What’s New in the International Classification of Diseases?

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From¬†Psychology Today: “Most of the initial news coverage of the¬†ICD-11‘s release¬†focused on its inclusion of a new mental disorder called¬†gaming disorder…However, while gaming disorder has received an extraordinary amount of news coverage,¬†many other significant changes to the mental disorders section of¬†ICD-11¬†have yet to receive sufficient attention.

Despite being popular with the general public (if the spate of¬†self-help books available on Amazon¬†is any indication), the¬†personality disorder¬†sections of both¬†the¬†ICD¬†and¬†DSM¬†have long been problematic, both conceptually and scientifically. The major scientific problem is that, although descriptively vivid, clinicians can’t reliably distinguish the personality disorder categories¬†from one another in practice. Thus, the long taken-for-granted assumption that¬†one’s supposedly disfigured personality can be¬†distinguished¬†as ‘borderline,’ ‘narcissistic,’ ‘dependent,’ ‘avoidant,’ or ‘schizoid’¬†is scientifically suspect.¬†Rather than relying on these long-maintained but scientifically problematic categories, researchers have argued that assessing personality disorders should be done by mapping people along various personality dimensions.¬†The¬†DSM-5¬†took tentative steps in this direction, but its proposed¬†hybrid trait model¬†was an odd compromise that retained some traditional personality disorder categories while also incorporating dimensional assessment measures of personality. The resulting¬†DSM-5¬†proposal was¬†deemed by some to be¬†overly complicated. It was ultimately¬†not officially adopted, but instead¬†relegated to a¬†section of the¬†DSM-5¬†containing proposals¬†needing further study.¬†The¬†ICD-11, by comparison, has gone all-in on a totally¬†overhauled personality disorders section. The old categories (borderline, antisocial, dependent, avoidant, etc.) have been completely jettisoned. In their place is one diagnosis–‘personality disorder’–which is diagnosed as¬†mild,¬†moderate, or¬†severe¬†after¬†assessing¬†personality along¬†six trait¬†domains. This is a radical departure.”

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