paranoid personality disorders, characterized by odd and eccentric behaviors 2, 3
- Cluster B includes borderline, histrionic, antisocial, and narcissistic personality disorders 2
- Cluster C disorders are more prevalent and include avoidant, dependent, and obsessive-compulsive personality disorders 2
Characteristics of Cluster A Personality Disorders
- Cluster A personality disorders are marked by odd and eccentric behaviors 3
- Schizotypal personality disorder (SPD), paranoid personality disorder (PPD), and schizoid PD are grouped together due to common patterns in symptomatology and shared genetic and environmental risk factors 3
- The DSM-IV-TR describes personality disorders as representing stable and enduring patterns of maladaptive traits 3
Treatment of Personality Disorders
- 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
- Patients with antisocial personality disorder may benefit from the use of mood stabilizers, antipsychotics, and antidepressants 2