Personality Disorders in DSM-5: An Eye to the Future

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The new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is now being used by clinicians.

The fourth edition, or DSM-IV, has been officially ousted and replaced by the fifth revision, or DSM-5.

For mental health newcomers, the DSM is the manual that mental health professionals refer to when diagnosing mental illnesses.

A major change in the DSM-5 is that there are no longer separate diagnostic branches for mental illnesses, personality disorders, and medically related mental illnesses. However, no specific changes were made in the diagnostic criteria for personality disorders.

The 10 DSM-5 Personality Disorders

Personality disorders are related to the way we think and feel about ourselves and others – those habits of mind and emotions that affect our ability to have successful relationships and function effectively in the world. In the DSM-5, as in the DSM-IV, there are 10 types of personality disorders listed:

  1. Antisocial personality disorder
  2. Avoidant personality disorder
  3. Borderline personality disorder
  4. Dependent personality disorder
  5. Histrionic personality disorder
  6. Narcissistic personality disorder
  7. Obsessive-compulsive personality disorder
  8. Paranoid personality disorder
  9. Schizoid personality disorder
  10. Schizotypal personality disorder

Although personality disorders will be diagnosed as before, those working on the DSM-5 considered and proposed changes to the personality disorder criteria. Their proposal for an alternative diagnostic methodology is included in Section III of the DSM-5.

Proposed Alternative Model for Personality Disorder Diagnosis

The alternative model is an attempt to move beyond diagnosing personality disorders using discrete categories. The reason is that personality traits and disorders are thought to be part of a continuous spectrum. So a trait can be normal or maladaptive, depending on its intensity.

The proposed method retains six categories of personality disorders:

  1. Borderline personality disorder
  2. Obsessive-compulsive personality disorder
  3. Avoidant personality disorder
  4. Schizotypal personality disorder
  5. Antisocial personality disorder
  6. Narcissistic personality disorder

The new PD-TS diagnosis

This alternate approach includes a new diagnosis of Personality Disorder-Trait Specified (PD-TS) to indicate the presence of a personality disorder that does not fall within the six specified categories. A PD-TS diagnosis requires clinicians to include trait profiles that might include personality identifiers such as paranoid, histrionic or dependent.

Criterion A and B

All of the personality disorder diagnoses are unified by being described according to criterion A and criterion B. Criterion A describes impairment in the self-functioning areas of identity and self-direction as well as the interpersonal-functioning areas of empathy and intimacy. Criterion B describes pathological traits in the five areas of negative affectivity (lack of emotional expression), antagonism, detachment, disinhibition and psychotic tendencies.

An impairment scale

There is a level-of-impairment scale in the proposed diagnostic method in which zero indicates no impairment and four means severe impairment.

The DSM-5 authors hope that clinicians will become familiar with this new diagnostic prototype as it is a way of diagnosing personality disorders to fit the patient, instead of fitting a patient into a predetermined diagnostic category.

Source: Psychiatric News

 
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