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23 Crim. Behav. & Mental Health 1 (2013)

handle is hein.journals/cbmh23 and id is 1 raw text is: Criminal Behaviour and Mental Health 23: 1-5 (2013) Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/cbm.1850 Editorial The classification of personality disorders in ICD-11: Implications for forensic psychiatry PETER TYRER, Centre for Mental Health, Department of Medicine, Imperial College, London W6 8RP, UK Twenty years ago, Criminal Behaviour and Mental Health carried an article from me entitled 'Flamboyant, erratic, dramatic, borderline, antisocial, sadistic, narcissistic, histrionic and impulsive personality disorder: who cares which?' (Tyrer, 1992). The many years since have confirmed the answer I gave in the article, the only ones who care are those with a vested interest in keeping these terms. The average clinician certainly does not seem to take much interest in these curious adjectives. When the International Classification of Diseases (11th edition) (ICD-11) working group for the revision of personality disorders met to review the use of the diagnostic categories in the ICD-10 (World Health Organisation, 1992) classification of personality disorders across different countries, we found that borderline, dissocial and mixed personality disorders were responsible for 95% of all personality disorder diagnoses, but more botheringly, they were diagnosed in well under 5% of all patients. When epidemiological studies show that the prevalence of personality disorders in the community is at or above 5% (Coid et al., 2006; Huang et al., 2009), there is clearly something wrong - this diagnostic system apparently leads to the 'Great Clinician Switch Off'. Why is this? The classification clearly has no clinical utility, and possible reasons include (1) the stigmatic nature of the label, (2) the high comorbidity between different personality disorders, which is clearly a false separation as nobody is prepared to argue that this represents true comorbidity in the form of separate disorders (Livesley and Jackson, 1986) and (3) the very high proportion of what is called personality disorder not otherwise specified in the Diagnostic and Statistical Manual (DSM) classification (Verheul and Widiger, 2004), giving the clear message 'a plague on your classification, it does not represent what I see in my clinic'. The more damning criticism is that neither the current US DSM nor Copyright t 2013 John Wiley & Sons, Ltd. 23: 1-5 (2013) DOI: 10.1002/cbm

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