Editorial: Entering the Brave New World of ICD-11 Personality Disorder Diagnosis

WHO member states are soon expected to migrate from the ICD-10 to the ICD-11 Classification of Mental Disorders (1), which must be used for different coding purposes in mental health care including national statistics and billing for health insurance companies (see Figure 1). While most diagnoses remain unchanged1, a fundamentally new approach to the classification of personality disorders (PD) is introduced (1, 2). Rather than diagnosing PDs according to familiar categorical types, the clinician is now requested to focus on general impairments of self- and interpersonal functioning, along with their cognitive, emotional, and behavioral manifestations, which can be classified according to their overall severity (i.e., Mild Personality Disorder, Moderate Personality Disorder, Severe Personality Disorder). Otherwise, the clinician can assign a sub-diagnostic Personality Difficulty code (akin to ICD-10 Z73.1 accentuated personality traits). The clinician is also allowed to assign one or more trait domain specifiers that contribute to the individual expression of personality disturbances (i.e., Negative Affectivity, Detachment, Dissociality, Disinhibition, Anankastia). Finally, with the aim of facilitating the identification of individuals who may respond to established treatments, a Borderline Pattern specifier has been included, which is essentially based on the DSM-5 Borderline PD diagnostic criteria. For a more detailed historical account and rationale behind the ICD-11 PD model, we refer to the overview article by Mulder in this special topic collection.