Table of Contents:

  1. Introduction
  2. PD traits:
    1. Negative Affectivity
    2. Detachment
    3. Dissociality
    4. Disinhibition
    5. Anankastia
    6. Borderline pattern

ICD-11 Personality Disorders

Theoretically, the DSM is the diagnostic manual used in the US, while the ICD is used in the rest of the world. However, in practice, the DSM is used in most Western countries, or both are consulted.

When it updated to its eleventh edition, the ICD completely overhauled its Personality Disorder section, collapsing all PDs into one disorder with trait domain specifiers. A person can have one or several traits within their PD.

The five traits are:

  • Negative Affectivity ("negative" emotions)
  • Detachment (similar to SzPD)
  • Dissociality (similar to AsPD and NPD)
  • Disinhibition (impulsivity)
  • Anankastia (similar to OCPD)

‘Borderline pattern’ is an optional specifier and ideally should be used in combination with other traits.

Schizotypal disorder is classified as a schizophrenic spectrum disorder, not as a personality disorder.

Negative affectivity

The core feature of the Negative Affectivity trait domain is the tendency to experience a broad range of negative emotions. Common manifestations of Negative Affectivity, not all of which may be present in a given individual at a given time, include:

  • experiencing a broad range of negative emotions with a frequency and intensity out of proportion to the situation;
  • emotional lability and poor emotion regulation;
  • negativistic attitudes;
  • low self-esteem and self-confidence;
  • and mistrustfulness.

Detachment

The core feature of the Detachment trait domain is the tendency to maintain interpersonal distance (social detachment) and emotional distance (emotional detachment). Common manifestations of Detachment, not all of which may be present in a given individual at a given time, include:

  • social detachment (avoidance of social interactions, lack of friendships, and avoidance of intimacy);
  • and emotional detachment (reserve, aloofness, and limited emotional expression and experience).

Dissociality

The core feature of the Dissociality trait domain is disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality, not all of which may be present in a given individual at a given time, include:

  • self-centeredness (e.g., sense of entitlement, expectation of others’ admiration, positive or negative attention-seeking behaviours, concern with one’s own needs, desires and comfort and not those of others);
  • and lack of empathy (i.e., indifference to whether one’s actions inconvenience or hurt others, which may include being deceptive, manipulative, and exploitative of others, being mean and physically aggressive, callousness in response to others’ suffering, and ruthlessness in obtaining one’s goals).

Disinhibition

The core feature of the Disinhibition trait domain is the tendency to act rashly based on immediate external or internal stimuli (i.e., sensations, emotions, thoughts), without consideration of potential negative consequences. Common manifestations of Disinhibition, not all of which may be present in a given individual at a given time, include:

  • impulsivity;
  • distractibility;
  • irresponsibility;
  • recklessness;
  • and lack of planning.

Anankastia

The core feature of the Anankastia trait domain is a narrow focus on one’s rigid standard of perfection and of right and wrong, and on controlling one’s own and others’ behaviour and controlling situations to ensure conformity to these standards. Common manifestations of Anankastia, not all of which may be present in a given individual at a given time, include:

  • perfectionism (e.g., concern with social rules, obligations, and norms of right and wrong, scrupulous attention to detail, rigid, systematic, day-to-day routines, hyper-scheduling and planfulness, emphasis on organisation, orderliness, and neatness);
  • and emotional and behavioural constraint (e.g., rigid control over emotional expression, stubbornness and inflexibility, risk-avoidance, perseveration, and deliberativeness).

Borderline pattern

The Borderline pattern specifier may be applied to individuals whose pattern of personality disturbance is characterised by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, as indicated by many of the following:

  • Frantic efforts to avoid real or imagined abandonment;
  • A pattern of unstable and intense interpersonal relationships;
  • Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self;
  • A tendency to act rashly in states of high negative affect, leading to potentially self-damaging behaviours;
  • Recurrent episodes of self-harm;
  • Emotional instability due to marked reactivity of mood;
  • Chronic feelings of emptiness;
  • Inappropriate intense anger or difficulty controlling anger;
  • Transient dissociative symptoms or psychotic-like features in situations of high affective arousal.