The individual differences between personality disorders (“species”) are then further defined by pathological personality traits. ICD-11 proposes to evaluate the severity of the impairment in personality functioning from no personality pathology through the subsyndromal condition of “personality difficulty” to mild, moderate and severe personality disorder diagnoses.

Impairment in personality functioning constitutes the core component of personality disorders distinguishing it from healthy personality as well as from other forms of mental disorders, thus demarcating the “genus of personality pathology” ( 9). Personality functioning in the AMPD is specified as intrapersonal (self) and interpersonal (other) functioning, which are in turn each subdivided into 2 aspects, identity and self-direction for self-functioning, as well as empathy and intimacy for interpersonal functioning ( 5).

This definition closely resembles Criterion A of the AMPD of DSM-5, which equally posits personality functioning as the sine qua non for the diagnosis of a personality disorder in general. The ICD-11 fundamentally defines personality disorders by “problems in functioning of aspects of the self (e.g., identity, self-worth, accuracy of self-view, self-direction), and/or interpersonal dysfunction (e.g., ability to develop and maintain close and mutually satisfying relationships, ability to understand others' perspectives and to manage conflict in relationships)” ( 8). One of the key issues is the new focus on personality functioning as the essence of personality disorder classification. However, at its core the new ICD-11 presents the first official version of a purely dimensional personality disorder classification with major implications for clinical practice and research. Meanwhile, the ICD-11 originally planned to abandon all specific personality disorders, but after intense criticism from several personality disorder expert organizations a special “borderline pattern descriptor” was included in the final version ( 1, 7). The AMPD provides a hybrid dimensional-categorical model with an evaluation of core personality functioning and five broad areas of pathological personality traits as well as identifying six specific personality disorder types ( 5, 6). A move toward a dimensional system was already planned for the last revision of the DSM, but in the last instance the old categorical model was retained in the main corpus and the newly developed “Alternative Model for Personality Disorders” (AMPD) was placed in section III reserved for emerging models and measures ( 4). The “traditional” categorical classification system has been the subject of decades-long critique and its deficiencies and shortcomings are well-known ( 3). Arguably the biggest change is the move from a categorical classification of personality disorders to a fully dimensional system ( 2). The upcoming 11th revision of the ICD includes “the most radical change in the personality disorders classification history” ( 1). Personality functioning can be considered to be the current “common ground” for the assessment of personality disorders and constitutes a considerable step forward in making personality disorder diagnosis both clinically meaningful and suitable for research purposes. and the Operationalized Psychodynamic Diagnosis-and the ICD-11 system are critically discussed. In a detailed conceptual analysis and review of existing empirical data, points of convergence and notable differences between major exponents of the psychodynamic tradition-object relations theory as developed by Kernberg et al. This focus on personality functioning converges with long-standing psychoanalytic/psychodynamic conceptualizations of personality pathology. The new system centers on the evaluation of the severity of impairment in the areas of self and interpersonal functioning. The new ICD-11 introduces a fully dimensional classification of personality disorders representing a fundamental change in personality disorder diagnosis with major implications for clinical practice and research. Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria.

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