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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

SO190

An ICD-11-based assessment of the prevalence of primary and secondary personality disorder diagnoses in high-security forensic services in the United Kingdom

AN ICD-11–BASED EVALUATION OF THE PREVALENCE OF PRIMARY AND SECONDARY PERSONALITY DISORDER DIAGNOSES WITHIN HIGH SECURE FORENSIC SERVICES IN THE UK

Personality disorder was identified in 30.8% of inpatients at a high-security forensic hospital; while ICD-10 subtyping was inconsistent, 87% of cases met ICD-11 criteria for severe personality disorder.

The aim of the study was to determine the prevalence of primary or secondary personality disorder diagnoses in a high-security hospital according to ICD-10 and to reclassify these diagnoses according to ICD-11, including the borderline pattern qualifier. The electronic medical records of all male inpatients at a high-security hospital in England were reviewed over 14 months; assessments used SPAN DOC (Schedule for Personality Assessment from Notes and Documents), mapped to the ICD-11 classification, with reliability first established using vignettes. Of 208 male patients, 64 (30.8%) had a personality disorder diagnosis; a total of 116 ICD-10 diagnoses were recorded for these 64 patients: dissocial 52 (81%), emotionally unstable personality disorder (EUPD) 29 (45%), paranoid 15 (31%), mixed 14 (22%), narcissistic disorder or traits 8 (12.5%), anxious 3 (6%), schizotypal 3 (6%), histrionic 1 (2%), and anankastic 1 (2%). Forty-one patients (64%) had more than one ICD-10 personality disorder diagnosis; 32 patients (50%) had two diagnoses, 9 (14%) had three, and 9 (14%) had a single specified diagnosis. Of the 64 patients with personality disorder, 34 (53%) had a co-occurring mental illness, while 30 (47%) had personality disorder alone; across the entire population, 144 patients (69%) had only mental illness recorded. According to ICD-11, 56 patients (87%) met criteria for severe personality disorder (Fisher's exact test p=0.0001), 6 (9%) for moderate personality disorder, 1 (2%) for mild personality disorder, and 1 (2%) for personality difficulty; trait domains of dissociality, negative affectivity, and disinhibition were present in 50 of the 64 cases (Fisher's exact test p=0.0002). The ICD-11 borderline pattern qualifier was identified in 39 cases (61%), a higher proportion than the ICD-10 EUPD diagnosis (29 cases, 45%); 38 of these 39 cases (97%) had severe personality disorder. According to the authors, psychiatrists in high-security settings reliably identify the presence of personality disorder, but remain inconsistent in subtyping because of overlap between diagnostic categories; ICD-11's emphasis on severity assessment will improve the clinical validity and utility of the diagnosis.

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