185 - General diagnostic requirements for personali

General diagnostic requirements for personality disorder

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Trait domain specifiers that may be recorded include the following: 6D11.0 Negative affectivity Detachment Dissociality Disinhibition Anankastia More detailed guidance about the personality characteristics reflected in the trait domain specifiers is provided in the following sections. Clinicians may also wish to add an additional specifier: Borderline pattern The borderline pattern specifier has been included to enhance the clinical utility of the classification of personality disorder. Specifically, use of this specifier may facilitate the identification of individuals who may respond to certain psychotherapeutic treatments. A complete description of a particular case of personality disorder includes the rating of the severity level and the assignment of the applicable trait domain specifiers (e.g. mild personality disorder with negative affectivity and anankastia; severe personality disorder with dissociality and disinhibition.) The borderline pattern specifier is considered optional but, if used, should ideally be used in combination with the trait domain specifiers (e.g. moderate personality disorder with negative affectivity, dissociality and disinhibition, borderline pattern). General diagnostic requirements for personality disorder Essential (required) features • An enduring disturbance characterized by problems in functioning of aspects of the self (e.g. identity, self-worth, accuracy of self-view, self-direction) and/or interpersonal dysfunction (e.g. ability to develop and maintain close and mutually satisfying relationships, ability to understand others’ perspectives and to manage conflict in relationships) is required for diagnosis. • The disturbance has persisted over an extended period of time (e.g. lasting 2 years or more). • The disturbance is manifested in patterns of cognition, emotional experience, emotional expression and behaviour that are maladaptive (e.g. inflexible or poorly regulated). • The disturbance is manifested across a range of personal and social situations (i.e. is not limited to specific relationships or social roles), although it may be consistently evoked by particular types of circumstances and not others. 6D11.1 6D11.2 6D11.3 6D11.4 6D11.5 Personality disorders and related traits | General diagnostic requirements for personality disorder

555 Personality disorders and related traits • The symptoms are not due to the direct effects of a medication or substance, including withdrawal effects, and are not better accounted for by another mental disorder, a disease of the nervous system or another medical condition. • The disturbance is associated with substantial distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning. • Personality disorder should not be diagnosed if the patterns of behaviour characterizing the personality disturbance are developmentally appropriate (e.g. problems related to establishing an independent self-identity during adolescence) or can be explained primarily by social or cultural factors, including sociopolitical conflict. Severity of personality disorder The areas of personality functioning shown in Box 6.2 should be considered in making a severity determination for individuals who meet the general diagnostic requirements for personality disorder. Box 6.2. Aspects of personality functioning that contribute to severity determination in personality disorder Degree and pervasiveness of disturbances in functioning of aspects of the self • Stability and coherence of one’s sense of identity (e.g. extent to which identity or sense of self is variable and inconsistent or overly rigid and fixed) • Ability to maintain an overall positive and stable sense of self-worth • Accuracy of one’s view of one’s characteristics, strengths, limitations • Capacity for self-direction (ability to plan, choose, and implement appropriate goals) Degree and pervasiveness of interpersonal dysfunction across various contexts and relationships (e.g. romantic relationships, school/work, parent-child, family, friendships, peer contexts) • Interest in engaging in relationships with others • Ability to understand and appreciate others’ perspectives • Ability to develop and maintain close and mutually satisfying relationships • Ability to manage conflict in relationships Pervasiveness, severity and chronicity of emotional, cognitive and behavioural manifestations of the personality dysfunction • Emotional manifestations • Range and appropriateness of emotional experience and expression • Tendency to be emotionally over- or underreactive • Ability to recognize and acknowledge emotions that are difficult or unwanted by the individual (e.g. anger, sadness) • Cognitive manifestations • Accuracy of situational and interpersonal appraisals, especially under stress • Ability to make appropriate decisions in situations of uncertainty • Appropriate stability and flexibility of belief systems • Behavioural manifestations • Flexibility in controlling impulses and modulating behaviour based on the situation and consideration of the consequences • Appropriateness of behavioural responses to intense emotions and stressful circumstances (e.g. propensity to self-harm or violence) The extent to which the dysfunctions in the above areas are associated with distress or impairment in personal, family, social, educational, occupational or other important areas of functioning Personality disorders and related traits | General diagnostic requirements for personality disorder