Comparative Examination of ICD-11 and DSM-5 Alternative Model in Personality Disorders

Abstract

Personality disorders tried to be explained by changing diagnoses and approaches varying from school to school throughout history. With the updated approaches and scientific developments in today's diagnostic booklets, developing and more understandable diagnostic categories for personality disorders are created. New models can be an important resource for diagnosis, treatment and common language among clinicians. Both ICD-11 and DSM-5 main part section III. have highlighted new models beyond the previous personality disorders diagnostic approach. In both models, personality disorders are examined according to severity levels and prominent personality features model. Moreover, personality disorder includes structures that take into account the course of basic personality traits such as self, identity and bilateral relations. While DSM-5 part III. Alternative model on personality disorders section has a content of 5 prominent features, 25 sub-features and functionality which are all for evaluating the disorder, the ICD-11 model includes an approach that includes five features and borderline pattern and definitions, and a 4-dimensional structure in which functionality is evaluated. Although both models include models of features that stand out in personality but not completely overlap with each other. For example, while Psychoticism finds its place as a personality trait in alternative model in section III of DSM-5, as it is not accepted in personality feature in ICD-11. In contrast, the borderline pattern is not named as a feature in DSM-5 in section III, but the ICD-11 treats the borderline pattern as a kind of feature. This is one of the important differences between the two guidelines. Similarly, the criteria by which functionality and impairment are evaluated are not compatible with each other and do not progress in parallel. This means that two different guidelines accept different severity levels as thresholds. However, it can be said that both models accept the personality disorders approach, which includes longitudinal processes in which personality traits can be seen instead of categorical models. The differences between the new models can be interpreted as an obstacle to the development of a common language in terms of diagnosis and treatment.

Keywords

• Personality disorders
• personality
• psychiatric diagnosis
• mental disorder

Kişilik Bozukluklarında ICD-11 ve DSM-5 Alternatif Modelin Karşılaştırmalı İncelenmesi

Öz

Kişilik bozukları tarih boyunca değişen tanılamalarla ve ekolden ekole değişen yaklaşımlarla açıklanmaya çalışılmıştır. Günümüzün tanı kitapçıklarında güncellenen yaklaşımlar ve bilimsel gelişmeler ile kişilik bozuklukları için gelişen ve daha anlaşılır olabilen tanı kategorileri oluşturulmaktadır. Yeni modeller tanı, tedavi ve klinisyenler arası ortak dil için önemli bir kaynak olabilir. Hem ICD-11’de hem de DSM-5 III ana bölümünde daha önceki kişilik bozuklukları tanı yaklaşımının ötesinde yeni modelleri öne çıkarmıştır. Her iki modelde de kişilik işlevselliği değerlendirilerek kişilik bozukluğu incelenmektedir. Değerlendirmede önce işlevselliğin bozulmasının şiddet seviyesi, daha sonra, benlikte, kimlikte ve ikili ilişkilere yansıması gibi özellikler incelenmektedir. DSM-5'te yer alan alternatif model kişilik bozuklukları bölümünde, kişilik bozukluklarında öne çıkan 5 temel özellik 25 alt özellik ve işlevselliğin değerlendirildiği bir içeriğe sahipken, ICD-11 kişilik bozukluğu modeli beş özellik ve sınırda örüntüsünü ve tanımlamasını içeren bir yaklaşımı ve işlevselliğin değerlendirildiği 4 boyutlu bir yapıyı içermektedir. İki modelin kişilikte öne çıkan kişilik özellikleri birbiriyle tamamen örtüşmemektedir. Örneğin, Psikotizm DSM-5 alternatif model kişilik bozukluklarında bir kişilik özelliği olarak kendine yer bulurken, ICD-11’de kişilik bozukluklarında bu özellik yer bulmamıştır. Sınırda örüntüsü DSM-5 alternatif model kişilik bozukluklarında bir özellik gibi isimlendirilmemektedir ancak ICD-11 sınırda örüntüsünü bir tür özellik olarak ele almaktadır. Bu durum iki kılavuz arasındaki önemli farklılıklardandır. Benzer şekilde işlevselliğin ve bozukluğun değerlendirildiği ölçütler birbirleriyle uyumlu ve paralel ilerlememektedir. Bu da iki farklı kılavuzun farklı şiddet seviyelerini eşik olarak kabul ettiği anlamını taşımaktadır. Ancak her iki modelinde kategorisel modeller yerine kişilik özelliklerin görülebildiği ve daha boylamsal süreçlerin içerdiği kişilik bozuklukları yaklaşımını kabul ettiği söylenebilir. Yeni modellerin birbirleriyle farklıklar göstermesi, tanı ve tedavi bakımından ortak dilin gelişmesine engel gibi yorumlanabilir.

Anahtar Kelimeler

• Kişilik bozuklukları
• kişilik
• psikiyatrik tanı
• ruhsal hastalıklar

Kaynakça

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