A New ICD-11 Category: Personality Difficulty

Letters to the Editor Patients With Personality Disorders in Everyday Clinical Practice—Implications of the ICD-11 by Prof. Dr. med. Sabine C. Herpertz, Dr. med. Isabella Schneider, Prof. Dr. Babette Renneberg, and Prof. Dr. med. Antonius Schneider in issue 1–2/2022

The core element of the newly structured ICD-11 classification of personality disorders is the dimensional and differentiated description of functional impairments at the personal and interpersonal level. As the ICD-11 became established in Germany, the category “personality difficulty” was introduced, conceived as a more weakly pronounced personality disorder—quasi a “personality disorder lite”—which can be confirmed by all medical specialties even without specific further training in psychotherapy/psychiatry. The criteria for diagnosing a “difficult” personality are blurred. The stated objective—the wider and earlier (in primary care) identification of the problem areas associated with personality disorders—is articulated in an imprecise way. The newly created category is intended to help code for complicated treatment conditions. The only concrete characteristic introduced is a greater investment in terms of time.

The ”difficult” personality is under threat of becoming the superspreader of personality disorders as a result of the bias in billing codes if the diagnostic and coding guidelines create incentives for opportune additional diagnoses. In dealing with a “difficult” personality, the core question arises of what is “difficult” about the patient. Do we not have to assume that different treatment providers may come to assess differently the degree of difficulty in the interactions?

For “difficult” personalities thus affected who have a stored additional diagnostic label, the following questions arise:

• How can I, as an affected “difficult patient” trust in the empathy of my treating physician?
• Will my “difficult” personality traits create problems if I want to take out private health insurance?
• How do I, someone with a “difficult” personality, find a treating physician who is willing to engage with me at all?

According to a quotation by Thomas Kötter, doctors tend to trivialize or deny their own symptoms, as a result of their own personalities (2). If this applies and results in a greater investment in time on the part of the treating physician, will they regard us patients then as “difficult” personalities?

DOI: 10.3238/arztebl.m2022.0190

Dr. med. Peter Bader

Arzt für Neurologie

Großweil

Conflict of interest statement

The author declares that no conflict of interest exists.

References

1. Herpertz SC, Schneider I, Renneberg B, Schneider A: Patients with personality disorders in everyday clinical practice—implications of the ICD-11. Dtsch Arztebl Int 2022; 119: 1–

2. Sauer Jana: Wenn der Arzt zum Patient wird. Der Hausarzt 2019; 7: 20–2.