Diagnosing Personality Disorders
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Instead of the milk of human kindness: troubles.
TO SORT out symptoms of mental disorders and diseases we need diagnostic criteria and other information to guide the good work.
The information provided on this page should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. The data compiled are for educational uses.
The main sources are (1) ICD-10 Classification of Mental and Behavioural Disorders by the Word's Health Organisation (WHO), Geneva, 1992, and (2) the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition ( DSM-IV) of 1994, by the American Psychiatric Association (APA), Arlington, VA. DSM-IV-TR is a text revision of it from 2000 and replacing DSM-IV.
To ease understanding, some ways of wording are simplified with no losses of meaning and only scantily, in step with principles of plain English as formulated by Martin Cutts. For example, "for a minimum of" is replaced by "at least", which means just the same and without loss of information. Overseriousness and loosely founded, but studied meticulousness are out of the place, and sacrificing plain English totally is not. [Peg]
The material here was compiled by me some years ago. Note the reservation set annexed to the survey. - TK, 2011
A PERSONALITY DISORDER is a severe disturbance in the character constitution and behaviour tendencies of the individual. Usually several areas of the personality are involved. Such a disturbance is nearly always associated with considerable personal and social disruption.
Below are the main personality disorders (general diagnostic guidelines). Each has its own pattern of symptoms (shown further down). Moreover, a personality disorder tends to appear in late childhood or adolescence and continues to be manifest into adulthood. Hence, diagnoses are not to be held of value for those younger than sixteen or seventeen years.
TO REPEAT, personality disorders are marked by long-lasting rigid patterns of thought and actions. They are inflexible, pervasive patterns or sets of inner experience and behaviour. They can cause serious problems and impairment of functioning and lessen thriving. To be diagnosed as part of a personality disorder, a conduct pattern must cause significant distress or impairment in personal, social, and/or occupational situations, but that is not all of the criteria that are to be met. Ten personality disorders can be grouped into three clusters:
A: ODD: Odd or eccentric disorders Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder (see reservatons above)
B: DRAMATIC: Dramatic, emotional, or erratic disorders Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
C: ANXIOUS: Anxious or fearful disorders Avoidant personality disorder
Dependent personality disorder
Obsessive-compulsive personality disorder (is not Obsessive-compulsive disorder)
"Personality Disorder NOS "
The DSM-IV contains a category for behavioural patterns that do not match the ten disorders on the list, but nevertheless have the characteristics of some personality disorder; this category is labeled Personality Disorder NOS (Not Otherwise Specified). The previous version of the DSM also contained the Passive-Aggressive Personality Disorder and the Self-Defeating Personality Disorder.
Passive-Aggressive Personality Disorder is a pattern of negative attitudes and passive resistance in interpersonal situations. Self-defeating personality disorder is characterised by behaviour that consequently undermines the person's pleasure and goals.
There is room for more probing in this terrain:
"Luxury loving personality disorder" is not on the list – and it is an imperfect world we live in as well.
Many are luxury-loving, and it is theoretically possible to suggest it as a specific mental disorder too – maybe related to narcissism, or some obsessive traits - and why not mall sale frenzy as well. However, from tentatively surmising that widespread love of luxury may slowly glide into a marked, subtle inner disease, and to having verified diagnostic criteria to substantiate claims by, the way is long and not easy. Perhaps just such work should be undertaken, for something needs to be done where all is not well.
What we hold on to is the stance that widespread abuse of oneself and others, widespread unequal distribution of goods and good condition on the planet, and not enough caring for about two thirds of humankind, do not need to be overlooked as possible symptoms of things worse than callousness. In the rich countries and in other countries as well, those with power and money seldom share their wealth substantially with the poor. There are exceptions.
Much that is common on this planet is neither beneficial nor healthy. You may suspect character disorders among the "new nobility" that wants to swim in luxury all life long, and among a lot of celebrity admirers too. Regrettably, those with money and power also have influence to bulwark against degraded esteem, so research "upward" can be difficult. A mere suspicion will not do. What is halfway suggested is that it might pay to investigate carefully how far and how widespread love of luxury is, and what criteria may be used to suggest a disease marked by such an overt, common symptom around. In other words, what could be involved is being adapted to a money-and-glamour focused culture, all in all.
To the degree the luxury lover needs to frolic by haughtiness through wealth, a certain lack of healthy play and merry behaviour early in life might be suspected, maybe substantial isolation too. Frolicing in unhealthy and basically unworthy and undignified ways should be investigated as a symptom of something deeper, and not regularly worshipped in common TV entertainment either.
Decay in basic relationships might serve decay of a sort, one that seeks substitutions in riches out of deep disappointments with one's relations.
Also, an urge for goodies as part of the lifestyle might serve as a weak indicator, and so on.
It could also be that developing love of luxury makes one oversentimental, and uncomfortable with less than the strikingly gorgeous – allied with fooling innocents.
Check old, deep wounds of the mind (traumas) to see the issue more cogently.
And mind that a suggestive list of items has not been verified, that much work needs to go into verifications that are made use of in common practice. Till then, refrain from using "love of luxury" as a characteriological disorder. If not, you may be called on to prove or document your labelling, and it may not be so pleasant for you.
GENERAL diagnostic criteria for personality disorders that are not attributable to gross brain damage or disease or to another psychiatric disorder, must meet the following criteria in addition to the specific criteria for any personality disorders:
A deep problem pattern can be manifested in two or more of these areas:
For different cultures and subcultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations. For diagnosing most of the subtypes listed below, clear evidence is usually required for at least three of the specific items in a clinical description list.
To recap: to qualify as a sign of a personality disorder a long-lasting pattern must be rigid and detected across a broad range of personal and social situations. It must lead to obvious and marked distress or impairment in social, occupational, or other important areas of functioning.
Its start can be traced back at least to adolescence or early adulthood. It is not better accounted for as a manifestation or consequence of another mind-disorder, and is not due to the direct physiological effects of a substance e.g. drug or a general medical condition such as head injury.
A blend of legal issues and psychiatric ones also result in this: People under 18 years old who fit the criteria of a personality disorder are usually not diagnosed with such a disorder, although they may be diagnosed with a related disorder. Antisocial personality disorder cannot be diagnosed in persons under eighteen.
MANY OF the deeply ingrained, maladaptive, lifelong behaviour patterns of personality disorders have been reckoned with for over half a century. Many causes have been speculated on, and there are a few outcomes of rearch too: Child abuse and neglect are risks for personality disorders in adulthood. The sexually abused may develop antisocial and impulsive conduct as grown-ups.
The DSM seeks to represent what the members of the American Psychiatric Association agree on. However, the diagnostic labels require personal interpretation from the users, and idea associations to key terms may be individualised with time, say the brothers Buzan. [Mmb 64-66], and given the blunderbuss nature of entry words that are assembled in groups or "category bags" or are called "pervasive patterns".
"Call a dog a bad name and hang him" has obvious parallells in modern psychiatry. The need for protection of victims of mislabelling stands out. Statistics brings evidence. There is no reason to think that all criminals are in jail or that all mentally disordered ones are taken care of. In fact, two thirds of the seriously mentally disordered ones are not treated. And there is no reason to ignore the facts that many sound persons are wrongly diagnosed and dishonoured thereby, to add to their previous burdens, if any.
Let us venture on an example. if you doubt that someone labelled as theatrically self-dramatising over and over is ill or just an actor (in suspense), check the words. The "bag" called "histrionic" relates to actors, acting, or the theatre, the dramatic and affected performance with artificial emotions, extravagant display of costumes and decor, or some exhibitionist flair. There is a grave risk that immature personality styles may be misunderstood as personality disorders in some conclaves. The thin blue line between who is a good, dramatic actor and a mental "fool of acting", a histrionically disordered fellow, may not be found.
Subjectivity in diagnoses (labelling) work is to be expected and not feared, then. Different people of different cultures, education, and experience draw the lines differently, understand diagnostic keywords idiosyncratically, and live well on top of that, even. Evidence that there there are clear "diagnostic thresholds" between normal and abnormal are either absent or only weakly supported. Much seems to be relative to the diagnosticians too. That is a reason why they often conclude differently in single cases. The chance is that some make a living of acting, others of branding undeveloped actors as mad. And the point is that different experts in diagnosis reach different conclusions. Be that as it may.
"WHERE you are not known, nobody speaks ill of you." This should bring comfort to the paranoid ones, just as "Most people don't know who you are anyway, so how can everybody hate you?"
Insight is of many kinds and degrees. The often overlooked point is how low the reliability may be in modern diagnoses. But there is room for improvement: evidence suggests that both structured interviews and broader information can improve reliability of diagnosis.
There is some overlapping of criteria among different disorders in the list. A way of dealing with the problem has been to group common personality disorders into three clusters, each group with a set of similar disorders. There is also a "not otherwise specified" basket category. Suffice to say that the evidence is that current diagnostic categories may not reveal all people with personality disorders and who need treatment, or better treatment. The methods have some built-in flaws of inaccuracy and labelling defects, but still are of much use.
Personality disorder symptoms, as with all mental disorders, can vary over time and become much more acute during times of stress in a person's life. One should try to reflect on various interactions between physical health and disease and personality disorders.
THERE are differences between personality disorders and other mental disorders. For example, the obsessive-compulsive personality disorder (OCPD) is defined differently than the obsessive-compulsive disorder (OCD). In the following you can find personality disorders defined by the concepts that professionals use, with nothing omitted from the central definitions.
Antisocial (Dissocial) Personality Disorder – WHO F60.2
THIS DISORDER usually comes to attention because of a gross disparity between behaviour and the prevailing social norms, and chalked out by at least three of the following:
There may also be persistent irritability as an associated feature. Conduct disorder during childhood and adolescence, though not invariably present, may further support the diagnosis.
INCLUDING: amoral, antisocial, asocial, psychopathic, and sociopathic personality (disorder)
EXCLUDING: conduct disorders - emotionally unstable personality disorder
Diagnostic criteria for 301.7 Antisocial Personality Disorder: DSM-IV & DSM-IV-TR
Individuals with this Cluster B Personality Disorder in their actions regularly disregard and violate the rights of others. These conducts may be aggressive or destructive and may involve breaking laws or rules, deceit or theft.
There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:
Anxious (Avoidant) Personality Disorder – WHO F60.6
PERSONALITY disorder chalked out by at least three of the following:
Diagnostic criteria for 301.82 Avoidant (Anxious) Personality Disorder - DSM-IV
Individuals with this Cluster C Personality Disorder are socially inhibited, usually feel inadequate and are overly sensitive to criticism.
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
Emotionally Unstable (Borderline) Personality Disorder - WHO F60.3
There is a marked tendency to act impulsively without considering the consequences, together with affective instability. The ability to plan ahead may be minimal, and outbursts of intense anger may often lead to violence or "behavioural explosions"; these are easily precipitated when impulsive acts are criticized or thwarted by others.
Two variants of this personality disorder are specified, and both share this general theme of impulsiveness and lack of self-control.
The predominant traits are emotional instability and lack of impulse control. Outbursts of violence or threatening behaviour are common, particularly in response to criticism by others.
INCLUDING: explosive and aggressive personality (disorder).
EXCLUDING: dissocial personality disorder.
Several of the marks of emotional instability are present; in addition, the patient's own self-image, aims, and internal preferences (including sexual) are often unclear or disturbed. There are usually chronic feelings of emptiness. A liability to become involved in intense and unstable relationships may cause repeated emotional crises and may be associated with excessive efforts to avoid abandonment and a series of suicidal threats or acts of self-harm (although these may occur without obvious precipitants).
INCLUDING: - borderline personality (disorder)
Diagnostic criteria for 301.83 Borderline Personality Disorder - DSM-IV
Individuals with this Cluster B Personality Disorder behave impulsively and their relationships, self-image, and emotions are unstable.
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Dependent Personality Disorder – WHO F60.7
Personality disorder marked by at least three of the following:
INCLUDING: - asthenic, inadequate, passive, and self-defeating personality (disorder)
Diagnostic criteria for 301.6 Dependent Personality Disorder
Individuals with this Cluster C Personality Disorder use their submissive and clinging conduct toward others to elicit care, depending on them for initiative, reassurance, decision making, and advice.
A pervasive and excessive need to be taken care of that leads to submissive and clinging conduct and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Histrionic Personality Disorder - WHO F60.4
Personality disorder chalked out by at least three of the following:
INCLUDING: - hysterical and psychoinfantile personality (disorder)
Diagnostic criteria for 301.50 Histrionic Personality Disorder - DSM-IV
Individuals with this Cluster B Personality Disorder exaggerate their emotions and go to excessive lengths to seek attention.
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Narcissistic Personality Disorder - WHO F60.8
THe ICD-10 does not specifically define the characteristics of this personality disorder. Instead, this disorder is classified in the category "Other Specific Personality Disorders". ICD-10 states that Narcissistic Personality Disorder is "a personality disorder that fits none of the specific rubrics F60.0-F60.7". That is, this personality disorder does not meet the diagnostic criteria for:
Diagnostic criteria for 301.81 Narcissistic Personality Disorder - DSM-IV & DSM-IV-TR
Individuals with this type of personality disorder have an excessive sense of how important they are. They demand and expect to be admired and praised by others and have limited capacity to appreciate others' perspectives.
A pervasive pattern of grandiosity (in fantasy or conduct), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Anankastic (Obsessive-Compulsive) Personality Disorder - WHO F60.5
Personality disorder chalked out by at least three of the following:
EXCLUDING: - obsessive-compulsive disorder.
Diagnostic criteria for 301.4 Obsessive-Compulsive Personality Disorder (OCPD)
Individuals with this sort of personality disorder sacrifice openness, spontaneity, and flexibility to pursue orderliness, control, and perfectionism.
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
Paranoid Personality Disorder - WHO F60.0
Personality disorder chalked out by at least three of the following:
EXCLUDING: - delusional disorder - schizophrenia
Diagnostic criteria for 301.0 Paranoid Personality Disorder - DSM-IV
Individuals with this Cluster A Personality Disorder distrust others and are suspicious of their motives.
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
Schizoid Personality Disorder - WHO F60.1
Personality disorder chalked out by at least three of the following:
Diagnostic criteria for 301.20 Schizoid Personality Disorder - DSM-IV
Individuals with this Cluster A Personality Disorder express only a limited range of emotion in social interactions and form few if any close relationships with others.
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
Schizotypal Personality Disorder – WHO F21
A disorder chalked out by eccentric behaviour and anomalies of thinking and affect which resemble those seen in schizophrenia, although no definite and characteristic schizophrenic anomalies have occurred at any stage. There is no dominant or typical disturbance, but any of the following may be present:
This diagnostic rubric is not recommended for general use because it is not clearly demarcated either from simple schizophrenia or from schizoid or paranoid personality disorders. If the term is used, three or four of the typical features listed above should have been present, continuously or episodically, for at least two years. The individual must never have met criteria for schizophrenia itself. A history of schizophrenia in a first-degree relative gives additional weight to the diagnosis but is not a prerequisite.
INCLUDING: - borderline schizophrenia - latent schizophrenia - latent schizophrenic reaction - prepsychotic schizophrenia - prodromal schizophrenia - pseudoneurotic schizophrenia - pseudopsychopathic schizophrenia - schizotypal personality disorder.
EXCLUDING: - Asperger's syndrome - schizoid personality disorder
Diagnostic criteria for 301.22 Schizotypal Personality Disorder - DSM-IV & DSM-IV-TR
Individuals with this Cluster A Personality Disorder, like individuals with schizoid personalities, have little capacity for close relationships but they are also eccentric in their conducts, perceptions, and thinking.
A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of conduct, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Diagnostic criteria for 309.81 Posttraumatic Stress Disorder - DSM-IV & DSM-IV-TR
Acute: if duration of symptoms is less than three months
Chronic: if duration of symptoms is three months or more.
Also: Acute Stress Disorder, battle fatigue, gross stress reaction, shell shock.
Mmb: Buzan, Tony, with Barry Buzan. The Mind Map Book. Rev. ed. London: BBC Books, 1995.
Peg: Cutts, Martin. The Plain English Guide. Oxford: Oxford University Press, 1996.
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