Specific Personality Disorders (F60)

Personality disorders are classified in ICD-10 under code F60 under the umbrella term specific personality disorders. Borderline disorder also falls under this category.

Guidelines

Here, a severe disturbance of the characterological constitution and behavior is present, which affects several areas of the personality. It is usually accompanied by personal and social impairments.

Personality disorders frequently first appear in childhood or adolescence (the transitional phase into adulthood - also known as the teenage years or separation from parents) and become definitively manifest in adulthood.

Age Restriction

The diagnosis of a personality disorder is not appropriate before the age of 15, 16 or 17.

Diagnostic Guidelines

The conditions are not directly attributable to more significant brain damage or disease or to another psychiatric disorder, and they fulfill the following criteria:

• Marked disharmony in attitudes and behavior in several functional areas such as affectivity, drive, impulse control, perception and thinking, and in relationships with others

• Enduring behavioral pattern - the abnormal behavior pattern is uniform and not limited to episodes of mental illness

• Pervasive impact - the abnormal behavior pattern is clearly maladaptive in many personal and social situations

• Early onset - the disorders always begin in childhood or adolescence and become permanently manifest in adulthood

• Subjective distress - the disorder leads to marked subjective distress, sometimes however only in the later course

• Functional impairment - the disorder is usually associated with marked limitations in occupational and social performance

Diagnostic Criteria

For the diagnosis of most subgroups, at least three of the respectively listed characteristics or behaviors must be present.

General Diagnostic Criteria

Criterion A: Deviant Patterns of Experience and Behavior

The characteristic and enduring inner patterns of experience and behavior of the affected persons deviate markedly overall from culturally expected and accepted standards (“norms”). This deviation manifests in more than one of the following areas:

• Cognition - perception and interpretation of things, people and events; attitudes and ideas about self and others
• Affectivity - range, intensity and appropriateness of emotional responsiveness and reaction
• Impulse control - and need gratification
• Interpersonal relationships - and the manner of dealing with them

Criterion B: Inflexible Behavior

The deviation is so pronounced that the resulting behavior is inflexible, maladaptive or otherwise dysfunctional in many personal and social situations (not limited to a specific triggering stimulus or a particular situation).

Criterion C: Distress

Personal distress, detrimental influence on the social environment, or both.

Criterion D: Stability and Duration

Evidence that the deviation is stable, of long duration, and has begun in late childhood or adolescence.

Criterion E: Exclusion of Other Mental Disorders

The deviation cannot be explained by the presence or consequences of another mental disorder of adulthood. However, episodic or chronic conditions may exist alongside this disorder or overlap with it.

Criterion F: Exclusion of Organic Causes

An organic disease, injury or marked functional disturbance of the brain must be excluded as a possible cause of the deviation.

Borderline Disorder in the Spectrum

Borderline disorder thus lies within personality disorders, within specific personality disorders F60.0, further within emotionally unstable personality disorder F60.3, and ultimately comprises the impulsive type F60.30 (which must be fulfilled) and the borderline type F60.31.

Classification Hierarchy

F60     Specific personality disorders
└── F60.3   Emotionally unstable personality disorder
    ├── F60.30  Impulsive type
    └── F60.31  Borderline type

Spectrum

Based on this structure, you can see that borderline disorder F60.31 can shift within the impulsive type F60.30, and this in turn can shift within the unstable personality disorder F60.3. This results in a broad spectrum for the borderline personality, which can lie at any point within the spectrum.

Commentary on Diagnosis

The determination of criteria A through F should be based on as many sources of information as possible. While it is sometimes possible to obtain sufficient evidence from a single interview with the affected person, as a general guideline:

• More than one interview with the affected person should be available
• Collateral histories should be obtained
• Third-party reports should be available

If necessary, the development of sub-criteria to define behavioral patterns is suggested that are specific to different cultures and concern social norms, rules and obligations.

When diagnosing a personality disorder for research purposes, the determination of a subtype is required. Where sufficient evidence exists that the affected person meets criteria from several criterion groups, more than one subtype may be classified.

Further Information

Borderline Disorder Detailed information on borderline personality disorder

The Ego Model Psychodynamic model and ego identity

Narcissism Narcissistic personality disorder