Tyrer P, Crawford M, Sanatinia R, Tyrer H, Cooper S, Muller-Pollard C, Christodoulou P, Zauter-Tutt M, Miloseska-Reid K, Loebenberg G, Guo B, Yang M, Wang D, Weich S. Preliminary studies of the ICD-11 classification of personality disorder in practice.
Personal Ment Health 2014;
8:254-63. [PMID:
25200623 DOI:
10.1002/pmh.1275]
[Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/17/2014] [Accepted: 08/21/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE
This study aims to compare ICD-10 and putative ICD-11 classifications of personality disorder in different clinical populations.
DESIGN
Prospective recording of ICD-10 and ICD-11 personality disorder classifications was carried out in (1) an anxious medical population, (2) an acute psychiatric in-patient population and (3) a retrospective recording of a mixed anxiety depression cohort in which all baseline data were scored from baseline information using the ICD-11 classification and compared with the original ICD-10 assessments.
METHOD
Comparison of ICD-10 and ICD-11 prevalence of personality disorder in each population was carried out.
RESULTS
Data from 722 patients were recorded. Using the ICD-10 criteria, the prevalence of generic personality disorder was 33.8% compared with 40.4% using the ICD-11 ones (χ2 = 6.7; P < 0.01), with 103 (14.3%) discordant assessments. Using the severity definitions in ICD-11, 34.3% of patients had personality difficulty. Severity level varied greatly by population; severe personality disorder was five times more common in the inpatient group. The four domain traits originally denoted as qualifying severity in ICD-11, negative affective, dissocial, anankastic and detached, were linked to anxious, borderline, dissocial, anankastic and schizoid personality disorders in ICD-10. Many patients had pathology in two or more domains.
CONCLUSIONS
The ICD-11 classification of personality disorder yields somewhat higher levels of personality dysfunction than ICD-10, possibly because the age range for the onset of diagnosis is now flexible. The range of severity levels make the classification more useful than ICD-10 in clinical practice as it identifies the greater pathology necessary for intervention.
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