Evidence

2018 surveillance of personality disorders (NICE guidelines CG77 and CG78)

Surveillance decision

Surveillance decision

We will not update the following guidelines on personality disorders:

Reasons for the decision

An advance preview of the new version 11 of the International Classification of Diseases (ICD-11) was released in June 2018. It will be presented at the World Health Assembly in May 2019 for adoption by member states. This version introduces substantial changes in the way personality disorder is classified. It removes all categories of personality disorder and replaces them with a single dimensional scale of personality disorder severity. Trait domain qualifiers may be applied to describe the personality characteristics that are most prominent, but do not count as diagnoses in their own right.

Given the pending changes in ICD-11 to personality disorder classification, we will not update the NICE guidelines on antisocial personality disorder and borderline personality disorder at this time. We will perform an exceptional surveillance review of these guidelines in 2021, in order to gauge the reaction of the community to ICD-11 and consider any potential impact before deciding whether to update NICE's personality disorder guidelines.

In the current surveillance of the 2 guidelines, new evidence identified either supported recommendations or was insufficient to propose an update. Specific considerations for the individual guidelines are stated below.

Antisocial personality disorder

The surveillance process for NICE guideline CG77 followed the static list review process therefore no formal evidence searches were done. Most evidence came from topic experts and is discussed in the views of topic experts section of this report.

Borderline personality disorder

Evidence supporting current recommendations was found for: patient experience; recognition of borderline personality disorder; borderline personality disorder in young people; and general psychotherapies.

Evidence was found for the following areas within the guideline scope but outside current recommendations, that was insufficient to update the guideline or showed no benefit: screening instruments; dialectical behaviour therapy (other than for women who self-harm); psychoeducation; transference-focused psychotherapy; mentalisation; motive-oriented therapeutic relationship; interpersonal psychotherapy; cognitive therapy; cognitive behavioural therapy; schema-focused therapy; and drug treatment.

For further details and a summary of all evidence identified in surveillance, see appendix A.


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