# 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

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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