How Personality Disorders Are Diagnosed Around the World: DSM and ICD

If you’ve read about personality disorders online, you may have noticed that descriptions, labels, and even diagnostic criteria don’t always line up neatly. That’s not because experts can’t agree that personality disorders exist — it’s because different countries use different diagnostic systems.

In North America, mental health professionals primarily rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM). In much of the rest of the world, clinicians use the International Classification of Diseases (ICD). While both systems aim to describe and diagnose the same underlying patterns, they take different approaches to classification, emphasis, and structure.

Understanding these differences can help explain why personality disorders may be described differently across countries, why diagnoses don’t always translate cleanly from one system to another, and why newer models are moving away from rigid labels toward more flexible, trait-based frameworks.

DSM: The U.S. and Canada’s Diagnostic Model 

The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association (APA), has gone through many revisions since it first appeared in 1952.

We are now on the fifth edition, published in 2013. Actually, to be more precise, the most recent is the 2022 "text revised," DSM-5-TR, which kept the same structure and disorders but updated language, examples, and research references.

The DSM lists 10 personality disorders (PDs):

• Narcissistic

• Borderline

• Antisocial (commonly known as sociopathy or psychopathy)

• Obsessive-Compulsive (different from the mental illness OCD)

• Histrionic

• Paranoid (different from paranoia as a symptom of mental illness)

• Avoidant

• Schizotypal (different from Schizophrenia) 

• Dependent

• Schizoid (different from Schizophrenia) 

A long-standing challenge with personality disorder diagnosis is the significant overlap between disorders. Many traits appear across multiple diagnoses, which can make strict categorization difficult.

To help organize these patterns, the DSM-III (published in 1980) introduced a three-cluster system (A, B, and C) for personality disorders. That framework has been maintained in every subsequent edition. While the list of ten PDs remains the same, the clusters group disorders with shared features together.

There are ongoing discussions and research into more modern ways to understand and diagnose these conditions.

One newer approach is called the Alternative DSM-5 Model for Personality Disorders, which appears in a special research section (Section III) of the DSM-5 and DSM-5-TR. This model focuses less on fixed categories and more on a trait-based system. It looks at levels of dysfunction and identifies problematic personality traits (like emotional lability, attention-seeking, or hostility) regardless of which “disorder” they fall under.

ICD: The International Model

The International Classification of Diseases (ICD) has moved away from listing specific personality disorder types.

Instead, it identifies Personality Disorder based on severity (mild, moderate, or severe) and then highlights prominent traits (e.g., borderline pattern, narcissistic features).

These newer diagnostic models are intended to reduce overlap between diagnoses and better reflect the range and complexity of personality functioning.

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