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Why We Need a New Classification of Personality Disorders

Peter J. Tyrer, MD
Interim Head of the Centre for Mental Health in the Division of Experimental Medicine, Professor of Community Psychiatry, Imperial College London

Dr. Peter Tyrer talks about the failures of the classifications of the DSM since 1958. He is a chair of the workgroup for the revision of personality disorders for ICD-11 and also a member of the DSm-5/ICD-11 harmonisation group. He starts by talking about a case, and how this case shows that the criteria in the DSM donít fit the case. The woman she talks about had a diagnosis of personality disorder, because she met criteria for borderline personality disorder, histrionic personality disorder, antisocial personality disorder, narcissistic personality disorder, and paranoid personality disorder, but clinicians gave her a diagnosis of bipolar disorder. He explains what is wrong with the classifications of the DSM in personality disorder: 1)comorbidity, 2) no severity assessment, 3) she doesnít tolerate any of the personality diagnoses and 4) she is treated for a disorder that she doesnít have. He states that the DSM does not look at the core characteristics of personality disorders. However, he is positive in that we can improve the diagnosis using ICD-11 recommendations, such as abolishing the categories of personality disorder, replacing them by levels of degree, assessing severity using trait domains and not using an age limit. h\He revisits the case and applies his proposed improvements to prove that this would help the value of a diagnosis. Lastly, he describes how diagnosis would change in practice using ICD-11 criteria.

 

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