Personality disorder: a disease in disguise

Figures & data

Table 1. Personality disorders in the ICD-10 (2).

Code	Disorder	Characteristics in brief
F60.0	Paranoid	Excessive sensitivity to setbacks, unforgiveness of insults, recurrent suspicions without justification regarding the sexual fidelity of the spouse or sexual partner, and a combative and tenacious sense of personal rights.
F60.1	Schizoid	Withdrawal from affectional, social, and other contacts, preference for fantasy, solitary activities, and introspection. Limited capacity to express feelings and to experience pleasure.
F60.2	Dissocial	Disregard for social obligations, callous unconcern for the feelings of others. Gross disparity between behaviour and prevailing social norms. Behaviour not readily modifiable by adverse experience, including punishment. Low tolerance to frustration; low threshold for discharge of aggression, including violence; tendency to blame others, all leading to conflict with society.
F60.3	Emotionally unstable	A tendency to act impulsively and without consideration of the consequences; unpredictable and capricious mood. Liability to outbursts of emotion and incapacity to control the behavioural explosions. Tendency to quarrelsome behaviour and to conflicts with others. Two types are distinguished: the impulsive type with emotional instability and lack of impulse control; and the borderline type, with added disturbances in self-image, aims, and internal preferences, chronic feelings of emptiness, intense and unstable interpersonal relationships, and a tendency to self-destructive behaviour, including suicide gestures and attempts.
F60.4	Histrionic	Shallow and labile affectivity, self-dramatization, theatricality, exaggerated expression of emotions, suggestibility, egocentricity, self-indulgence, lack of consideration for others, easily hurt feelings, and continuous seeking for appreciation, excitement, and attention.
F60.5	Anankastic	Feelings of doubt, perfectionism, excessive conscientiousness, checking and preoccupation with details, stubbornness, caution, and rigidity. There may be insistent and unwelcome thoughts or impulses that do not attain the severity of an obsessive-compulsive disorder.
F60.6	Anxious [avoidant]	Feelings of tension and apprehension, insecurity and inferiority. A continuous yearning to be liked and accepted, hypersensitivity to rejection and criticism with restricted personal attachments, and a tendency to avoid certain activities by habitual exaggeration of the potential dangers or risks in everyday situations.
F60.7	Dependent	Pervasive passive reliance on other people to make one’s major and minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive compliance with the wishes of elders and others, and a weak response to the demands of daily life. Lack of vigour may show itself in the intellectual or emotional spheres; often a tendency to transfer responsibility to others.
F60.8	Other specific	Eccentric, ‘haltlose’ type, immature, narcissistic, passive-aggressive, psychoneurotic.
F60.9	Unspecified	Diffuse symptoms, not fully qualifying for specific PD, but with the general criterion fulfilled.

Table 2. Personality disorders in the forthcoming ICD-11.

6D10 Personality disorder
Description	Personality disorder is characterized by problems in functioning of aspects of the self (e.g. identity, self-worth,accuracy of self-view, self-direction), and/or interpersonal dysfunction (e.g. ability to develop and maintain close and mutually satisfying relationships, ability to understand others’ perspectives and to manage conflict in relationships) that have persisted over an extended period of time (e.g. 2 years or more). The disturbance is manifested in patterns of cognition, emotional experience, emotional expression, and behaviour that are maladaptive (e.g. inflexible or poorly regulated) and is manifested across a range of personal and social situations (i.e. is not limited to specific relationships or social roles). The patterns of behaviour characterizing the disturbance are not developmentally appropriate and cannot be explained primarily by social or cultural factors, including socio-political conflict. The disturbance is associated with substantial distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.
	6D10.0	6D10.1	6D10.2
	Mild	Moderate	Severe
Description	All general diagnostic requirements for Personality Disorder are met. Disturbances affect some areas of personality functioning but not others (e.g. problems with self-direction in the absence of problems with stability and coherence of identity or self-worth) and may not be apparent in some contexts. There are problems in many interpersonal relationships and/or in performance of expected occupational and social roles, but some relationships are maintained, and/or some roles carried out. Specific manifestations of personality disturbances are generally of mild severity. Mild Personality Disorder is typically not associated with substantial harm to self or others but may be associated with substantial distress or with impairment in personal, family, social, educational, occupational, or other important areas of functioning that is either limited to circumscribed areas (e.g. romantic relationships, employment) or present in more areas but milder.	All general diagnostic requirements for Personality Disorder are met. Disturbances affect multiple areas of personality functioning (e.g. identity or sense of self, ability to form intimate relationships, ability to control impulses and modulate behaviour). However, some areas of personality functioning may be relatively less affected. There are marked problems in most interpersonal relationships and the performance of most expected social and occupational roles are compromised to some degree. Relationships are likely to be characterized by conflict, avoidance, withdrawal, or extreme dependency (e.g. few friendships maintained, persistent conflict in work relationships and consequent occupational problems, romantic relationships characterized by serious disruption or inappropriate submissiveness). Specific manifestations of personality disturbance are generally of moderate severity. Moderate Personality Disorder is sometimes associated with harm to self or others, and is associated with marked impairment in personal, family, social, educational, occupational, or other important areas of functioning, although functioning in circumscribed areas may be maintained.	All general diagnostic requirements for Personality Disorder are met. There are severe disturbances in functioning of the self (e.g. sense of self may be so unstable that individuals report not having a sense of who they are or so rigid that they refuse to participate in any but an extremely narrow range of situations; self-view may be characterized by self-contempt or be grandiose or highly eccentric). Problems in interpersonal functioning seriously affect virtually all relationships, and the ability and willingness to perform expected social and occupational roles is absent or severely compromised. Specific manifestations of personality disturbance are severe and affect most, if not all, areas of personality functioning. Severe Personality Disorder is often associated with harm to self or others and is associated with severe impairment in all or nearly all areas of life, including personal, family, social, educational, occupational, and other important areas of functioning.
6D11 Prominent personality traits or patterns
Description	Trait domain qualifiers may be applied to Personality Disorders or Personality Difficulty to describe the characteristicsof the individual’s personality that are most prominent and that contribute to personality disturbance. Trait domainsare continuous with normal personality characteristics in individuals who do not have Personality Disorder orPersonality Difficulty. Trait domains are not diagnostic categories, but rather represent a set of dimensions thatcorrespond to the underlying structure of personality. As many trait domain qualifiers may be applied as necessary todescribe personality functioning. Individuals with more severe personality disturbance tend to have a greater numberof prominent trait domains.
6D11.0	Negative affectivity in personality disorder or personality difficulty
6D11.1	Detachment in personality disorder or personality difficulty
6D11.2	Dissociality in personality disorder or personality difficulty
6D11.3	Disinhibition in personality disorder or personality difficulty
6D11.4	Anankastia in personality disorder or personality difficulty
6D11.5	Borderline pattern

Excerpt from reference (41) with permission from WHO.

WHO. International statistical classification of diseases and related health problems 10th revision 2016 [July 9, 2018]. Available from: http://apps.who.int/classifications/icd10/browse/2016/en.

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