Comparison of ICD-10 Diagnostic Guidelines and Research Criteria for Enduring Personality Change after Catastrophic Experience

Abstract

Enduring personality change after catastrophic experience (EPCACE) is a diagnostic category included in the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), as one of the adult personality disorders. Preliminary investigation suggests there is considerable endorsement in principle for this new category amongst experts in the field of intentional human trauma, yet many aspects of the diagnosis remain contentious. EPCACE is described in 2 sets of ICD-10 criteria: the Diagnostic Criteria for Research (DCR) and the Clinical Description and Diagnostic Guidelines (CDDG). Studies have found that the use of the DCR and CDDG for some disorders has created issues related to lack of compatibility and agreement between these 2 versions. This article examines the similarities and differences between the DCR and CDDG for EPCACE. Using background literature to inform our analysis, this article highlights issues related to the stressor criterion, symptom criteria, impairment criterion, criterion related to exclusion of personal vulnerability and early psychiatric history, symptom duration and relationship of post-traumatic-stress disorder with EPCACE. The similarities and differences between the research criteria and diagnostic guidelines of EPCACE are consistent with concerns already identified in the literature for other disorders. This presents a challenge to the way in which diagnostic criteria are conceptualized and stated.

Developmental perspectives on personality: implications for ecological and evolutionary studies of individual differences

“…To date, relatively few researchers have looked at the effects of adult experience on adult personality (but see below). However, this topic has recently attracted considerable attention from psychologists, based on abundant evidence that stressful events in adulthood do have enduring effects on human personality (Beltran et al 2009;Jovanovic & Ressler 2010).…”

Polish Studies on the KZ Syndrome Might Shed Additional Light on the Diagnostic Category of ‘Enduring Personality Change after Catastrophic Experience’: A Comment on Beltran et al. (2009)

“…Recently, Beltran et al [1] have published a very interesting and stimulating paper comparing ICD-10 research criteria and diagnostic guidelines for 'enduring personality change after catastrophic experience' (EPCACE) in this journal. In the conclusion of their paper, the authors listed several issues which still pose a challenge in the diagnosis of EPCACE, such as complexity of symptoms, impairment/ functioning criteria and irreversibility of personality change.…”

Reply to the Commentary by Dr. Karolina Krysinska, PhD, on the Article by Beltran et al. [Psychopathology 2009;42:113–118]

“…It seems a pity that modern nosologies do not encompass both adverse and positive outcomes in their formulations. We highlight the importance of positive changes in our discussion [1] .…”

“…In particular settings, personality factors may have increased vulnerability to trauma or increased the chances of survival. Our discussion concerning criterion D of EPCACE [1] offered some tentative suggestions to address this complex challenge.…”

“…Thank you for the opportunity to respond to the commentary made by Dr. K. Krysinska on our paper 'Comparison of ICD-10 diagnostic guidelines and research criteria for enduring personality change after catastrophic experience' published in this journal [1] . Dr. Krysinska's letter [2] summarizing the psychosomatic sequelae of KZ syndrome, the factors impacting on symptom expression and the long-term prognosis of this constellation provides a very important contribution in this field of practice and research as it makes the data from studies on the K-Z syndrome published in the Polish language accessible to a wider audience.…”