Den hybrid-dimensionale diagnosemodel for personlighedsforstyrrelser i ICD-11

Abstract

Following a turbulent historical development, a hybrid-dimensional model for classification of personality disorder has been approved for the upcoming revision of the European diagnostic manual (ICD-11), replacing previous categorical models. According to many, this marks a paradigm shift in the conceptualization of personality disorder.

This bachelor thesis aims to gain a broad understanding of this new diagnostic model and how its configuration reflects psychological theory. The content of the model is therefore examined in the light of two theoretical paradigms with opposing views on the ontology of diagnoses. On one hand, the model is analyzed applying empirical evidence and theory based on the trait approach to personality and personality disorder, reflecting the ontology of realism. On the other hand, essential concepts from Foucault and Hacking are used for a theoretical analysis of the model, representing the nominalist ontology. It is argued that while the two primary components, a severity scale and a classification based on maladaptive trait domains, are congruent with evidence and theory supporting a dimensional approach to of normal and abnormal personality, the third, a categorical borderline qualifier, is not. Foucault’s examination of discourses as well as Hacking’s concept of the looping effect contribute with an alternative understanding of the model. It is argued that a strong discourse about borderline personality disorder, maintained in part by a large population of diagnosed individuals, yields the necessity for the inclusion of a borderline qualifier to enable the approval of the model. From this perspective, the model as a whole reflects predominant discourses about personality disorder in our culture and historical context.

Following the analysis of the hybrid-dimensional model, the assumptions of scientific theory underlying the realist and nominalist views are discussed in relation to diagnoses and diagnostic systems more broadly. A comparison and evaluation of strengths and weaknesses of the two approaches leads up to the suggestion that a synthesis might advantageously be applied in future construction of diagnostic models.

Bedømmelse: 12