The ICD-11 classification of Personality Disorders focuses on core personality dysfunction, while allowing the practitioner to classify three levels of severity (Mild Personality Disorder, Moderate Personality Disorder, and Severe Personality Disorder) and the option of specifying one or more prominent trait domain qualifiers (Negative Affectivity, Detachment, Disinhibition, Dissociality, and Anankastia). Additionally, the practitioner is also allowed to specify a Borderline Pattern qualifier. This article presents how the ICD-11 Personality Disorder classification may be applied in clinical practice using five brief cases. (1) a 29-year-old woman with Severe Personality Disorder, Borderline Pattern, and prominent traits of Negative Affectivity, Disinhibition, and Dissociality; (2) a 36-year-old man with Mild Personality Disorder, and prominent traits of Negative Affectivity and Detachment; (3) a 26-year-old man with Severe Personality Disorder, and prominent traits of Dissociality, Disinhibition, and Detachment; (4) a 19-year-old woman with Personality Difficulty, and prominent traits of Negative Affectivity and Anankastia; (5) a 53-year-old man with Moderate Personality Disorder, and prominent traits of Anankastia and Dissociality. The ICD-11 Personality Disorder classification was applicable to five clinical cases, which were classified according to Personaity Disorder severity and trait domain qualifiers. We propose that the classification of severity may help inform clinical prognosis and intensity of treatment, whereas the coding of trait qualifiers may help inform the focus and style of treatment. Empirical investigation of such important aspects of clinical utility are warranted.

This study reexamined the organization of Young’s 18 early maladaptive schemas and their hypothesized associations with experiences of need-thwarting parental experiences in childhood and the “vulnerable child” mode of emotional distress in adulthood. A large Danish sample (N = 1054) of 658 clinical- and 391 nonclinical adults completed measures of early maladaptive schemas, parenting styles, and the vulnerable child mode. We identified four higher-order schema domains as most appropriate in terms of interpretability and empirical indices (“Disconnection & Rejection”, “Impaired Autonomy & Performance”, “Excessive Responsibility & Standards”, and “Impaired Limits”). All four schema domains were differentially associated with conceptually relevant need-thwarting parental experiences. Apart from “Impaired Limits”, the schema domains meaningfully accounted for the association between need-thwarting parental experiences in childhood and emotional states of feeling like a “vulnerable child” in adulthood. We conclude that four domains of early maladaptive schemas are empirically and conceptually consistent with Young’s schema therapy model of personality pathology and longstanding emotional disorders. Findings warrant replication using different populations and if possible a prospective multi-method design. A scoring key for computing the four schema domains is provided.

Introduction: The DSM-5 Alternative Model of Personality Disorders (AMPD) and the ICD-11 classification of personality disorders (PD) are largely commensurate and, when combined, they delineate 6 trait domains: negative affectivity, detachment, antagonism/dissociality, disinhibition, anankastia, and psychoticism. Objective: The present study evaluated the international validity of a brief 36-item patient-report measure that portrays all 6 domains simultaneously including 18 primary subfacets. Methods: We developed and employed a modified version of the Personality Inventory for DSM-5 – Brief Form Plus (PID5BF+). A total of 16,327 individuals were included, 2,347 of whom were patients. The expected 6-factor structure of facets was initially investigated in samples from Denmark (n = 584), Germany (n = 1,271), and the USA (n = 605) and subsequently replicated in both patient- and community samples from Italy, France, Switzerland, Belgium, Norway, Portugal, Spain, Poland, Czech Republic, the USA, and Brazil. Associations with interview-rated DSM-5 PD categories were also investigated. Results: Findings generally supported the empirical soundness and international robustness of the 6 domains including meaningful associations with familiar interview-rated PD types. Conclusions: The modified PID5BF+ may be employed internationally by clinicians and researchers for brief and reliable assessment of the 6 combined DSM-5 and ICD-11 domains, including 18 primary subfacets. This 6-domain framework may inform a future nosology for DSM-5.1 that is more reasonably aligned with the authoritative ICD-11 codes than the current DSM-5 AMPD model. The 36-item modified PID5BF+ scoring key is provided in online supplementary Appendix A see www.karger.com/doi/10.1159/000507589 (for all online suppl. material).

This study examined the utility of the Level of Personality Functioning Scale–Brief Form 2.0 (LPFS–BF 2.0) in measuring features corresponding to self–other impairment of personality functioning as defined in the new general diagnostic guidelines for Personality Disorder in DSM-5 Section III and ICD-11. A mixed clinical sample (N = 228) composed of 121 psychiatric outpatients and 107 incarcerated addicts was administered the LPFS–BF 2.0, World Health Organization Wellbeing Index (WHO–5), Symptom Checklist–90–Revised (SCL–90–R), Personality Inventory for DSM–5 (PID–5), and the Schema Mode Inventory (SMI). The LPFS–BF 2.0 yielded two latent components that correspond to an interpretation of self- and interpersonal functioning, and showed relevant associations with severity indexes, well-being, dysfunctional schema modes, and lack of healthy functioning modes. The LPFS–BF 2.0 also demonstrated incremental prediction of reduced healthy adult functioning, fulfillment, and well-being over and above the total PID–5 trait score, although this did not apply to dysregulated anger and overcompensatory coping. Taken together, the LPFS–BF 2.0 is a psychometrically satisfactory instrument that generally captures theoretically expected self–other features of personality dysfunctioning, in particular lack of healthy functioning and fulfillment but to a lesser degree overcompensatory and antagonistic features. Findings warrant replication in different clinical and forensic populations.

Purpose of review: The International Classification of Diseases, 11th Edition (ICD-11) classifies personality disturbance according to levels of severity. This article reviews the literature on levels of personality functioning in relation to clinical management and treatment, and proposes how these findings apply to the ICD-11 classification of personality disorders. Recent findings: Findings were primarily derived from studies using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Level of Personality Functioning Scale (LPFS), Kernberg's Level of Personality Organization, and the general P-factor of personality disorder. Severity of personality dysfunction is related to treatment outcome, risk of dropout, therapeutic alliance, readiness for treatment, risk of harm to self or others, risk of dissociation and psychotic-like breaks, coherence in narrative identity, reflective functioning, and epistemic trust. Summary: The overall level of personality disorder severity indicates risk of negative outcomes and may be used as decision tool for ‘personalized medicine’ and required treatment intensity (e.g., strength of alliance and the need for establishing epistemic trust). Beyond the ICD-11 guidelines for determining personality disorder severity, these implications also apply to practitioners using comparable frameworks such as the DSM-5 LPFS and Kernberg's Level of Personality Organization. Future research should focus on the interaction of severity with trait qualifiers in relation to clinical management.

Objective: The personality disorder domains proposed for the ICD‐11 comprise Negative Affectivity, Detachment, Dissociality, Disinhibition, and Anankastia, which are reasonably concordant with the higher‐order trait domains in the Alternative DSM‐5 Model for Personality Disorders.Method: We examined (i) whether designated DSM‐5 trait facets can be used to describe the proposed ICD‐11 trait domains, and (ii) how these ICD‐11 trait features are hierarchically organized. A mixed Danish derivation sample (N = 1541) of 615 psychiatric out‐patients and 925 community participants along with a US replication sample (N = 637) completed the Personality Inventory for DSM‐5 (PID‐5). Sixteen PID‐5 traits were designated to cover features of the ICD‐11 trait domains.Results: Exploratory structural equation modeling (ESEM) analyzes showed that the designated traits were meaningfully organized in the proposed ICD‐11 five‐domain structure as well as other recognizable higher‐order models of personality and psychopathology. Model fits revealed that the five proposed ICD‐11 personality disorder domains were satisfactorily resembled, and replicated in the independent US sample.Conclusion: The proposed ICD‐11 personality disorder domains can be accurately described using designated traits from the DSM‐5 personality trait system. A scoring algorithm for the ICD‐11 personality disorder domains is provided in appendix.