Personality is the totality of psychological mechanisms, temperament, intelligence and adaptability. If one is struggling with long-standing difficulties in relationships, dealing with emotions and general functioning, it is possible that a diagnosis for personality disorders is needed. But how do we distinguish between psychological problems and deep personality problems? With the answer comes the new ICD-11 classification, which features a new approach to diagnosing personality disorders.
What exactly are personality disorders?
Personality disorders are established patterns of thinking, feeling and behaving that significantly deviate from cultural norms and cause difficulties in daily functioning. We define personality disorders as ingrained and established patterns manifested in inflexible responses to a variety ofsocial or individual situations.
They are estimated to affect about 12% of the general population and as many as 50% of psychiatric patients.
New approach. Diagnosis in ICD-11 – what has changed?
The previous ICD-10 classification distinguished several specific types of personality disorders, such as borderline or schizoid personality. The new ICD-11 classification introduces a completely different approach, focusing on:
- Severity of the disorder – from mild to severe
- Dominant personality traits
This is an important change that can have a huge impact on diagnosis and treatment.
Severity of the disorder
The ICD-11 distinguishes three degrees of severity of personality disorders:
- Mild
- Moderate
- Severe
In addition, a category of “personality difficulties” has been introduced, which is not yet a full-blown disorder.
As a patient, you may be wondering, what is the significance of this? Well, determining severity allows you to better tailor treatment and assess prognosis. A person with a mild disorder will need a different therapeutic approach than someone with a severe personality disorder.
Personality traits – domains
Based on the ICD-11, it distinguishes five main personality traits that can be prevalent in people with the disorder.
The main domains or domain patterns are:
6D11.0 Negativistic affectivity – a tendency to experience a shocking range of negative emotions, with frequent labile emotions and poor emotion regulation.
6D11.1 Detachment from reality – tendency to maintain interpersonal distance and emotional dissonance, e.g., reserve, detachment, limited expression.
6D11.2 Dyssociality – tendency to be egocentric e.g. sense of entitlement, expectation of admiration and lack of empathy, disregard for the rights and feelings of others.
6D11.3 Disinhibition – a tendency to act rashly in accordance with immediate external or internal stimuli, without regard for negative conspecifics.
6D11.4 Anankastia – focusing on one’s own rigid standards of conduct, controlling one’s own and others’ conduct and control of situations.
6D11.5 Borderline pattern – pervasive instability of interpersonal relationships, self-image and emotions, and marked impulsivity, e.g. frantically trying to avoid abandonment, replicating unstable and intense relationships.
As a patient, understanding your dominant traits can help you learn more about yourself and your reactions in situations that are difficult for you.
The therapist, knowing the specifics of the patient’s traits, can better adjust the style of work, communication and goals of therapy. For example, in the case of high negative affectivity, learning to regulate emotions will be key and with a tendency to detachment, interpersonal skills training will be essential.
Case study – a new description of personality disorder cases. Criterion according to ICD11
Here are some examples of how specific diagnostic criteria in ICD-11 can be applied in practice:
a 29-year-old woman with severe personality disorder, borderline pattern and dominant features of negative emotionality, disinhibition and dissociality.
a 36-year-old man with mild personality disorder and dominant features of negative emotionality and detachment.
a 26-year-old man with severe personality disorder and dominant traits of dissociality, disinhibition and detachment.
a 19-year-old woman with personality difficulties (below the threshold of the disorder) and dominant traits of negative emotionality and anankasticity.
What does this mean for patients? A gradual shift away from ICD-10
ICD-11 focuses on the global severity level of the disorder and the five main personality traits. Changes in the classification of disorders allow specialists to more efficiently assess personality functioning, determine the severity of the disorder and identify dominant traits. The ICD-11 international classification of disorders can bring many benefits:
- More precise diagnosis.
- Better tailoring of treatment.
- Less stigma (moving away from “labeling” with specific types of disorders).
- More flexibility in assessing changes over time.
As a psychotherapist, I see the advantages of this approach. First of all, the ICD-11 does not focus on specific categories of disorders (such as borderline or antisocial personality) but assesses the overall level of personality dysfunction. It can be mild, moderate or severe – depending on how dysfunctional one’s interpersonal relationships, perception of self and others, ability to control impulses, etc., are.
This approach better reflects clinical reality; after all, two patients with the same diagnostic “label” may present completely different levels of difficulty. By assessing the severity of the disorder, the psychotherapist or psychologist immediately knows whether the patient requires intensive, specialized therapy (for severe disorders), or whether a milder form of psychological support (for milder disorders) is sufficient.
Summary
The new ICD-11 classification of personality disorders is a step toward a more personalized approach to diagnosis and treatment. As a patient, you can expect a more precise assessment of your condition and better tailored therapy.
Remember that a diagnosis of personality disorder is not a judgment but a starting point for working on yourself. Your unique characteristics can be both a source of difficulty and a source of strength – it all depends on how you learn to use them. The new classification gives you more opportunities to tailor therapy to your individual needs.
If you suspect you have a personality disorder or already have a diagnosis, don’t hesitate to seek professional help – online psychotherapy
Bibliography:
P.Galecki. Study of the Mental State of Diagnosis According to ICD-11. edra Urban & Partner.2022.
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-05640-3