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Chapter 9 - Personality Disorders

Published online by Cambridge University Press:  13 October 2023

By
Roger Mulder
Edited by
Peter Tyrer
Peter Tyrer
Affiliation:
Emeritus, Imperial College London
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Summary

When the ICD-11 working group for the revision of the classification of personality disorders was established in 2010, there was both an increasing concern, followed by general consensus, that the existing classification in ICD-10 and DSM-IV were no longer fit for purpose. First, the system was complex, with around 80 criteria and 10 separate categories. These categories had evolved from historical precedents, clinical experience, and committee consensus. There was no coherent model or theory for the diagnoses. Some categories had their origins in Galen’s temperaments described over 1800 years ago (Galen, 192), while others, such as borderline personality disorder, had appeared very recently. Clinicians responded to this confusion by often ignoring the whole concept of personality disorders, resulting in low rates of diagnosis in clinical practice. Rates of clinical diagnoses are generally reported to be less than one-quarter of those in systematic prevalence studies.1 When clinicians did make a personality disorder diagnosis, they usually confined themselves to 2 of the 10 categories; borderline personality disorder or antisocial personality disorder, or used the catch-all ‘personality disorder not otherwise specified’ (PD-NOS), or mixed and other personality disorders (61.0) in ICD-10.

Type
Chapter
Information
Making Sense of the ICD-11
For Mental Health Professionals
 , pp. 110 - 121
Publisher: Cambridge University Press
Print publication year: 2023

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References

Mulder, R.T., Newton-Howes, G., Crawford, M.J., Tyrer, P.J. (2011). The central domains of personality pathology in psychiatric patients. J Pers Disord, 25(3), 364–377.CrossRefGoogle ScholarPubMed
Verheul, R., Widiger, T.A. (2004). A meta-analysis of the prevalence and usage of the personality disorder not otherwise specified (PDNOS) diagnosis. J Pers Disord, 18(4), 309–319.CrossRefGoogle Scholar
Bernstein, D.P., Iscan, C., Maser, J., Board of Directors of the Association for Research in Personality Disorders, Board of Directors of the International Society for the Study of Personality Disorders. (2007). Opinions of personality disorder experts regarding the DSM-IV personality disorders classification system. J Pers Disord, 21(5), 536–551.Google Scholar
Costa, P.T., McCrae, R.R. (1992). The five-factor model of personality and its relevance to personality disorders. J Pers Disord, 6, 343–359.CrossRefGoogle Scholar
Hengartner, M.P., Müller, M., Rodgers, S., Rössler, W., Ajdacic-Gross, V. (2014). Interpersonal functioning deficits in association with DSM-IV personality disorder dimensions. Soc Psychiatry Psychiatr Epidemiol, 49(2), 317–325.CrossRefGoogle ScholarPubMed
Gotzsche-Astrup, O., Moskowitz, A. (2016). Personality disorders and the DSM-5: scientific and extra-scientific factors in the maintenance of the status quo. Aust N Z J Psychiatry, 50(2), 119–127.CrossRefGoogle ScholarPubMed
Frances, A. (1982). Categorical and dimensional systems of personality diagnosis: a comparison. Compr Psychiatry, 23(6), 516–527.CrossRefGoogle ScholarPubMed
Ekselius, L., Lindström, E., von Knorring, L., Bodlund, O., Kullgren, G. (1994). A principal component analysis of the DSM-III-R axis II personality disorders. J Pers Disord, 8(2), 140–148.CrossRefGoogle Scholar
Crawford, M.J., Koldobsky, N., Mulder, R.T., Tyrer, P. (2011). Classifying personality disorder according to severity. J Pers Disord, 25(3), 321–330.CrossRefGoogle ScholarPubMed
Kvarstein, E.H., Karterud, S. (2013). Large variation of severity and longitudinal change of symptom distress among patients with personality disorders. Personal Ment Health, 7(4), 265–276.CrossRefGoogle ScholarPubMed
Blasco‐Fontecilla, H., Baca‐Garcia, E., Dervic, K., et al. (2009). Severity of personality disorders and suicide attempt. Acta Psychiatr Scand, 119(2), 149–155.CrossRefGoogle ScholarPubMed
Conway, C.C., Hammen, C., Brennan, P.A. (2016). Optimizing prediction of psychosocial and clinical outcomes with a transdiagnostic model of personality disorder. J Pers Disord, 30(4), 545–566.CrossRefGoogle ScholarPubMed
Wright, A.G.C., Hopwood, C.J., Skodol, A.E., Morey, L.C. (2016). Longitudinal validation of general and specific structural features of personality pathology. J Abnorm Psychol, 125(8), 1120–1134.CrossRefGoogle ScholarPubMed
World Health Organization. (2018). ICD-11, the 11th Revision of the International Classification of Diseases. Geneva: World Health Organization. [Available from: https://icd.who.int/.]Google Scholar
Yang, M., Tyrer, H., Johnson, T., Tyrer, P. (2021). Personality change in the Nottingham Study of Neurotic Disorder: 30-Year cohort study. Aust NZ J Psychiatry, 56(3), 260–269.CrossRefGoogle Scholar
Yang, M., Coid, J., Tyrer, P. (2010). Personality pathology recorded by severity: national survey. Br J Psychiatry, 197(3), 193–199.CrossRefGoogle ScholarPubMed
Tracy, M., Tiliopoulos, N., Sharpe, L., Bach, B. (2021). The clinical utility of the ICD-11 classification of personality disorders and related traits: a preliminary scoping review. Aust NZ J Psychiatry, 55(9), 849–862.CrossRefGoogle ScholarPubMed
Kim, Y.-R., Tyrer, P., Lee, H.-S., et al. (2015). Preliminary field trial of a putative research algorithm for diagnosing ICD-11 personality disorders in psychiatric patients: 2. Proposed trait domains. Personal Ment Health, 9(4), 298–307.CrossRefGoogle ScholarPubMed
Mulder, R.T., Horwood, J., Tyrer, P., Carter, J., Joyce, P.R. (2016). Validating the proposed ICD-11 domains. Personal Ment Health, 10(2), 84–95.CrossRefGoogle ScholarPubMed
Bach, B., Sellbom, M., Kongerslev, M., et al. (2017). Deriving ICD-11 personality disorder domains from DSM-5 traits: initial attempt to harmonize two diagnostic systems. Acta Psychiatr Scand, 136(1), 108–117.CrossRefGoogle ScholarPubMed
Krueger, R.F., Derringer, J., Markon, K.E., Watson, D., Skodol, A.E. (2012). Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med, 42(9), 1879–1890.CrossRefGoogle ScholarPubMed
Bach, B., Sellbom, M., Skjernov, M., Simonsen, E. (2018). ICD-11 and DSM-5 personality trait domains capture categorical personality disorders: finding a common ground. Aust NZ J Psychiatry, 52(5), 425–434.CrossRefGoogle ScholarPubMed
Lotfi, M., Bach, B., Amini, M., Simonsen, E. (2018). Structure of DSM-5 and ICD-11 personality domains in Iranian community sample. Personal Ment Health, 12(2), 155–169.CrossRefGoogle ScholarPubMed
Lugo, V., de Oliveira, S.E.S., Hessel, C.R., et al. (2019). Evaluation of DSM-5 and ICD-11 personality traits using the Personality Inventory for DSM-5 (PID-5) in a Brazilian sample of psychiatric inpatients. Personal Ment Health, 13(1), 24–39.CrossRefGoogle Scholar
Sellbom, M., Solomon-Krakus, S., Bach, B., Bagby, R.M. (2020). Validation of Personality Inventory for DSM–5 (PID-5) algorithms to assess ICD-11 personality trait domains in a psychiatric sample. Psychol Assess, 32(1), 40–49.CrossRefGoogle Scholar
Oltmanns, J.R., Widiger, T.A. (2018). A self-report measure for the ICD-11 dimensional trait model proposal: the personality inventory for ICD-11. Psychol Assess, 30(2), 154–169.CrossRefGoogle ScholarPubMed
Bach, B., Mulder, R.T. (2022). Empirical foundation of the ICD-11 Classification of Personality Disorders. In Huprich, S.K. (Ed.), Personality Disorders and Pathology: Integrating Clinical Assessment and Practice in the DSM-5 and ICD-11 Era. Washington, DC: American Psychological Association.Google Scholar
Somma, A., Gialdi, G., Fossati, A. (2020). Reliability and construct validity of the Personality Inventory for ICD-11 (PiCD) in Italian adult participants. Psychol Assess, 32(1), 29–39.CrossRefGoogle ScholarPubMed
Oltmanns, J.R., Widiger, T.A. (2020). The Five-Factor Personality Inventory for ICD-11: a facet-level assessment of the ICD-11 trait model. Psychol Assess, 32(1), 60–71.CrossRefGoogle ScholarPubMed
Kerber, A., Schultze, M., Müller, S., et al. (2022). Development of a short and ICD-11 compatible measure for DSM-5 maladaptive personality traits using ant colony optimization algorithms. Assessment, 29(3), 467–487.CrossRefGoogle Scholar
Bach, B., Kerber, A., Aluja, A., et al. (2020). International assessment of DSM-5 and ICD-11 personality disorder traits: toward a common nosology in DSM-5.1. Psychopathology, 53(3-4), 179–188.CrossRefGoogle Scholar
Skodol, A.E., Clark, L.A., Bender, D.S., et al. (2011). Proposed changes in personality and personality disorder assessment and diagnosis for DSM-5 Part I: description and rationale. Personal Disord, 2(1), 4–22.CrossRefGoogle ScholarPubMed
Chamberlain, S.R., Stochl, J., Redden, S.A., Grant, J.E. (2018). Latent traits of impulsivity and compulsivity: toward dimensional psychiatry. Psychol Med, 48(5), 810–821.CrossRefGoogle ScholarPubMed
Hopwood, C.J., Kotov, R., Krueger, R.F., et al. (2018). The time has come for dimensional personality disorder diagnosis. Personal Ment Health, 12(1), 82–86.CrossRefGoogle ScholarPubMed
Tyrer, P. (2009). Why borderline personality disorder is neither borderline nor a personality disorder. Personal Ment Health, 3(2), 86–95.CrossRefGoogle Scholar
Sharp, C. (2016). Current trends in BPD research as indicative of a broader sea-change in psychiatric nosology. Personal Disord, 7(4), 334–343.CrossRefGoogle ScholarPubMed
Mulder, R.T., Horwood, L.J., Tyrer, P. (2020). The borderline pattern descriptor in the International Classification of Diseases, 11th Revision: a redundant addition to classification. Aust NZ J Psychiatry, 54(11), 1095–1100.CrossRefGoogle ScholarPubMed
Herpertz, S.C., Huprich, S.K., Bohus, M., et al. (2017). The challenge of transforming the diagnostic system of personality disorders. J Pers Disord, 31(5), 577–589.CrossRefGoogle ScholarPubMed
Tyrer, P., Mulder, R.T., Kim, Y.R., Crawford, M.J. (2019). The development of the ICD-11 classification of personality disorders: an amalgam of science, pragmatism, and politics. Annu Rev Clin Psychol, 15, 481–502.CrossRefGoogle ScholarPubMed
Chanen, A.M., McCutcheon, L. (2013). Prevention and early intervention for borderline personality disorder: current status and recent evidence. Br J Psychiatry, 202 (S54: Youth mental health: appropriate service response to emerging evidence), S24–S29.Google Scholar
Blum, N., St John, D., Pfohl, B., et al. (2008). Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up. Am J Psychiatry, 165(4), 468–478.CrossRefGoogle ScholarPubMed
Zanarini, M.C., Frankenburg, F.R., Reich, D.B., Fitzmaurice, G. (2012). Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry, 169(5), 476–483.CrossRefGoogle ScholarPubMed
Lieb, K., Völlm, B., Rücker, G., Timmer, A., Stoffers, J.M. (2010). Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials. Br J Psychiatry, 196(1), 4–12.CrossRefGoogle ScholarPubMed
Duggan, C., Huband, N., Smailagic, N., Ferriter, M., Adams, C. (2008). The use of pharmacological treatments for people with personality disorder: a systematic review of randomized controlled trials. Personal Ment Health, 2(3), 119–170.CrossRefGoogle Scholar
Mulder, R.T., Bach, B. (2022). Assessment and treatment of PDs within the ICD-11 Framework. In Huprich, S.K. (Ed.), Personality Disorders and Pathology: Integrating Clinical Assessment and Practice in the DSM-5 and ICD-11 Era. Washington, DC: American Psychological Association.Google Scholar
Tyrer, P., Mulder, R.T. (2018). Dissecting the elements of borderline personality disorder. Personal Ment Health, 12(2), 91–92.CrossRefGoogle ScholarPubMed
Tyrer, P., Mulder, R. (2022). Personality Disorder: From Evidence to Understanding. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Nutt, D., Glue, P. (1989). Monoamine oxidase inhibitors: rehabilitation from recent research? Br J Psychiatry, 154, 287–291.CrossRefGoogle ScholarPubMed
Grant, J.E., Baldwin, D.S., Chamberlain, S.R. (2021). Time to reconsider monoamine oxidase inhibitors for obsessive compulsive disorder? A case series using phenelzine. J Clin Psychopharmacol, 41, 461–464.CrossRefGoogle ScholarPubMed

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