Dimensional conceptualization and diagnosis of personality disorder in the ICD-11
DOI:
https://doi.org/10.17533/udea.rp.e346148Keywords:
personality disorder, cie-11, diagnosis, dimensional, personality traitsAbstract
During the past decade, strong controversies have developed about whether or not to continue using categorical systems for the diagnosis of personality disorders, on the wake of the double classification proposed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Currently, the new edition of the International Classification of Diseases (CIE-11) adopts a completely dimensional approach based on the best possible evidence, which represents a historical milestone regarding the conceptualization and classification of personality disorders in diagnostic systems. In this article, the history of diagnoses of personality disorders is reviewed and the new CIE-11 diagnostic model is briefly presented in order to analyze, based on these contents and some research results, its advantages over categorical diagnosis and to raise some questions about its empirical validation and its possible implications, both for professional practice and for the social field.
Downloads
References
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. DOI: https://doi.org/10.1037/per0000460
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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/10.1002/pmh.1252
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. DOI: https://doi.org/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. DOI: https://doi.org/10.1192/bjp.188.5.423
Crawford, M., Koldobsky, N., Mulder, R. y Tyrer, P. (2011). Classifying personality disorder according to severity. Journal of Personality Disorders, 25(3), 321-330. DOI: https://doi.org/10.1521/pedi.2011.25.3.321
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. DOI: https://doi.org/10.1037/pas0000757
Crocq, M. (2013). Milestones in the history of personality disorders. Dialogues in Clinical Neuroscience, 15(2), 147-153. DOI: https://doi.org/10.31887/DCNS.2013.15.2/macrocq
Ekselius, L. (2018). Personality disorder: a disease in disguise. Upsala Journal of Medical Sciences, 123(4), 194-204. DOI: https://doi.org/10.1080/03009734.2018.1526235
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. DOI: https://doi.org/10.4103/ijsp.ijsp_26_18
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. DOI: https://doi.org/10.4067/s0717-92272018000400260
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. DOI: https://doi.org/10.1016/j.jpsychores.2012.05.001
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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/10.1037/a0039972
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. DOI: https://doi.org/10.1002/pmh.1248
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. DOI: https://doi.org/10.1002/pmh.1305
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. DOI: https://doi.org/10.1002/pmh.1335
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. DOI: https://doi.org/10.1017/S0033291711002674
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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/10.1521/pedi.2011.25.3.364
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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/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. DOI: https://doi.org/10.1002/pmh.190
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. DOI: https://doi.org/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. DOI: https://doi.org/10.1146/annurev-clinpsy-050718-095736
Tyrer, P., Reed, G. y Crawford, M. (2015). Classification, assessment, prevalence, and effect of personality disorder. The Lancet, 385(9969), 717-726. DOI: https://doi.org/10.1016/S0140-6736(14)61995-4
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. DOI: https://doi.org/10.1521/pedi.2004.18.4.309
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. DOI: https://doi.org/10.1192/bjp.2018.202
Watts, J. (2019). Problems with the ICD-11 classification of personality disorder. The Lancet Psychiatry 6(6), 461-463. DOI: https://doi.org/10.1016/S2215-0366(19)30127-0
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Revista de Psicología Universidad de Antioquia
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Texts submitted for evaluation to the Journal of Psychology of the University of Antioquia must have never been published before, nor been accepted for future publication by any other journal.
Upon the Journal’s acceptance for publication of submitted material, the author partially transfers his/her rights on the article, preserving those relative to its non-commercial use and academic circulation as a free-access file.
Except if otherwise decided, this Journal’s content is covered by a Creative Commons licence “Attribution - Non-commercial – share a like” Colombia 4.0. The licence can be checked out here.
