In the field of psychological diagnosis, two classification systems play a key role: the DSM-5 and the ICD-10. Although both are used to describe and categorize mental disorders, there are subtle yet significant differences between them. I have previously discussed personality disorders according to the DSM-5. Since during an appointment covered by the National Health Fund (NFZ), a psychologist (like any other specialist) is required to make a diagnosis and enter the appropriate code in the medical records, I am often asked what a given code means, how a patient should understand it, and whether they should focus on it (i.e., worry about it). In response to these questions, I would like to focus on the ICD-10 classification, offering a comprehensive overview of specific personality disorders (F60), their characteristics, and key differences compared to their American counterpart (DSM-5).
What are specific personality disorders (F60) in ICD-10?
Before we move on to a detailed discussion of the individual types, it is worth recalling how ICD-10 defines the category of specific personality disorders (F60) itself: profound disturbances in an individual’s personality and behavioral tendencies that are not a direct consequence of a disease, injury, or other brain trauma, nor of any other psychiatric disorder. They typically involve several areas of personality and are almost always associated with significant personal distress and social dysfunction. A characteristic feature is that these patterns emerge in childhood or adolescence and persist into adulthood.
Specific Personality Disorders (F60) – Description and Characteristics
The ICD-10 classification, under category F60, identifies eight specific types of personality disorders. Below is a brief description of each:
F60.0 – Paranoid personality disorder
People with this disorder are characterized by excessive sensitivity to failure, a tendency to hold grudges for long periods of time, and suspiciousness. They tend to misinterpret neutral or friendly actions by others as hostile or contemptuous. They are also characterized by a combative and inflexible attitude in defending their own rights, which is disproportionate to the situation. Such individuals are also excessively suspicious. This set of traits may also be accompanied by an inflated sense of self-worth.
F60.1 – Schizoid Personality Disorder
The main characteristic of this disorder is a withdrawal from emotional, social, and other interactions. These individuals prefer solitude, daydreaming, and introspection. They have a limited ability to express emotions and experience pleasure. As a result, they come across as emotionally cold and distant.
F60.2 – Antisocial Personality Disorder
This disorder is characterized by a flagrant disregard for norms, rules, and the feelings of others. People with antisocial personality disorder have a low tolerance for frustration and a low threshold for aggression. They are unable to maintain long-term relationships, although they have no difficulty forming them. They often show a lack of guilt and an inability to learn from their mistakes.
F60.3 – Emotionally unstable personality
ICD-10 distinguishes two subtypes here:
- Impulsive Type (F60.30): This type is characterized by emotional instability and a lack of impulse control. Outbursts of violent behavior are common, especially in response to criticism.
- Borderline type (F60.31): The clinical picture is more complex. In addition to emotional instability and impulsivity, there are disturbances in self-image, goals, and preferences. A sense of emptiness, a tendency to enter into intense and unstable relationships, and self-harming behaviors are also characteristic.
F60.4 – Histrionic Personality Disorder
People with this disorder are characterized by superficial and emotionally unstable behavior, dramatization, theatricality, and excessive emotional expression. They tend to seek approval and the spotlight. Their behavior is often inappropriately seductive, and their relationships with others are shallow.
F60.5 – Anankastic Personality Disorder
The dominant traits here are perfectionism, a need for control, rigidity, and excessive conscientiousness. These individuals are so absorbed in details, rules, and order that they lose sight of the main goal of their actions. Their excessive caution and meticulousness can lead to significant difficulties in making decisions and delegating tasks.
F60.6 – Anxious (avoidant) personality disorder
It is characterized by a constant sense of tension, anxiety, and inferiority. These individuals are convinced that they are unattractive and of lesser value than others. This leads them to avoid social and professional situations that involve interacting with people, out of fear of criticism or rejection.
F60.7 – Dependent Personality Disorder
People with this disorder tend to passively defer to others when making important life decisions. They feel helpless when they are alone because of an excessive fear of being unable to take care of themselves. They have difficulty expressing dissent and taking the initiative.
In the ICD-10 classification, there are two additional diagnoses in this category: “other specified personality disorders” (F60.8) and unspecified personality disorders (F60.9). The F60.8 diagnosis includes personality types such as narcissistic, eccentric, submissive, immature, passive-aggressive, and psychoneurotic. The F60.9 diagnosis, on the other hand, is used in situations where a personality disorder is present but does not meet the criteria for any of the specific categories.
ICD-10 vs. DSM-5: Key Differences in Classification
Although many categories are similar, there are differences in the approach taken by the two classifications. The first—and most obvious—difference is the organizational structure. The ICD-10 presents personality disorders as a linear list of specific disorders (F60), while the DSM-5 divides them into three clusters (A, B, C)—bizarre/eccentric, dramatic/unstable, and anxious/avoidant. This cluster-based approach in the DSM-5 makes it easier to remember and understand the similarities between the disorders.
The second significant difference concerns the classification of schizotypal personality disorder. In the ICD-10, this disorder is classified under schizotypal disorders (F21), whereas in the DSM-5, it is classified as a personality disorder within Cluster A. This difference has practical implications for diagnosis and treatment planning, as it alters the perspective on the nature of the disorder.
The third difference concerns narcissistic personality. The DSM-5 explicitly identifies narcissistic personality disorder in Cluster B, whereas the ICD-10 does not have a separate category for this disorder. This can pose a challenge for clinicians working in ICD-10-based healthcare systems, who must seek the best diagnostic fit.
The fourth difference concerns emotionally unstable personality. ICD-10 distinguishes two subtypes here—impulsive (F60.30) and borderline (F60.31)—while the DSM-5 treats borderline personality disorder as a single, distinct category. The division into subtypes in the ICD-10 allows for more precise diagnosis, but it can also lead to confusion in clinical practice.
Finally, it is worth noting the difference in the overall methodological approach. ICD-10 is based primarily on a categorical model, whereas the DSM-5, although also categorical, includes an alternative dimensional model of personality disorders in Section III. This dimensional model in the DSM-5 reflects contemporary scientific research, which suggests that personality disorders may be better understood as dimensions of pathological traits rather than as distinct categories.
Summary
Familiarity with the ICD-10 classification is essential for every psychologist and psychiatrist practicing in Poland. Although the DSM-5 is gaining popularity and is frequently used in scientific research, the ICD-10 remains the official diagnostic system used in the Polish healthcare system. It is worth noting, however, that the World Health Organization has already implemented a new version—ICD-11—which has been in effect internationally since January 1, 2022. Poland, like other European countries, has been given a five-year period to implement this newer classification and adapt it to the national diagnostic system. This means that in the near future, specialists will transition to the new standard, but for now, ICD-10 remains our everyday working tool.
The diagnoses included in the ICD-10 classification are primarily of practical importance—they facilitate communication among specialists, support treatment planning, and aid in documenting the course of treatment. Although some names of disorders may sound alarming or be associated with colloquial language, it is important for patients to understand that these are merely scientific terms intended to ensure diagnostic precision. A personality disorder is a description of certain patterns of behavior and thinking that can be changed and developed. A patient who is familiar with the characteristics of their diagnosis has the opportunity to better understand themselves and, as a result, work more consciously toward change.
Footnotes
[6] https://remedium.md/icd10/zaburzenia-psychiczne-i-zaburzenia-zachowania/zaburzenie-schizotypowe
PATIENT PRIVACY PROTECTION All statements, examples, and patient stories cited in the articles on this blog have been significantly altered, anonymized, and modified to prevent them from being linked to real patients. These changes include altering names, ages, genders, details of the situations, and other identifying characteristics. Any resemblance to actual persons is purely coincidental.
