Diagnosis of personality disorders in youth

PURPOSE OF REVIEW: Diagnosis of personality disorders (PDs) in children and adolescents remains clinically controversial, despite revisions in DSM-5-TR Alternative Model for Personality Disorders (AMPD) and ICD-11 removing formal age-limits for PD diagnosis. This review synthesizes recent 12-18-month evidence on conceptual debates, diagnostic frameworks, assessment instruments, cross-cultural considerations, diagnostic risks (over-diagnosis versus under-diagnosis), and clinical-ethical implications for personality pathology among young people. RECENT FINDINGS: Dimensional severity-centred systems (AMPD Criterion-A/ICD-11 personality-functioning severity) have gained empirical ground for youth populations, yet categorical and dimensional approaches show partial nonoverlap in clinical adolescent cohorts. Validated brief self-report screening tools (LPFS-BF 2.0, BPFSC-11, LoPF-Q 12-18 screener) cannot replace semi-structured clinical interviews (STiP-5.1, CI-BPD). Youth PD presentations vary substantially across cultural contexts; identity-disturbance may be less prominent in nonwestern samples. Longitudinal data confirm substantial plasticity of personality-functioning in adolescence, while sub-threshold personality pathology predicts later psychosocial impairment. Ethical scholarship favours staged-care over stepped-care models, arguing that appropriate early diagnosis reduces rather than amplifies stigma. SUMMARY: Contemporary youth-PD diagnosis requires hybrid categorical-dimensional, multiinformant assessment. Clinicians must differentiate normative adolescent developmental turmoil from enduring personality-related functional impairment. Gaps persist in youth-specific cut-offs for dimensional tools, cross-cultural measurement invariance, and longitudinal real-world clinical outcome research.