Conceptualización y Diagnóstico Dimensional del Trastorno de Personalidad en el CIE-11
DOI:
https://doi.org/10.17533/udea.rp.e346148Palabras clave:
trastorno de personalidad, CIE-11, diagnóstico, dimensional, rasgos de personalidadResumen
Durante la pasada década se desarrollaron fuertes polémicas acerca de si continuar utilizando o no sistemas categoriales para el diagnóstico de los trastornos de personalidad, a raíz de la doble clasificación planteada por el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5). En la actualidad, la nueva edición de la Clasificación Internacional de Enfermedades (CIE-11) adopta un enfoque completamente dimensional basado en la mejor evidencia posible, el cual supone un hito histórico respecto a la conceptualización y clasificación de los trastornos de personalidad en los sistemas diagnósticos. En este artículo se revisa la historia del diagnóstico del trastorno de personalidad y se presenta brevemente el nuevo modelo diagnóstico del CIE-11 para, a partir de estos contenidos y de algunos resultados de investigación, analizar sus ventajas respecto al diagnóstico categorial y plantear algunos interrogantes acerca de su validación empírica y sus posibles implicaciones, tanto para la práctica profesional como a nivel social.
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Aluja, A., Sayans-Jiménez, P., García, L., y Gutiérrez, F. (2021). Location of International Classification of Diseases–11th revision and diagnostic and statistical manual of mental disorders. Fifth Edition. Dimensional trait models in the alternative five-factor personality space. Personality Disorders: Theory, Research, and Treatment, 12(2), 127–139.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders. DSM-5. Fifth Edition. American Psychiatric Publishing. Bach, B. y Anderson, J. (2020). Patient-Reported ICD-11 personality disorder severity and dsm-5 level of personality functioning. Journal of Personality Disorders, 34(2), 231–249. doi: 10.1521/pedi_2018_32_393.
Bach, B. y First, M. (2018). Application of the ICD-11 classification of personality disorders. BMC Psychiatry, 18, 351-365. doi: 10.1186/s12888-018-1908-3.
Bach, B., Kerber, A., Aluja, A., Bastiaens, T., Keeley, J., Claes, L., Fossati, A., Gutiérrez, F., Oliveira, S., Pires, R., Riegel, K., Rolland, J., Roskam, I., Sellbom, M., Somma, A., Spanemberg, L., Strus, W., Thimm, J., Wright, A. y Zimmermann, J. (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. doi: 10.1159/000507589.
Bach, B., Sellbom, M., Kongerslev, M., Simonsen, R., Krueger, R. y Mulder, R. (2017). Deriving ICD-11 personality disorder domains from DSM-5 traits: initial attempt to harmonize two diagnostic systems. Acta Psychiatrica Scandinavica, 136(1), 108-117. doi: 10.1111/acps.12748.
Bach, B., Sellbom, M., Skjernov, M., y Simonsen, E. (2018). ICD-11 and DSM-5 personality trait domains capture categorial personality disorders: finding a common ground. Australian and New Zealand. Journal of Psychiatry, 52(5), 425-434. doi: 10.1177/0004867417727867.
Bagby, R. y Widiger, T. (2020). Assessment of the ICD-11 dimensional trait model: an introduction to the Special Section. Psychological Assessment, 32(1), 1-7. doi: 10.1037/pas0000785.
Beckwith, H., Moran, P. y Reilly, J. (2014). Personality disorder prevalence in psychiatric outpatients: a systematic literature review. Personality and Mental Health, 8(2), 91-101.
Berrios, G. (2008). Historia de los síntomas de los trastornos mentales. La psicopatología descriptiva desde el siglo XIX. México: Fondo de Cultura Económica.
Caspi, A. y Moffitt, T. (2018). All for one and one for all: mental disorders in one dimension. American Journal of Psychiatry, 175(9), 831–844. doi: 10.1176/appi.ajp.2018.17121383.
Coid, J., Yang, M., Tyrer, P., Roberts, A. y Ullrich, S. (2006). Prevalence and correlates of personality disorder in Great Britain. British Journal of Psychiatry, 188(5), 423-431.
Crawford, M., Koldobsky, N., Mulder, R. y Tyrer, P. (2011). Classifying personality disorder according to severity. Journal of Personality Disorders, 25(3), 321-330.
Crego, C. y Widiger, T. (2020). The convergent, discriminant, and structural relationship of the DAPP-BQ and SNAP with the ICD-11, DSM-5, and ffm trait models. Psychological Assessment, 32(1), 18-28. doi: 10.1037/pas0000757.
Crocq, M. (2013). Milestones in the history of personality disorders. Dialogues in Clinical Neuroscience, 15(2), 147-153.
Ekselius, L. (2018). Personality disorder: a disease in disguise. Upsala Journal of Medical Sciences, 123(4), 194-204.
Farnam, A. y Zamanlu, M. (2018). Personality disorders: the reformed classification in International Classification of Diseases-11 (ICD-11). Indian Journal of Social Psychiatry, 34, S49-S53.
Figueroa, G. (2018). Una nueva propuesta de clasificación de los trastornos de personalidad: la clasificación internacional de enfermedades CIE-11. Revista Chilena de Neuro-Psiquiatría, 56(4), 260-268.
Fok, M., Hayes, R., Chang, C., Stewart, R., Callard, F. y Moran, P. (2012). Life expectancy at birth and all-cause mortality among people with personality disorder. Journal of Psychosomatic Research, 73(2), 104-107.
Gamache, D., Savard, C., Leclerc, P., Payant, M., Berthelot, N., Côté, A., Faucher, J., Lampron, M., Lemieux, R., Mayrand, K., Nolin, M-C. y Tremblay, M. (2021). A proposed classification of ICD-11 severity degrees of personality pathology using the Self and Interpersonal Functioning Scale. Frontiers in Psychiatry, 12. doi: 10.3389/fpsyt.2021.628057.
Gutiérrez, F., Aluja, A., Ruiz, J., García, L., Gárriz, M., Gutiérrez, A., Gallardo, D., Navarro, M., Alabérnia-Segura, M., Mestre, J., Torrens, M., Peri, J., Sureda, B., Soler, J., Pascual, J., Vall, G., Calvo, N., Ferrer, M., Oltmanns, J. y Widiger, T. (2021a). Personality disorders in the ICD-11: spanish validation of the picd and the saspd in a mixed community and clinical sample. Assessment, 28(3), 759- 772. doi: 10.1177/1073191120936357.
Gutiérrez, F., Peri, J., Gárriz, M., Vall, G., Arqué, E., Ruiz, L., Condomines, J., Calvo, N., Ferrer, M. y Sureda, B. (2021b). Integration of the ICD-11 and DSM-5 dimensional systems for personality disorders into a unified taxonomy with non-overlapping traits. Frontiers of Psychiatry, 12. doi: 10.3389/fpsyt.2021.591934.
Herpertz, S., Huprich, S., Bohus, M., Chanen, A., Goodman, M., Mehlum, L., Moran, P., Newton, G., Scott, L. y Sharp, C. (2017). The challenge of transforming the diagnostic system of personality disorders. Journal of Personality Disorders, 31(5), 577- 589. doi: 10.1521/pedi_2017_31_338.
Hopwood, J., Kotov, R., Krueger, R., Watson, D., Widiger, T., Althoff, R., Ansell, E., Bach, B., Bagby, R., Blais, M., Bornovalova, M., Chmielewski, M., Cicero, D., Conway, C., De Clercq, B., De Fruyt, F., Docherty, A., Eaton, N., Edens, J.,…Zimmermann, J. (2018). The time has come for dimensional personality disorder diagnosis. Personality and Mental Health, 12(1), 82-86. doi: 10.1002/pmh.1408.
Huprich, S. (2020). Personality disorders in the ICD-11: Opportunities and Challenges for advancing the diagnosis of personality pathology. Current Psychiatry Reports, 22, 40. doi: 10.1007/s11920-020-01161-4.
Keeley, J., Reed, G., Roberts, M., Evans, S., Medina, M., Robles, R., Rebello, T., Sharan, P., Gureje, O., First, M., Andrews, H., Ayuso, J., Gaebel, W., Zielasek, J. y Saxena, S. (2016). Developing a science of clinical utility in diagnostic classification systems field study strategies for ICD-11 mental and behavioral disorders. American Psychologist, 71(1), 3-16.
Kim, Y., Blashfield, R., Tyrer, P., Hwang, S. y Lee, H. (2014). Field trial of a putative research algorithm for the diagnosis of ICD-11 personality disorders in psychiatric patients: 1. severity of personality disturbance. Personality and Mental Health, 8(1), 67-78.
Kim, Y., Tyrer, P., Lee, H., Kim, S., Hwang, S., Lee, G. y Mulder, R. (2015). Preliminary field trial of a putative research algorithm for diagnosing ICD-11 personality disorders in psychiatric patients: 2. proposed trait domains. Personality and Mental Health, 9(4), 298-307.
Kim, Y., Tyrer, P., Lee, H., Kim, S., Connan, F., Kinnaird, E., Olajide, K. y Crawford, M. (2016). Schedule for personality assessment from notes and documents (SPAN-DOC): preliminary validation, links to the icd-11 classification of personality disorder, and use in eating disorders. Personality and Mental Health, 10(2), 106-107.
Krueger, R., Derringer, J., Markon, K., Watson, D. y Skodol, A. (2012). Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychological Medicine, 42(9), 1879-1890.
Livesley, W. (2020). Why is an evidence-based classification of personality disorder so elusive? Personality and Mental Health, 15, 8-25. doi: 10.1002/pmh.1471.
McCabe, G. y Widiger, T. (2020). A comprehensive comparison of the ICD-11 and DSM-5 section iii personality disorder models. Psychological Assessment, 32(1), 72-84. doi: 10.1037/pas0000772.
Mulder, R., Horwood, L. y Tyrer, P. (2020). The borderline pattern descriptor in the International Classification of Diseases, 11th Revision: a redundant addition to classification. Australian & New Zealand Journal of Psychiatry, 54(11), 1095-1100. doi: 10.1177/0004867420951608.
Mulder, R., Horwood, J., Tyrer, P., Carter, J., y Joyce, R. (2016). Validating the proposed ICD-11 domains. Personality and Mental Health, 10(2), 84-95. doi: 10.1002/pmh.1336.
Mulder, R., Newton, G., Crawford, M. y Tyrer, P. (2011). The central domains of personality pathology in psychiatric patients. Journal of Personality Disorders, 25(3), 364-377.
Olajide, K., Munjiza, J., Moran, P., O'Connell, L., Newton, G., Bassett, P., Akintomide, G., Ng, N., Tyrer, P., Mulder, R. y Crawford, M. (2018). Development and psychometric properties of the Standarized Assessment of Severity of Personality Disorder (SASPD). Journal of Personality Disorders, 32(1), 44-56. doi: 10.1521/pedi_2017_31_285.
Oltmanns, J., Smith, G., Oltmanns, T. y Widiger, T. (2018). General factors of psychopathology, personality, and personality disorder: across domain comparisons. Clinical Psychological Science, 6(4), 581–589. doi: 10.1177/2167702617750150.
Oltmanns, J. y Widiger, T. (2018). A self-report measure for the ICD-11dimensional trait model proposal: the personality inventory for icd-11. Psychological Assessment, 30(2), 154-169. doi: 10.1037/pas0000459.
Oltmanns, J. y Widiger, T.A. (2019). Evaluating the assessment of the ICD-11 Personality Disorder Diagnostic System. Psychological Assessment, 31(5), 674-684. doi: 10.1037/pas0000693.
Oltmanns, J. y Widiger, T. (2020). The Five-Factor Personality Inventory for ICD-11: a facet-level assessment of the icd-11 trait model. Psychological Assessment, 32(1), 60-71. doi: 10.1037/pas0000763.
Organización Mundial de la Salud (2020). CIE-11 para las estadísticas de mortalidad y morbilidad (CIE-11 EMM). Trastornos de la personalidad y rasgos relacionados. Recuperado de https://icd.who.int/browse11/l-m/es#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f37291724.
Reed, G., First, M., Kogan, C., Hyman, S., Gureje, O., Gaebel, W., Maj, M., Stein, D., Maercker, S., Tyrer, P., Claudino, A., Garralda, E., Salvador, L., Ray, R., Saunders, J., Dua, T., Poznyak, V., Medina, M., Pike, K.,…Saxena, S. (2019). Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry, 18(1), 3–19. doi: 10.1002/wps.20611.
Rek, K., Thielmann, I., Henkel, M., Crawford, M., Piccirilli, L., Graff, A., Mestel, R. y Zimmermann, J. (2020). A psychometric evaluation of the Standardized Assessment of Severity of Personality Disorder (saspd) in nonclinical and clinical German samples. Psychological Assessment, 32(10), 984-990. doi: 10.1037/pas0000926.
Sellbom, M., Solomon, S., Bach, B. y Bagby, R. (2020). Validation of Personality Inventory for DSM–5 (PID-5) algorithms to assess ICD-11 personality trait domains in a psychiatric sample. Psychological Assessment, 32(1), 40–49. doi:10.1037/pas0000746.
Sleep, C., Lynam, D. y Miller, J. (2021). Personality impairment in the DSM-5 and ICD-11: current standing and limitations. Current Opinion in Psychiatry, 34(1), 39–43. doi: 10.1097/YCO.0000000000000657.
Somma, A., Gialdi, G. y Fossati, A. (2020). Reliability and construct validity of the Personality Inventory for ICD-11 (PICD) in italian adult participants. Psychological Assessment, 32(1), 29-39. doi: 10.1037/pas0000766.
Tyrer, P. (2020). Why we need to take personality disorder out of the doghouse. British Journal of Psychiatry, 216(2), 65-66. doi: 10.1192/bjp.2019.125.
Tyrer, P., Coombs, N., Ibrahimi, F., Mathilakath, A., Bajaj, P., Ranger, M., Rao, B. y Din, R. (2007). Critical developments in the assessment of personality disorder. British Journal of Psychiatry, 190(S49), S51-S59. doi: 10.1192/bjp.190.5. s51.
Tyrer, P., Crawford, M. y Mulder, R. (2011). Reclassifying personality disorders. The Lancet, 377, 1814-1815. doi: 10.1016/S0140-6736(10)61926-5.
Tyrer, P., Crawford, M., Mulder, R., Blashfield, R., Farnam, A., Fossati, A., Kim, Y., Koldobsky, N., Lecic, D., Ndetei, D., Swales, M., Clark, L. y Reed, G. (2011). The rationale for the reclassification of personality disorders in the 11th Revision of the International Classification of Diseases (ICD-11). Personality and Mental Health, 5(4), 246-259.
Tyrer, P., Crawford, M., Sanatinia, R., Tyrer, H., Cooper, S., Muller, C., Christodoulou, P., Zauter, M., Miloseka, K., Loebenberg, G., Guo, B., Yang, M., Wang, D. y Weich, S. (2014). Preliminary studies of the ICD-11 classification of personality disorder in practice. Personality and Mental Health, 8(4), 254-263. doi: 10.1002/pmh.1275.
Tyrer, P., Mulder, R., Kim, YR. y Crawford, MJ. (2019). The development of the icd-11 classification of personality disorders: an amalgam of science, pragmatism, and politics. Annual Review of Clinical Psychology, 15, 482-502.
Tyrer, P., Reed, G. y Crawford, M. (2015). Classification, assessment, prevalence, and effect of personality disorder. The Lancet, 385(9969), 717-726.
Verheul, R. y Widiger, T. (2004). A meta-analysis of the prevalence and usage of the personality disorder not otherwise specified (PDNOSS) diagnosis. Journal of Personality Disorders, 18(4), 309-319.
Volkert, J., Gablonski, T., y Rabung, S. (2018). Prevalence of personality disorders in the general adult population in Western countries: systematic review and meta-analysis. The British Journal of Psychiatry, 213(6), 709-715. doi: 10.1192/bjp.2018.202.
Watts, J. (2019). Problems with the ICD-11 classification of personality disorder. The Lancet Psychiatry 6(6), 461-463.
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