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J Pers Disord. 2017 Oct;31(5):577-589. doi: 10.1521/pedi_2017_31_338. Epub 2017 Sep 14.

The Challenge of Transforming the Diagnostic System of Personality Disorders.

Author information

1
Department of General Psychiatry, University of Heidelberg, Germany.
2
Department of Psychology, University of Detroit Mercy, Michigan.
3
Institute of Psychiataric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
4
Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.
5
The Mount Sinai Hospital, Bronx, New York.
6
National Centre for Suicide Research and Prevention, Oslo, Norway.
7
Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, United Kingdom.
8
University of Otago, Wellington, New Zealand.
9
University of Pittsburgh, Pennsylvania.
10
Department of Psychology, University of Houston, Texas.

Abstract

While the DSM-5 alternative model of personality disorder (PD) diagnosis allows the field to systematically compare categorical and dimensional classifications, the ICD-11 proposal suggests a radical change by restricting the classification of PDs to one category, deleting all specific types, basing clinical service provision exclusively upon a severity dimension, and restricting trait domains to secondary qualifiers without defining cutoff points. This article reflects broad international agreement about the state of PD diagnosis. It is argued that diagnosis according to the ICD-11 proposal is based on broad, potentially stigmatizing descriptions of impaired functioning and ignores much of the impressive body of research and treatment guidelines that have advanced the care of adults and adolescents with borderline and other PDs. Before radically changing classification, which highly impacts the provision of health care, head-to-head field trials coupled with the views of patients as well as thorough debate among scientists are urgently needed.

PMID:
28910213
PMCID:
PMC5735999
DOI:
10.1521/pedi_2017_31_338
[Indexed for MEDLINE]
Free PMC Article

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