ICD-11 personality disorder dimensional model — structured clinical viva

Nosology. ICD-11 replaces multi-type stacking with one personality disorder diagnosis graded by severity (mild/moderate/severe), then trait domain qualifiers (negative affectivity, detachment, dissociality, disinhibition, anankastia), plus optional borderline pattern. Personality difficulty is subthreshold. This addresses artificial comorbidity of ICD-10 types.^[1][2]

Assessment order. Longitudinal history and organic/substance/episodic exclusion → general PD requirements → severity → traits → borderline pattern if indicated → risk, capacity, safeguarding, formulation. DSM AMPD Criterion A/B is the closest DSM cousin for dual-system discussion.^[2]

“Cluster B ×3” recode. Likely one moderate or severe PD with negative affectivity, disinhibition, and possible dissociality elements ± borderline pattern — not three diseases.^[1][2]

Utility. Clinicians often rate ICD-11 as more useful than ICD-10 typing for communication and planning; severity matches care intensity.^[3]

Management. Severity guides intensity; traits guide interpersonal focus. Structured psychotherapy first-line for moderate–severe borderline-pattern presentations (name DBT/MBT/schema/TFP/GPM). Medication is not disease-modifying for PD as a whole; treat comorbidity with review dates.^[4][5]