Strengths | Weaknesses |
---|---|
ICD-10 Classification of Personality Disorder types | |
Are based on a well-established and longstanding tradition of clinical observations. | Suffer from heterogeneity and excessive co-occurrence (e.g., most patients meet criteria for at least one other category). |
Clinicians tend to think in terms of types or “gestalts”. | Clinicians tend only to use the categories of Borderline, Antisocial, and Unspecified Personality Disorder, while neglecting the other categories. |
Polythetic criteria allow many different combinations and variations of Personality Disorder types. | Two different patients with the same Personality Disorder type may not share a single symptom (e.g., Schizoid), which allows unclear diagnostic patterns. |
Are largely consistent with established clinical theory, and have been subjected to extensive research. | There is limited evidence (with the exception of Borderline-related features) that Personality Disorder types are sound phenotypes or biological markers. |
Categorical diagnostic thresholds match categorical decision-making in medical practice and requirements by insurance companies. | Diagnostic thresholds may be pseudo-accurate and clinical decision-making is not always a categorical matter of “present” versus “absent”, and subthreshold diagnosis may have clinical significance. |
Provides a manageable number of personality disorder categories (i.e., 8–10 types). | The polythetic categorical approach includes 58 specific criteria in addition to 6 general diagnostic criteria, which can be cumbersome for busy practitioners to evaluate. |
ICD-11 classification of severity and trait domains | |
A global severity determination informs prognosis, risk, and intensity of treatment. | A global severity determination, without considering typology, may be vague, imprecise, and therefore not very informative. |
A global severity classification is simple and manageable for low resource settings, and it prevents diagnostic co-occurrence. | A global severity classification may be too minimalistic and unsophisticated for specialist clinical practice. |
The option of portraying compositions of 3 severity levels and 5 additional trait domains virtually allows clinicians to describe 93 variations of a personality disorder. | A total of 93 different compositions of a personality disorder diagnosis can be too complex for clinical practice and communication. |
Trait domains are empirically-derived “building blocks” of personality pathology. | Many clinicians are unfamiliar with the trait domains - and it is not straightforward how to translate them into clinical practice. |
Classification of severity and trait domains allow future treatment trials to focus on global human functioning as well as homogenous phenotypes (i.e., trait domains). | No longer correspondence with established research and clinical recommendations for personality disorder types (except for Borderline). |
Continuity with empirical taxonomies of a global p-factor, internalizing-externalizing spectra, the five-factor model, and the DSM-5 Alternative Model of Personality Disorders (AMPD). | Discontinuity with familiar, well-established, and historically important personality disorder types (except for Borderline). |