Questions arising from the application of the ICD-11 diagnoses of complex post traumatic stress disorder and personality disorder

Abstract

There is an overlap between the International Classification of Diseases for Mortality and Morbidity Statistics- 11th Revision (ICD-11) diagnoses of complex post-traumatic stress disorder (CPTSD) and personality disorder. When the latter is comorbid with post-traumatic stress disorder (PTSD), this may allow for a false positive CPTSD diagnosis. This fact has both clinical implications and throws into relief theoretical questions about the ontology of trauma and personality disorder-related pathology. These questions are presented as a call for further research.

Key points

• The ICD 11 introduces a new CPTSD diagnosis, and a new conceptualisation of personality disorder.

• Despite the advances of the ICD 11, the arrangement of these constructs allows for issues which may pose difficulties for clinicians working in this area.

• There remain a variety of epistemological and ontological questions concerning trauma and the type of difficulties captured by the diagnosis of personality disorder. These will require future research to clarify.

Keywords:

• Personality disorder
• CPTSD
• EUPD
• BPD
• trauma

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 This article is concerned with the diagnostic category of personality disorder, and the practical application of this. Outside of the remit of this article, the authors support the views put forward by the Consensus Statement (Lamb et al., 2018).

2 Specifically, this review includes: Cloitre et al. (2013); Cloitre et al. (2014); Hyland et al. (2019); Frost et al. (2020); Jowett et al. (2020); along with studies with less explicit focus on differentiating the two constructs; but which still provide some suggestions in this area.

3 There are perennial questions about why a small proportion of service-users who meet criteria for a personality disorder diagnosis do not report attachment disturbances/ adverse childhood experiences, which could also bear further investigation.