Mulder Roger T
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
Front Psychiatry. 2021 May 10;12:655548. doi: 10.3389/fpsyt.2021.655548. eCollection 2021.
The ICD-11 classification of personality disorders represents a paradigm shift in diagnosis. This was felt necessary because previous personality disorder classifications had major problems. These included unnecessary complexity, inconsistency with data on normal personality traits, and minimal consideration of severity despite this being shown to be the major predictor of outcome. The ICD-11 classification abolishes all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as "mild," "moderate," or "severe." Patient behavior can be described using one or more of five personality trait domains; negative affectivity, dissociality, anankastia, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier. The ICD-11 shows considerable alignment with the DSM-5 Alternative Model for Personality Disorders. Early evidence around the reliability and validity of the new model appear promising, although at present there is still limited specific evidence due to the model being so recently finalized. However, for the model to be successful, it needs to be embraced by clinicians and used widely in normal clinical practice.
《国际疾病分类第11版》（ICD - 11）中人格障碍的分类代表了诊断领域的范式转变。之所以认为有必要这样做，是因为先前的人格障碍分类存在重大问题。这些问题包括不必要的复杂性、与正常人格特质数据不一致，以及尽管严重程度已被证明是预后的主要预测因素，但对其考虑极少。ICD - 11分类废除了除人格障碍一般描述之外的所有人格障碍类别。该诊断可进一步具体分为“轻度”“中度”或“重度”。患者行为可用五个个性特质领域中的一个或多个来描述：消极情感性、反社会性、强迫性、疏离性和放纵性。临床医生还可指定一个边缘型模式限定词。ICD - 11与《精神疾病诊断与统计手册第5版》（DSM - 5）人格障碍替代模型有相当程度的一致性。关于新模型可靠性和有效性的早期证据看起来很有前景，不过由于该模型最近才最终确定，目前具体证据仍然有限。然而，要使该模型取得成功，需要临床医生接受并在正常临床实践中广泛使用。
