Is ICD-11 Personality Disorder Dimensional Enough? A Necessary Positive Expansion for Improving Clinical Utility

One of the sections of the International Classification of Diseases 11th Revision (ICD-11), which focuses on the diagnosis of personality disorder (PD), has received great support from the scientific community for dimensionally focusing on its functioning instead of categories of low validity and utility for daily clinical practice.

The goal of this paper is to provide a positive framework to complement the personality spectrum, and thus, with a comprehensive approach, strengthen the usefulness of the ICD-11-PD model.

This is a narrative review focused on primary literature identified through searches conducted in PubMed and Web of Science in April 2024. The keywords used were "personality disorder," "dimensional models of personality disorders," and "ICD-11 personality disorders." Given the nature of the review, we included studies employing diverse diagnostic criteria for personality disorders, as well as those based on the new ICD-11 definition.

Despite the promising benefits of this new model, preliminary evidence has highlighted several shortcomings, including low discriminant validity, weak latent structures, and a lack of clarity in distinguishing between PD and normal personality. From this perspective, complementary positive framework is proposed, which designates happiness and social well-being as determinants of the clinical importance of personality functioning in the new ICD-11-PD model.

With this integrative model, such deficiencies could be better addressed by providing a personalized and empowering assessment and intervention approach that can obtain cost-effective results in primary and specialized care.