Table 3.

Strengths and Weaknesses of the ICD-10 and ICD-11 models of Personality Disorders

Strengths	Weaknesses
ICD-10 Classification of Personality Disorder types
Are based on a well-established and longstanding tradition of clinical observations.	Suffer from heterogeneity and excessive co-occurrence (e.g., most patients meet criteria for at least one other category).
Clinicians tend to think in terms of types or “gestalts”.	Clinicians tend only to use the categories of Borderline, Antisocial, and Unspecified Personality Disorder, while neglecting the other categories.
Polythetic criteria allow many different combinations and variations of Personality Disorder types.	Two different patients with the same Personality Disorder type may not share a single symptom (e.g., Schizoid), which allows unclear diagnostic patterns.
Are largely consistent with established clinical theory, and have been subjected to extensive research.	There is limited evidence (with the exception of Borderline-related features) that Personality Disorder types are sound phenotypes or biological markers.
Categorical diagnostic thresholds match categorical decision-making in medical practice and requirements by insurance companies.	Diagnostic thresholds may be pseudo-accurate and clinical decision-making is not always a categorical matter of “present” versus “absent”, and subthreshold diagnosis may have clinical significance.
Provides a manageable number of personality disorder categories (i.e., 8–10 types).	The polythetic categorical approach includes 58 specific criteria in addition to 6 general diagnostic criteria, which can be cumbersome for busy practitioners to evaluate.
ICD-11 classification of severity and trait domains
A global severity determination informs prognosis, risk, and intensity of treatment.	A global severity determination, without considering typology, may be vague, imprecise, and therefore not very informative.
A global severity classification is simple and manageable for low resource settings, and it prevents diagnostic co-occurrence.	A global severity classification may be too minimalistic and unsophisticated for specialist clinical practice.
The option of portraying compositions of 3 severity levels and 5 additional trait domains virtually allows clinicians to describe 93 variations of a personality disorder.	A total of 93 different compositions of a personality disorder diagnosis can be too complex for clinical practice and communication.
Trait domains are empirically-derived “building blocks” of personality pathology.	Many clinicians are unfamiliar with the trait domains - and it is not straightforward how to translate them into clinical practice.
Classification of severity and trait domains allow future treatment trials to focus on global human functioning as well as homogenous phenotypes (i.e., trait domains).	No longer correspondence with established research and clinical recommendations for personality disorder types (except for Borderline).
Continuity with empirical taxonomies of a global p-factor, internalizing-externalizing spectra, the five-factor model, and the DSM-5 Alternative Model of Personality Disorders (AMPD).	Discontinuity with familiar, well-established, and historically important personality disorder types (except for Borderline).